CONGESTION OF THE KIDNEYS. 



355 



Principal clinical forms of nephritis in man. (Signifi- 

 cation of the term " Bright's disease.") In man, excluding suppu- 

 rating nephritis, we distinguish three principal forms of nephritis : 



1. Acute nephritis, which is generally related to an infectious dis- 

 ease and usually quickly terminates in cure or death ; it very rarely 

 passes into a chronic state. The principal symptoms are: polyuria, 

 slight albuminuria, very high specific gravity of the urine, hya- 

 line cylinders, renal epithelium, white and red corpuscles in the 

 urine. 



2. Chronic parenchymatous nephritis, which often leads to death 

 or ends in atrophy of the kidney. Its evolution is very slow. Its 

 principal symptoms are : oliguria, albuminuria, increase of the spe- 

 cific gravity of the urine; cylinders, white corpuscles, epithelial 

 cells in the course of fatty degeneration, various forms of detritus, 

 more rarely red corpuscles in the urine ; tendency to dropsy. It is 

 characterized anatomically by a much marked epithelial desquama- 

 tion. 



3. Renal induration y granulous kidney ^ atrophied kidney y sclerosed 

 kidney. It is often developed at the expense of chronic parenchy- 

 matous nephritis; its evolution is very slow and obscure. Its 

 principal symptoms are : polyuria, slight albuminuria, a lessening 

 of the specific weight of the urine, infrequency of germ elements, 

 absence of dropsy, hypertrophy of the heart. It is characterized 

 anatomically by an interstitial connective tissue proliferation. 



We generally designate by the expression " Bright's disease" 

 (from the name of the celebrated kidney pathologist, R. Bright^) 

 the ensemble of the renal affections accompanied by albuminuria 

 (Bright, Leyden, etc.) ; some authors give the appellation to the 

 true nephritis by adding to it amyloid degeneration of the kidney 

 (Yirchow, Aufrecht, Wagner, etc.) ; Krebs reserves it for primary 

 interstitial nephritis. In view of this diversity, it seems to us 

 that this earlier designation ought to be completely abandoned and 

 replaced by a terminology based upon the actual pathological anat- 

 omy. In veterinary pathology it has given rise to deplorable con- 

 fusion on the subject of hemoglobinuria of the horse.^ 



1 Bright; Reports of Medical Cases, London, 1827. 



2 Bright's disease corresponds to a perfectly defined state from a clinical point of 

 view — being characterized by a persistent albuminuria, dropsies, and a lesion of the 

 kidneys; but the progress of pathological histology has established the plurality of 

 these anatomical varieties. At the present day we recognize the following forms: 

 1. Chronic parenchymatous, diffuse or epithelial nephritis, determining the condition of 



