HEMOPHILIA 449 



The assumption of a " hemophilic " and an " angio-neurotie " hematuria is not 

 justifiable. " On pent dire, qu'il n'y a pas d'hematurie essentielle : toutes les 

 hematuries sont symptomatiques et relevant d'une cause generale (toxique ou 

 infeetieuse) ou d'une affection renale." 



Tedenat also questions the occurrence of true essential hematuria. His 

 own experience relates to four cases of which two were very probably con- 

 nected with nephrolithiasis; nephrotomy produced a cure. In another case 

 the hemorrhage ceased after the removal of a small hydatid cyst of the kidney. 

 In the fourth case the cause of the hematuria was a carcinoma of the colon 

 compressing the ureter, after the removal of which the hemorrhages perma- 

 nently ceased. 



Pousson also denies the existence of essential hematuria; he calls atten- 

 tion particularly to the hemorrhages which result from the retention of urine, 

 in consequence of floating kidneys, or from other causes. For instance, he 

 observed an apparent renal hematuria in a patient in whom there was at the 

 left renal opening of the ureter a mucous membrane valve which caused, from 

 time to time, a more or less complete retention of urine. After division of 

 the valve and fixation of the kidney the hemorrhages ceased. In another case 

 a stone embedded in the mouth of the ureter produced the hemorrhage. 



In this connection Albarran remarks that the cases of so-called essential 

 hematuria may be divided as follows: 1. Hematuria in floating kidney; 2. In 

 hydronephrosis; 3. Hematuria in early stages of chronic nephritis. Seven- 

 teen cases of this latter form are already mentioned in literature. He adds 

 another case occurring in a patient aged fifty-three. The hemorrhage ceased 

 after nephrotomy. The diagnosis of diifuse parenchymatous and interstitial 

 nephritis was confirmed by the microscopical examination of an excised por- 

 tion of the kidney. Boursier emphasizes that so-called essential hematuria 

 may for a long time be the only symptom of a nephrolithiasis. In the urate 

 and oxalate diathesis severe hematuria is also observed without any stone 

 being present ; it may be that the small crystals produce an irritation of the 

 renal parenchyma and so eventually lead to periodic hematuria. 



Hamonic calls attention to hematuria as a premonitory symptom of cer- 

 tain renal affections (parenchymatous nephritis, nephrolithiasis, tuberculosis, 

 carcinoma). 



Galland-Gleize also confirms this fact. He communicates reports of four 

 cases in which for a year and a half to seven years hemorrhage had preceded 

 the disease later determined (kidney-bladder stone, tumor of the bladder). 



Loumeau agrees with those who do not believe in essential hematuria ex- 

 cept when the microscopic investigation demonstrates that the "renal epi- 

 thelium" is normal. But we should require even more than this; not only 

 the integrity of the epithelium but also that of the entire parenchyma should 

 be determined after a portion of the kidney has been excised and examined. 

 This will be still insufficient for an anatomical diagnosis, as the pathologic 

 process is not always uniformly distributed over the entire organ. But, apart 

 from the actual, diffuse disease of the kidney, this objection is much more valid 

 for those diseases of the renal tissue which arise from a focus, such as a stone, 

 etc. Here the investigation of one, or even of several, portions of the kidney 

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