UREMIA 437 



more, in other diseases a corresponding or greater reduction in 

 alkalinity may occur without uremia. The development of this 

 terminal acidity, together with the finding of albumose in the 

 blood of a nephritic by Schumm, 1 suggests the probability of 

 active autolytic processes occurring in uremia. Neuberg and 

 Strauss 2 have also found glycocoll in considerable quantities 

 (1.5 per mille) in the blood-serum of a uremic patient and in 

 the blood of nephrectomized rabbits. 



The Cause of Uremia. Putting all the known facts 

 together, we find the weight of evidence indicating that uremia 

 is due to poisoning with organic substances, probably ante- 

 cedents of urea, but of unknown nature. The poison or poisons 

 may be sufficiently concentrated to cause structural alterations 

 in the cortical ganglion-cells (chromatolysis) which have been 

 repeatedly found in uremia. As yet, however, we are com- 

 pletely in the dark as to whether the substances causing the 

 uremia are such well-known antecedents of urea as ammonium 

 carbamate and other ammonium salts, or some quite specific and 

 unfamiliar nitrogenous substances which arise in the cells as the 

 result of the action of accumulated decomposition-products of 

 the proteids. To account for an accumulation of the antecedents 

 of urea we do not need to assume a perversion of metabolism 

 as the cause, if we appreciate that the various reactions of met- 

 abolism, being due to catalytic agents, go on to the point of 

 establishing a chemical equilibrium. If for any cause the 

 kidneys cannot excrete all the urea formed, its accumulation in 

 the blood and tissues will necessarily lead to a blocking of the 

 steps of urea formation, and a corresponding accumulation of the 

 antecedents of urea in the body. On the other hand, it is to be 

 borne in mind that the decrease in elimination of nitrogen in 

 nephritis is not so great as is ordinarily assumed, the popular 

 error being due to the fact that most clinical estimations of 

 urinary nitrogen are based on the determination of the urea 

 alone. In nephritis the urea may constitute a much smaller 

 proportion of the total urinary nitrogen than in health, on ac- 

 count of the relatively greater proportion of nitrogen eliminated 

 in other forms. According to numerous observers, particularly 

 the Italians, the proportion of these intermediary nitrogenous 

 bodies may be increased in the blood, even when the urinary 

 nitrogen is normal in amount, and if this statement is correct, 

 then presumably abnormal metabolism, rather than defective 

 renal elimination, is primary ; in which case the renal lesions 



1 Hofmeister's Beitr., 1903 (4), 453. 



2 Berl. klin. Woch., 1906 (43), 258. 



