Course, Diagnosis. 999 



exertion and after taking cold. In other cases the edema which 

 develops in a certain stage of the disease disappears, the ap- 

 parent improvement being accompanied by an increase in the 

 quantity_ of urine voided. Eventually the clinical picture of 

 chronic indurative nephritis may develop. 



Diagnosis. Chronic nephritis can be recognized only by 

 means of urinary analysis, all other symptoms pointing only 

 to general nutritive disturbances. For differential diagnosis 

 it IS necessary to consider the change in the amount of urine 

 voided, the presence of albumen in considerable quantity, and 

 the presence of epithelia and of casts from the tubuli uriniferi. 



Acute diffuse nephritis differs from the chronic form by 

 its more rapid evolution, by the more considerable diminution 

 in the amount of urine voided, and especially by the presence 

 in the urine of numerous red blood corpuscles. It must, how- 

 ever, not be forgotten that acute exacerbations may occur in 

 the course of chronic nephritis, which sometimes render a 

 diagnosis extremely difficult, in case the history or, after the 

 acute symptoms have quieted down, the further course of the 

 disease do not afford any information on the true nature of 

 the trouble. — ^Amyloid kidney is very easily mistaken for 

 chronic non-indurative nephritis, the more so as both processes 

 may exist simultaneouly (see p. 987). — In venous hyperemia 

 of the kidneys the urine has a higher specific gravity and con- 

 tains at most traces of albumen and few renal elements. — 

 In atrophy of the kidney there is polyuria, the urine is light 

 in color, watery, the specific gravity low, the percentage of 

 albumen small and the sediment contains only few renal ele- 

 ments ; hypertrophy of the heart is also frequent. 



Prognosis. The course varies in different cases in so far 

 as the animals may be kept alive for years under favorable 

 external conditions, while severe exertion and insufficient nutri- 

 tion render the course more rapid. Other things being equal, the 

 prognosis becomes more unfavorable, the less urine is voided, 

 and the more albumen and renal elements it contains, or the 

 more prominent the cardiac weakness becomes. 



Treatment. This is the same as in acute nephritis. First of 

 all the diet must be regulated in such a manner that the 

 patients, which are to be saved from, all severe exertion, should 

 receive only good non-irritating food (in carnivora an absolute 

 milk diet is here also most effective [see p. 994] ). 



In the presence of oliguria and of dropsy cataphoresis 

 and especially subcutaneous injections of pilocarpine repeated 

 daily for weeks may have a good effect. Diuretic remedies are 

 administered in order to increase the amount of urine (page 

 996), and in cardiac weakness heart remedies (see valvular dis- 

 eases) are administered. The anemia also requires appropriate 



