Symptoms. 1009 



of inflammatory foci and in the involvement of adjoining tissue ; 

 the abscesses may or may not be in communication with the 

 lumen of the urinary tubules or with the pelvis of the kidney; 

 the changes may be unilateral or bilateral. 



If the inflammation develops rapidly in both kidneys, the 

 same objective symptoms become apparent as in acute diffuse 

 nephritis (p._ 992). Especially the sensation of pain in the 

 kidney is quite marked; in horses slight attacks of colic are 

 observed occasionally, also arching of the rigid back ; while 

 walking one or both hind feet are not advanced as far as usual 

 (Benjamin observed paralytic weakness of one posterior ex- 

 tremity in a horse and is inclined to refer it to a compression 

 of the plexus lumbo-sacralis by the inflamed kidney). In very 

 rare cases the enlarged kidney or the purulent perirenal con- 

 nective tissue produces a painful swelling above the lumbar 

 region. 



The voiding of urine is often disturbed in like manner as 

 in the non-purulent acute nephritis. But the amount as well 

 as the physical and chemical properties of the urine are not 

 altered much, if only few abscesses are in course of slow evolu- 

 tion, without injuring the adjoining renal tissue noticeably and 

 without communicating with the renal pelvis or the urinary 

 tubules. In other eases, especially if the evolution progresses 

 more rapidly, the urine shows the same or similar changes as 

 in the acute diffuse inflammation (see p. 992). After the pus 

 enters the urinary tubules or the renal pelvis the urine becomes 

 cloudy, milky or mixed with floccules, it contains pus cells, renal 

 elements, crystals of triple phosphates, and free ammonia. 

 Exceptionally the sediment contains small portions of kidney 

 substance (Leisering) and occasionally hemorrhage takes place 

 in the kidneys. 



If the hand is placed below the transverse processes of 

 the lumbar vertebrae or into the rectum it is possible to de- 

 termine pain, unilateral or bilateral enlargement of the kidneys 

 and, in the presence of large abscesses, fluctuation which may 

 be limited or may involve the entire kidney. 



Edematous infiltrations are observed very rarely. 



On rapid development of the inflammatory process or in 

 septic pyemic infection severe general symptoms are observed, 

 in other cases only temporary rises in temperature and grad- 

 ually increasing emaciation. If the purulent inflammation is 

 severe and affects both kidneys uremia may also follow. 



In a slower evolution of the purulent process, especially 

 if it is limited to one kidney, clinical symptoms seem some- 

 times to be entirely absent. The same is true for the hema- 

 togenic purulent nephritis of hogs (Degen). 



Diagnosis. Purulent nephritis can be recognized with cer- 

 tainty only then when objective symptoms suggest this form 

 of nephritis, when pain, fluctuation of the kidney, albummuria 



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