348 Disease of Kidney 



part of this vascular change, the arteries lose their elasticity, and one 

 day, as the vigorous ventricle is straining to force some unusually 

 impure blood through the resisting capillaries, a vessel gives way, 

 perhaps in the brain, and the patient is attacked with apoplexy. 



The effect of the impure blood upon the lungs is to cause cough, 

 bronchitis, and pneumonia ; upon the stomach, to cause dyspepsia, loss 

 of appetite, and vomiting ; upon the bowel, to set up diarrhoea ; and 

 upon the brain, to give rise to headache, convulsions, and coma. 



Occasionally the uriniferous tubules become distended in number- 

 less spots by limpid urine, producing general cystic degeneration of the 

 gland. As a tubule bulges, the vascular tissue and the neighbouring 

 tubules disappear from pressure, the pyramids being first pressed 

 upon and wasted. 



There is much truth in the saying that a man is as old as his 

 kidneys. 



The practitioner should make it his rule to exatnine the urine of 

 every patient with obscure illness ; when it contains albumen or casts 

 he may expect to find the pulse hard and resisting, the temporal arteries 

 mobile and tortuous, the impulse of the heart increased, and its 

 apex-beat displaced outside the normal line. The kidneys of such a 

 patient should be rested to the utmost, by placing him upon a diet 

 without alcohol and poor in nitrogenous foods ; the bowels and skin 

 should be encouraged to eliminate by purgings and sweatings, and he 

 should be specially careful to avoid chills and violent exercise. 



The kidney may be ruptured from a blow on the loin, btood escaping 

 into the surrounding tissues, and also into the ureter, where it is well 

 mixed with the urine. If a clot be carried into and plug the ureter, 

 urine may collect above it. (For Surgical Kidney see p. 410.) 



Hydronephrosis. If from congenital malformation of ureter, 

 bladder, or urethra, pressure of a tumour, clot, or stricture, there be 

 serious impediment to the outflow of urine, the fluid collects in the 

 interior of the kidney, and, by the mere effect of pressure, causes 

 wasting of all the proper renal tissue and converts the gland into a 

 mere water-bag. 



A large and painless tumour, possibly yielding a sense of fluctuation, 

 fills the entire lumbar region, and, on aspiration, limpid urine is with- 

 drawn. For certain, the tumour is dull on percussion behind, but there 

 will be resonance in front if the colon intervene between it and the 

 anterior abdominal wall. The obstruction being overcome, an enor- 

 mous quantity of pale urine is passed and the area of dulness subsides, 

 the diaphragm descending and the coils of intestine passing outwards 

 to resume their proper place. 



The fluid of hydronephrosis does not change its position as the 

 patient is turned ; this distinguishes hydronephrosis from ascites, 

 not from ovarian dropsy. In ovarian disease, however, there ma; 

 be some resonance in the loins, and the dulness is traceable in 



