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DISEASES OF THE URINARY APPARATUS. 



designate under the names of 'Harge white kidney, large fatty 

 kidney, fatty inflammatory kidney/' a moderate tumefaction of 

 the organ with slightly marked fatty degeneration of the epithe- 

 lium ; the cortical substance is then a pale-gray color, filled with 

 stripes or white spots (adiposity), and of very soft consistence ; in 

 the calf we have found these points to have a lardaceous appear- 

 ance. When the inflammatory œdema is prominent and masks the 

 characters of fatty degeneration of the epithelium, we have what is 

 called " large spotted kidney." Here the organ is much tumefied ; 

 upon section, the thickness of the cortical substance appears con- 

 siderably augmented ; it is softened, infiltrated, and of reddish-gray 

 color. When the glomeruli are principally aifected, and when the 

 migration of the red globules is profuse, we say that there is chronic 

 nephritis of the glomeruli or chronic hemorrhagic nephritis. 



2. Stage of sclerous, interstitial, and indurative 

 NEPHRITIS. It is characterized by hyperplasia, connective tissue 

 induration, and atrophy of the true glandular parenchyma. The 

 inflammatory process is marked at the outset by a cellular infiltra- 

 tion of the interstitial connective tissue, and later by hypertrophy 

 of this tissue, the compression of the capillaries which are located 

 in it, and their obliteration. The epithelial alterations are not very 

 apparent ; the glomeruli are isolated, either by capsular thickening 

 or by tumefaction of the vascular walls, which frequently undergo 

 hyaline degeneration. The atrophy of the glomeruli ultimately 

 involves that of the uriniferous canaliculi. 



At a more advanced period, after months or years, there are 

 formed in the structure of the kidney cicatricial centres which 

 contract the surface of the organ (contracted kidney, granular 

 kidney, granular atrophy).^ The kidney becomes reduced more 

 and more (atrophied and indurated kidney); the small projections 



1 Three principal theories have been advanced on the pathogenesis of the small 

 granular kidney. According to the first, the alterations of the renal epithelium con- 

 stitute the earlier part of the process, and the interstitial connective tissue lesion is 

 consecutive. According to the second (Traube), it is in the interstitial connective 

 tissue that the sclerous process originates, this giving rise secondarily to the modifi- 

 cations of the glandular epithelium, and finally atrophy of the kidney. According to 

 the third (Peter, Lancereaux, Gull and Sutton), the lesions of the kidney are but a 

 localization of generalized arteriosclerosis, an affection characterized by inflammatory 

 alterations of the small vessels, often also by atheroma of the more voluminous 

 vessels— alterations which are said to determine sclerosis and hemorrhages in the 

 parenchymatous organs ; in the kidney they would constitute the initial process of 

 interstitial nephritis (Dieulafoy). — n. d. t. 



