Chapter X: Part 10

Finally violent overexertion as in coursing, causes congestion with albuminuria, and blood globules and even casts in the urine. This is common to the human athlete, who undergoes a violent and continued overexertion, race and draught horses, and dogs.

_Lesions._ When congestion is produced experimentally by cantharides the kidneys are found to be enlarged and the cortex gorged with blood so that it has a deep red or blackish port wine hue, with here and there spots of ecchymosis. The veins, capillaries and glomeruli are especially congested, and the epithelial cells of the convoluted tubes have become laterally distended, so that they approximate to a globular form. A loose coagulum containing blood globules may be found in the capsule of the glomerulus and in the convoluted tubes.

_Symptoms._ These are arching and stiffness of the loins, a tardy, dragging movement of the hind limbs and tenderness of the loins. The urine may be scanty or in excess, and tends to be passed frequently, in small quantities and with evidence of pain. It may be clear, pinkish or bloody, and shows albumen and frequently casts, and blood globules or small clots. There is some impairment of appetite, and, in severe cases, nausea and vomiting, with, it may be, diarrhœa, nervous depression, dullness and stupor. When due to poison or other transient cause the symptoms improve when this factor has been stopped.

_Treatment._ When due to poison taken by the stomach this must be stopped, and the stomach and bowels evacuated by an emetic (ipecacuan) and laxative (sodium sulphate). Appropriate treatment must be made in case of burns or skin eruptions. When surgical cases are due to infection rather than simple shock or sympathetic irritation, antiseptic injections of the bladder are indicated. In all cases alike a warm bath is an important adjunct. When irritation is due to cantharides, it may be calmed by camphor, 2 grains every three or four hours. Other anodynes may be given as required. Rest is essential and, as appetite is recovered, a moderate amount of amylaceous puddings. A warm building or comfortable clothing is desirable.

NEPHRITIS.

The renal inflammations have not been fully investigated in the domestic animals, and even in man, the pathology of several of the forms is still enveloped in some measure of doubt. _In man_ the following conditions have been noted:

1st. _Acute parenchymatous nephritis_ with enlarged kidney and degenerated tubules.

2d. _Chronic parenchymatous nephritis_ with enlarged kidney and degenerated tubules.

3d. _Acute diffuse_ (_desquamative, interstitial_) _nephritis_ with enlarged kidney and glomeruli, tubules and connective tissue degenerated.

4th. _Chronic diffuse_ (_desquamation, interstitial_) _nephritis._

5th. _Suppurative nephritis and pyelo-nephritis_, infection may be from injury.

6th. _Perinephritis_: infection of connective tissue with adjacent disease.

_In domestic animals_ the following distinctions have been made:

1st. _Acute nephritis._

2d. _Chronic nephritis._

3d. _Purulent nephritis and pyelo-nephritis._

4th. _Perinephritis._

ACUTE NEPHRITIS. ACUTE BRIGHT’S DISEASE.

Animals affected. Causes: hyperæmia, traumas, cold, chill, fever,
bacteria, toxins, overfeeding, nitrogenous food, raw potatoes, xanthin
products, acrid diuretics, diuretic insects, suppression of
micturition, skin lesions, burns, embolism, calculus. Symptoms: colic,
trembling, rigor, arched, stiff, tender loins, stiffness in quarters,
drags hind legs, urination frequent, movements of penis and testicle,
costiveness, grinding teeth, anorexia, vomiting (in dogs, cats and
pigs), fever, dropsies, uræmic convulsions, urine scanty, high
colored, red or bloody, thin, cloudy or turbid, albuminous, purulent,
oxalates, urates, hippurates, hæmatoidin, epithelium, mucus, casts.
Prognosis: resolution in three days, or uræmia, suppuration,
degenerations. Lesions: kidney enlarged, softened, friable, red,
yellow, black, purulent, glomerulitis, tubular nephritis, interstitial
nephritis. Treatment: rest, warm building, warm clothing, green or
sloppy, amylaceous food, bleeding, cupping, skin friction,
fomentations, warm bath, hot air bath, sinapisms, anodynes, laxatives,
diaphoretics, heart tonics, alkaline diuretics, paracentesis, bitters,
iron, phosphates, hydrogen peroxide, cubebs, etc.

_Genera affected._ This has been seen in horse, ox, dog, sheep and pig.

_Causes._ It is ascribed to the most varied causes, such as: hyperæmia, blows and injuries on the back and loins, sprains of the loins, abrupt wheeling when in galop, exposure to cold winds, and storms, especially when perspiring and fatigued, sudden suppression of perspiration, extreme terror, bacterial infection and infection by toxins (in septicæmia, pyæmia, influenza, contagious pneumonia, uterine sepsis, omphalitis, infectious angina (Friedberger), bronchitis (Siedamgrotzky), glanders, tuberculosis). Among dietary causes are named: a rich nitrogenous food (grains, beans, peas, vetches, cotton seed, clover), raw potatoes in excess, cotton seed meal, agents that increase the nitrogenous and xanthin bodies in the urine.

Dr. Alfred C. Croftan, in his experiments with xanthin bodies on rabbits, found that xanthin and hypoxanthin produced great increase of arterial pressure, atheromatous changes in the vessel walls consisting in thickening of the intima, with small celled infiltration and necrotic changes in different areas of the vessel walls. This in the kidney produces the primary interstitial form of nephritis known as gouty kidney and associated with retention of uric acid and other xanthin bodies. The accompanying cardiac hypertrophy, so common with such kidneys, he attributes to the increased intravascular pressure.

Irritant vegetables that are resinous or diuretic, and irritant diuretic insects are incriminated (cantharides, caterpillars in grass, or on plants, etc., lice on cabbages particularly,—Cruzel, Neubert). Irritant drugs that are eliminated by the kidneys have been equally charged (tar, carbolic acid, iodoform, chlorate of potash, nitrate of potash, phosphorus, arsenic, lead, mercury). Compulsory suppression of micturition is undoubtedly injurious in house dogs shut up, mares kept long in harness, or horse on railway car, above all if this follows a diuretic or drinking abundantly. In such cases it is altogether probable that bacteria already exist in the blood or kidneys and take occasion to attack the tissues weakened by the overdistension or other inimical cause. This is all the more probable seeing that the kidneys are a favorite channel for the elimination of bacteria present in the system. It should be noted that nephritis is liable to supervene on extensive skin burns, chronic dermatitis and other skin diseases. Some cases are traceable to embolism, the clots coming from the lungs, heart or arteries, in others the irritation is due to calculi in the renal pelvis or tubules, and their attendant bacteria. These are especially common in cattle that are winter fed on dry food. Again, the infection may have travelled forward through the ureters from a pre-existing infective cystitis.

_Symptoms._ There may be obscure or intense colic; trembling or rigor may occur, yet is often omitted or unobserved; the loins are arched; the hind feet are advanced under the belly, or there is frequent shifting of the weight from one foot to the other; the walk shows stiffness of the back and hind limbs which appear to straddle or drag behind; urination is frequent in small amount, or there are frequent ineffectual attempts to urinate; the patient is indisposed to lie down, and if he does so it is carefully, with difficulty and groaning; the testicles are drawn up and dropped alternately, the penis is often protruded from and retracted within its sheath, the loins are sensitive to pinching, percussion, or electric current; when mounted the animal drops under the weight; he carries the head low and refuses to go fast. In bad cases there is constipation, grinding of teeth, anorexia, and in dogs, vomiting. Temperature may be normal or there may be considerable fever. Dogs may lie curled up, with occasional tremors. Dropsical effusions are frequent in the form of anasarca under the chest or abdomen, or beneath the lower jaw, or as stocking of the limbs, or the effusion may occur into an internal serous cavity. Convulsions may occur from brain poisoning by urea or other retained urinary product.

In the slighter forms the severe symptoms may be absent, and the _condition of the urine_ must be investigated as affording _the most constant and characteristic_ phenomena.

The _urine_ is usually scanty, high colored, of a high specific gravity and is passed often with pain and groaning. At the outset of an acute attack it may be bloody; later it may be only cloudy or turbid from the excess of epithelial and pus cells, leucocytes, salts and albumen. Early in the disease the casts may contain red blood cells, and renal epithelium, later leucocytes, nuclei, granules, pus cells, crystals and other matters. Albumen is usually abundant as demonstrated by boiling and nitric acid.

_Soda carbonate crystals_, rhomboid, rosette-shaped or spherical and effervescing with acetic acid, abundant in normal herbivorous urine may be greatly reduced or absent in nephritis.

=Soda oxalate crystals=, tetrahedral and insoluble in acetic acid, and normal in herbivora and carnivora, are increased if the urine is acid as in severe nephritis, but also in rheumatism, tetanus, septicæmia, angina, heaves, and other affections with defective æration of the blood.

=Ammonio-magnesian phosphate crystals=, rhomboid but insoluble in acetic acid, are found in alkaline (ammoniacal) or neutral urine, and appear to be often due to intestinal fermentations.

_Cystine crystals_, flat hexagonal plates, precipitated in healthy urine, but dissolved by ammonia are absent in retained and fermented specimens.

=Uric acid crystals=, rhomboids and plaques, brick red, and normal in the urine of carnivora and flesh-fed omnivora, may be present in herbivora not only in acute nephritis, but in other extensive inflammations attended with anorexia and the consumption of the animal tissues.

=Hippuric acid crystals=, right rhombic prisms and their derivatives, and insoluble in hydrochloric acid or ether, are greatly increased in all febrile diseases in herbivora, nephritis included.

=Hæmatoidin crystals=, fine needles or bundles of the same, yellowish red, are found in nephritis, hæmaturia, heaves, etc.

=Epithelium, if columnar=, points to disease of the kidney tubes, though very similar cells are derived from the urethra in both male and female. Squamous epithelium points to the cystic mucosa and is not increased in nephritis.

=Mucus= in cylindroid form may point to nephritic congestion or inflammation, but this may be present in health, and may show in irregular masses derived from the renal pelvis or the bladder. Mucous casts are always extremely elastic and mobile, and lack the even clear cut margins of the casts of nephritis. They are much more common in horses urine than in that of other animals.

=Tube casts= are especially indicative of nephritis and exudation into the uriniferous tubes. They are much firmer than the mucous cylinders and have smoother and more even margins. If relatively thick and straight they probably come from the straight tubes; if sinuous or twisted, from the convoluted tubes. With a similar basis substance they often enclose different solid bodies and have been named accordingly:—=epithelial casts= when containing cylindroid, or polyhedral cells may be unhesitatingly referred to the uriniferous tubules:—=granular casts= in which the homogeneous cast is impregnated with granular cells and free granules of proteid, fatty, or mineral matter, point directly to inflammation affecting the uriniferous tubules and their epithelial lining:—=blood casts= enclosing red blood globules imply hemorrhage, or congestion or inflammation of the tubules, with blood extravasation or diapedesis:—=casts containing leucocytes and pus cells bespeak= suppurative inflammation of the tubules:—=calcareous casts= entangle numerous crystals and granules, mainly of lime carbonate, and effervesce with acetic acid:—=hyaline casts= are homogeneous, clear, so transparent that it is sometimes necessary to stain them with iodine or aniline to make them distinct; they are found in nephritis and especially in the chronic forms:—=colloid casts= or =waxy casts=, or =amyloid casts= may designate a class of firmer cylinders, clear, homogeneous and refractive, and often bearing fatty or blood globules, crystals or fungi. They may have a yellow color, or they may give the amyloid mahogany reaction with the iodo-potassic iodide solution (even in the absence of amyloid degeneration of the kidney; Jaksch).

_Progress._ Acute nephritis may advance for three days or more and then terminate in resolution, or go on to complete anuria with coma, to suppuration, gangrene or chronic nephritis.

=Resolution= is marked by general improvement of pulse, breathing and expression, clearing of the urine, and return of appetite. The urine may remain albuminous for eight days longer.

=Complete suppression of urine= has persisted five days in cattle (Funk), and seven days in horses (Friedberger), accompanied by intense fever, dullness, stupor and coma ending in death from uræmia.

=Purulent urine= is white, milky, albuminous, granular, with epithelial cells and casts and pus cells, showing their double nuclei with acetic acid. There are usually rigor, hyperthermia (106° F.), thirst, intermittent colics, diarrhœa, perspiration, uncertain walk, and stocked legs. Convulsions have been noticed in the horse (Didie), cow (Pflug) and bitch (Trasbot). The horse may turn in a circle (Friedberger) or have amaurosis (Didie). Death usually occurs in two weeks.

=Gangrene= is likely to prove fatal. Berger has seen death occur in three days in the horse, and Trasbot in four days in a cow, after a large cantharides blister.

_Pathological Anatomy._ The kidney is enlarged, soft, friable, dark red, yellow with red spots, or having areas of hemorrhage. When fatty it is marbled, pale yellow or white and red. The capsule is easily detached. On section it is bloody, oozing or even dropping blood, or a pale creamy fluid. The pelvis contains urine, thick, gelatinoid, bloody or purulent. The latter condition must not be confounded with the thick pus-like mucus which normally occupies the renal pelvis in the horse.

The lesions of the secreting portions of the kidney will vary with the concentration of the inflammation in one or other of the separate tissues.

In =glomerulitis= from toxic irritants, the capsules enclose an albuminous liquid exudate, the capillaries are overdistended, their walls thickened and cloudy, and thrombi with an excess of red globules and leucocytes block them at intervals. This capillary obstruction extends to the plexus surrounding the convoluted tubules.

In =tubular nephritis= there is congestion of the plexus covering the convoluted tubes, and the epithelium shows cloudy swelling, with fatty granules and hyalin droplets in the desquamating cells.

With =interstitial nephritis= there is an exudate into the interstitial connective tissue between the tubules, and into the tubules, forming hyalin casts. The epithelium of the tubules are swollen, granular, opaque and desquamating.

In =suppurative nephritis= may be found all stages of abcedation from minute points, gray or yellow, and only just visible to the naked eye, in the midst of the deep red congested tissues, through the larger white suppurative areas, to the extensive abscess formed by a coalescence of the many, the intervening tissue having broken down by a necrotic disintegration. In the earlier stages the pus infiltrates the parenchyma so that it may be comparable to a sponge filled with this liquid.

_Treatment._ The first consideration is rest, with a warm building or clothing to solicit the action of the skin and lessen the work of the kidneys. Warm summer weather is favorable, or we should secure a sunny, comfortable, loose box, or a building heated by a stove. In default of this, warm woolen blankets, hood and leg bandages should be secured. If the case is mild enough to allow of appetite, the food for herbivora may be green food in summer and carrots, beet, turnip, potato or ensilage in winter. The dog may have buttermilk or sweet milk or mush and milk. Meat is objectionable because of the amount of urea and other urinary products which it produces.

Trasbot strongly recommends general bleeding in strong, vigorous horses and cattle, attacked by the disease in an acute form, but deprecates it in the lymphatic, fat, or debilitated.

Omitting the general bleeding, one can always find a good and safe alternative in bleeding the animal into his own tissues. Shaving the loins and cupping has often an excellent effect. An approach to this may be had by vigorous rubbing by several men at once, of the limbs and the whole surface of the body, by warm fomentations over the loins by means of spongio-piline or surgeon’s cotton covered with dry blankets, or by winding a hose round the body through which warm water is forced, or finally by a bath of steam or hot air, or in small animals of warm water. The dog may be placed in a bath of 80° or 90° F., which is allowed to gradually cool to 65° or 70°. In all these cases the greatest care must be taken to avoid chill when the animal is taken out. He should be quickly rubbed dry in a warm room and blanketed.

Counter-irritants act in the same way, and mustard or hot water hotter than the hands can bear may be applied. Turpentine, cantharides and other diuretic counter-irritants must be carefully avoided. An old practice of laying a freshly removed sheep skin over the loins, with the flesh side inward, often causes a distinct exudation, thickening of the skin and derivation.

A damp cloth, laid across the loins and thoroughly covered with dry to prevent any evaporation and chill, will usually give great relief and may be kept on for days.

Internal medication must at first be mainly anodyne, laxative and diaphoretic. The two latter classes are at once derivative and eliminating, carrying out through other channels, waste products that would otherwise have taxed the kidneys.

Among anodynes, the bromide of camphor (horse, 1–2 drs., dog, 2 to 5 grs.), bromide of potassium (horse, 1 dr., dog, 1 to 3 grs.), or hyoscyamus may be used, and repeated twice daily.

Purgatives must be restricted to such as have no tendency to act on or irritate the kidneys. Castor oil, or sweet oil for the larger animals, or for the dog senna or jalap, may be given every morning to secure free movement.

As diaphoretics, ipecacuanha, Dover’s powder, tartar emetic, and even pilocarpin may be used. The last named agent is especially useful when dropsy sets in, or uræmic stupor or coma threatens (horse 3 grs., ox 7 grs., dog ½ to ⅓ gr. according to size). If the heart shows weakness it must be sustained by digitalis, strophanthus, caffein or nitro-glycerine, and the pilocarpin withheld.

In a sufficiently strong subject the stupor or coma may be met by the abstraction of blood, which benefits by the dilution of that which is left.

Eclampsia may be further met by the inhalation of ether or chloroform, or the rectal injection of chloral or bromide solution.

As the inflammation abates, if the action of the kidney is still insufficient in spite of the free drinking of pure water, alkaline diuretics may be given in small doses (tartrate, acetate or citrate of potash, bicarbonate of soda, saltpeter).

In excessive dropsy avoid sloughing by lancing the most tensely swollen parts to allow drainage, and keep the parts disinfected with carbolic or other antiseptic lotion. For ascites or hydrothorax, aspirate, and apply a compressory bandage.

During convalescence a course of bitters (cinchona, salicin, gentian, nux vomica) and iron (phospho-tartar, iodide or phosphate) will often be called for. Anæmia may be met by doses of peroxide of hydrogen or the inhalation of oxygen.

In the advanced stages benefit may accrue from the use of small doses of cubebs, copiaba, oil of turpentine or buchu, which have a tonic action on the renal mucosa.

PURULENT NEPHRITIS.

Causes: general, traumatic, metastatic, infective, wounds, shocks,
strains, blows, falls, crowding, heavy loads, calculi, infective
embolism. Lesions: miliary or large abscesses, diffuse suppuration,
softening, disintegration, fistula. Symptoms: obscure, nephritic
symptoms following distant abscess, chill, hyperthermia, general
symptoms of nephritis, pus in urine, anæmia, emaciation. Treatment: to
external wound, antiseptics, evacuate abscess, extirpate kidney with
pyonephrosis, in dog or pig, calcium sulphide, sulphites, copiaba.

_Causes._ Aside from the main causes of nephritis, the suppurative form may be determined by traumatic or metastatic infective conditions. Under _traumatic_ factors may be named punctured or gunshot wounds, shocks and strains connected with falls, blows, crowding, compression, too heavy weights on the back (pack, rider, two wheeled cart loaded too heavily forward and going down hill), and finally calculi in the uriniferous tubules. Under _metastatic_ factors come all infections, pyæmia, omphalitis, any suppurative affection of the lungs, (abscess, pneumonia, broncho-pneumonia), pharyngitis, etc. Embolic renal abscess may start from endocarditis, arteritis, or pulmonary phlebitis.

_Lesions._ There may be a circumscribed renal abscess like a good large orange, or many small gray spots like millet seeds, peas or hazel nuts, having purulent centres and containing pus cocci or bacilli. In other cases a diffuse inflammation suppurates throughout till the whole gland becomes a pulpy mass of pus, blood and broken down kidney tissue (pyonephrosis). In traumatic cases the pus centres around the wound or injury, perhaps invading adjacent parts, and even communicating through the skin externally along the line of the original wound. The pus may burrow in different directions in the cortex or under the capsule with abscess at intervals (perinephritis), or along the vessels to the medullary structure.

_Symptoms._ These are often obscure. The sudden appearance of kidney disease in the course of a suppurative affection elsewhere, the extension being ushered in by a chill or rigor or attended by a succession of these, and the course marked by a variable hyperthermia is very suggestive. Stiffness and weakness of the hind parts and tenderness of the loins are significant; also, in carnivora and omnivora, nausea and vomiting. When the kidney can be felt by the hand in the rectum or in the small animals, through the flaccid abdominal walls, the manifest enlargement, the tenderness, and in some cases even fluctuation will assist in diagnosis. In such cases, puncture by a large hypodermic needle, or a small trochar may betray the presence of pus and complete the diagnosis. If the pus escapes into the pelvis of the kidney it may be recognized in the urine. The case is very liable to become chronic, and is then marked by anæmia and emaciation.

_Treatment._ When an external wound exists it must be treated, antiseptically, with boric acid, potassium permanganate, or other antiseptic lotion. If a single large abscess exists, puncture evacuation through needle or trochar, and washing out with an antiseptic solution is the obvious resort. Any foreign body must of course be removed. If the suppuration is diffused through the whole mass of softened kidney, the resort of extirpation may be considered. This is always dangerous as provocative of infectious peritonitis, but it is less so in dogs and swine than in other animals owing to their natural antagonism to pus microbes. The operation should be attempted extraperitoneally, the incision being made beneath the anterior lumbar transverse processes and carried inward through the sublumbar connective tissue. The renal artery will require ligature with antiseptic catgut and all manipulations should be aseptic or antiseptic. Even if successful, this operation leaves the subject in a dangerous state, as in case of kidney disease at any future time, there is no second kidney to compensate for the temporary loss of function and uræmic poisoning is to be dreaded.

Apart from surgical measures the general treatment would be largely the same as for acute infectious nephritis. As antiseptics calcium sulphide, the different sulphites, copiaba, etc., will be indicated.

PERINEPHRITIS.

Definition. In cattle on low damp lands, acrid plants, sprain, blow,
calculus, from purulent nephritis, in anæmia. Symptoms: of nephritis,
soiling of tail or prepuce, albumen, pus or blood in urine, lameness,
unilateral or bilateral, lumbar swelling, in small animals
fluctuation, history. Lesions: abscesses around kidney, under capsule,
intercommunicating. Treatment: as in purulent nephritis.

Suppuration in the connective tissue between the kidney and its capsule is seen in cattle in low condition, on damp, unimproved soils like undrained river bottoms and estuaries, abounding in acrid and diuretic plants. Even among such animals it is rare and has probably a directly exciting cause in a sprain or blow on the loins, or the presence and movement of a renal calculus. It may extend from suppurations in the substance of the kidney and to such extension the weak or anæmic condition materially contributes. In man, in which such conditions have been more frequently observed, a weak or cachectic condition is considered as an essential accessory factor along with the traumatic lesion (R. Harrison). Similar conditions may be expected to bring about perinephritis in any one of our domestic animals. The author has observed it especially on the low lands on the banks of the Ouse in Yorkshire, England.

_Symptoms._ These are mainly those of nephritis in general, shivering, stiff movement in the hind limbs, straddling, frequent passage of urine, straining, difficulty in lying down and rising, tenderness of the loins, dropping when mounted, groaning when turned in a short circle. If the suppuration communicates with the pelvis of the kidney there may be, in females, soiling of the tail, and in males of the prepuce. Blood may be passed with the urine, and pus cells and albumen are found when it is examined. If one kidney only is affected, there is lameness in the corresponding hind limb, the special feature being inability to extend it backward. A swelling on the one side of the loins, and beneath the lumbar transverse processes just posterior to the last rib, is likely to be a marked symptom, and if this persists and is especially prominent at one point, an exploratory incision or puncture will detect the presence of the pus. Fluctuation can rarely be detected, yet in small animals with very flaccid abdomen, the swollen, tender kidney and even fluctuation should be detected at times. The history of the case, the low, damp pasturage, the access to acrid plants, the alimentation with hay or grain covered with cryptogams, the fact of an injury and the low, weak, anæmic condition of the animal should contribute to a satisfactory diagnosis.

_Lesions._ In bovine kidneys affected in this way we have found general inflammation and exudation around the entire kidney and inside the capsule, with numerous small abscesses, in many instances communicating with each other. They may extend through the capsule and invade surrounding organs.

_Treatment._ In the treatment of cases of this kind the general principles of therapeutics for nephritis are about all that can be attempted in the lower animals. Fomentations over the loins are especially desirable as a means of relieving the suffering, and moderating inflammatory action. To the same end is the allowance of plenty of pure water as a diluent. Then the various agents that antagonize suppuration may be thought of, and some one selected for use. Beside the antisuppurants already mentioned one may use copiaba, cubebs, or turpentine in small doses, salicylates, or the sulphide or sulphite of calcium. Surgical interference by puncture or incision and antiseptic irrigation can only be thought of when the abscess is single and circumscribed; never when the whole periphery of the organ is involved. In the latter case the only rational surgery would be the desperate resort of the removal of the entire kidney.

PYELITIS. PYELONEPHRITIS. INFLAMMATION OF THE RENAL PELVIS.

Definition. Causes: primary from vegetable irritants in food, toxins,
cryptogams, pelvic calculus, strongylus gigas; secondary from renal
calculus, parasite, tubular urethral or vesical infection, infecting
deposits, metastasis. Symptoms: as in nephritis, pus, blood, or
albumen in urine, tender, arched loins, purulent polyuria, with
spheroidal epithelium. Diagnosis. Lesions: inflammation, calculus,
etc., in pelvis. Treatment: pure water, sodium bicarbonate,
antiseptics, balsams, fomentations, piperazin, extraction of calculus.

Suppurative inflammation of the mucosa lining the renal pelvis may occur in the acute or chronic form.

_Causes._ It may be either primary or secondary. As a =primary= disease it may be the result of poisoning by irritant diuretics such as cantharides, turpentine, colchicum or balsams, or shoots of the coniferæ, it may be due to the passage of the irritant products of cryptogams found in musty fodder or grain, or it may come from the irritation caused by the toxins of bacteria developed in the system or in food or drink. Cases that develop from the irritation of a pelvic calculus or precipitate, and from the presence of the strongylus gigas (in dogs) may also be placed in this class.

As =secondary= causes are those in which the inflammation starting in the uriniferous tubes extends down to and implicates the pelvis, and the still more frequent instances of extension of purulent infection upward from the ureter, bladder or prostate, so as to involve the pelvis. So in blocking of the urethra by strongylus, stricture, clot or calculus, and in spasm of the sphincter vesicæ, the delayed urine is liable to undergo fermentation with evolution of ammonia, and not only the bladder but the ureter and renal pelvis may suffer. Again, the occurrence in the kidney of the hyperplasia of cancer, glanders (horse) and tuberculosis (cow) may be the direct cause of pyelitis. Similarly foci of infection in the kidney may be found in distemper in the dog, and in the contagious pneumonia and influenza of the horse. In man infection from the bowel through the migration of the bacillus coli communis to the devitalized kidney and contents in hydronephrosis, has been traced, and the liability to this must be still greater after the surgical insertion of the ureters in the rectum as a substitute for the obliterated bladder and urethra. Again, in the intra-arterial migrations of the strongylus (sclerostoma) armatus pus microbes may be carried to the kidney and reach the pelvis.

_Symptoms._ These are in the main those of nephritis with marked rigors. The presence of pus cells and albumen in the urine may come from suppuration in the substance of the kidney itself, or sub-capsular abscess opening into the pelvis, or it may come from cystitis, prostatitis or urethritis. The special stiffness and tenderness of the loins, polyuria in which the liquid is purulent, but free from uriniferous casts, and in which it is charged with the spheroidal epithelium of the pelvis (not the columnar of the tubules), may afford presumptive evidence of pyelitis. But pyelitis is usually combined with nephritis or cystitis and the complications prevent diagnosis. In some cases the urine is scanty and strongly albuminous, and in others a round calculus will block, at intervals, the opening of the ureter giving rise to obstruction of the flow from that kidney and the occurrence of violent renal colic lasting until the stone is again dislodged backward.

_Diagnosis_ cannot often be certain. Purulent urine, with a considerable number of the spheroidal cells of the pelvis, and the general signs of nephritis may be taken as diagnostic. A great excess of such epithelial cells would on the contrary point to cystitis.

_Lesions._ In the early stages the mucosa of the pelvis is congested, red, and sometimes, with calculus, hæmorrhagic. Later it becomes thickened by exudate, which fills also the submucous tissue. In some instances the pelvis is distended by an impacted calculus, in others the obstruction of the ureter by an impacted calculus or a swelling has led to overdistension of the pelvis, and ammoniacal fermentation of its contents. Coincident inflammatory lesions of the kidney, ureter, or bladder are common.

_Prognosis_ is not hopeful. Where it has resulted as a descending infection from the kidney, the severity of the primary lesion renders the case a grave one, while if it has been an ascending inflammation from the bladder it is no less so.

_Treatment._ Diluent (watery) diuretics are especially indicated. Pure water may be given _ad libitum_. To this may be added if necessary moderate doses of bicarbonate of soda or potash with such non-irritating antiseptics as salicylic acid, salicylate of soda, sulphite of soda, sulphide of calcium, quinia or chamomile. Trasbot even recommends small doses of vegetable astringents, balsam of Tolu, or Peru or of Copiaba, or oil of turpentine or tar water. Apart from simple water, the diuretic agents may be used with greater freedom if the solid parts of the kidney are little or not at all involved and if the urine contains no casts of the uriniferous tubes.

Benefit may also be obtained from fomentations, or cupping of the loins, and even from the application of mustard and counter-irritants.

If the active symptoms subside the continued use of tonics would be indicated, especially quinia, and also of the balsams with the view at once of antisepsis and toning up of the mucous membrane.

In case of calculus of the pelvis surgical extraction is virtually the only resort, though a very desperate one. Its increase may be retarded or prevented by antisepsis, a liberal use of water, and the exhibition of piperazin or some of the essential oils.

CHRONIC NEPHRITIS.

Cases destroyed as eating their heads off. Causes: sequel of acute
nephritis, swill, lead, experimentally, microbian invasions, toxins,
metastatic embolism, extension from aortic disease, sclerostoma,
nitrogenous overfeeding, toxins of putrid food, or cryptogams,
valvular disease of the right heart, rheumatism, heaves, calculus,
starvation, debility, retention of urine. Symptoms: emaciation, flabby
muscles, lack of vigor, stiff loins and quarters, short step,
straddling, fatigue under slight exertion, groaning in trot, or in
turning, droops when mounted, slow to rise on hind limbs, poor
capricious appetite, anæmia, stocked legs, dropsies, urine of lower
density, albuminous, with granular epithelium and casts, abundant in
early stages, scanty with weakened heart and degenerated kidneys.
Secondary palpitations, bronchial catarrh, pneumonia, hemorrhage,
stupor, lethargy, vertigo, etc. Lesions: recent cases, kidney large,
cortex firm, capsule adherent, with granular fatty debris, and tubular
casts; old cases, kidney contracted, fibroid, glomeruli and tubules
atrophied. Bronchitis, pneumonia, hepatic cirrhosis, heart enlarged,
fatty, dilated, insufficient valves. Prognosis unfavorable. Treatment:
gentle exercise, warmth, succulent food, amylaceous, tonics, iron,
bitters, mineral acids, heart tonics, for polyuria bromides or
iodides, balsams, pilocarpin, fomentations or sinapisms to loins.

Chronic nephritis has received little attention in the lower animals for various reasons. The lower animals largely escape the causative factors of alcoholism and chronic lead and copper poisoning, and when suffering from any chronic affection that disqualifies the animal for use and renders it anæmic and emaciated it is naturally sacrificed to save the cost of maintenance. In spite of this a considerable number of cases have been recorded in horses, and cattle and especially in dogs and cats.

_Causes._ Cases of acute nephritis sometimes improve and give promise of recovery without completing the work of convalescence. Trasbot notes such cases in the dog, and Dickinson in the ox. Alcoholic nephritis and degenerations are to be sought for especially in cattle kept on distillery and brewery dregs. Lead taken in small quantities in soft water that has run through lead pipes or stood in leaden cisterns produces in cows and other animals chronic affections of the kidney. Ellenberger and Hofmeister have produced the disease experimentally with lead and copper respectively.

Microbian invasions of the kidney that advance slowly like glanders and tubercle are further causes of chronic nephritis. Other secondary microbian infections of the kidney are complications of infectious diseases in other parts, including abscess, pyæmia, septicæmia, ulcerative endocarditis of the left heart, bronchitis, pneumonia (Fröhner), and of others less directly in the line of the circulation, as omphalitis, uterine phlebitis (Lustig), abscess of the nasal sinuses, bones, and fistulæ (Trasbot).

In other cases the nephritis is evidently a result of the irritation caused by toxins in process of elimination by the kidneys, as there is no evidence of a nephritic infection.

In some instances minute emboli originating in the lungs or heart, become the starting point of the nephritis, which slowly extends by reason of infection or low condition and special susceptibility. Disease of the aorta or renal artery may lead to this condition as noticed by Cadeac and Lustig. Cadeac has also noticed its association with aneurism of the mesenteric arteries so that the strongylus (sclerostoma) armatus may be considered as a factor. Again in old horses and dogs it has been associated with atheroma of the aorta and renal vessels (Trasbot).

Overfeeding is not without its influence, especially when on animal food, which charges the kidneys with excreting an excess of the irritating urea and uric acid, and this is one reason why it is far more frequent in house dogs than in other domestic animals. When the meat is already decomposing and putrid there is the added evil of a quantity of toxins and even of microbes to be eliminated from the system by the much abused kidneys. Add to these that the dog’s urine is even in the normal condition more dense and contains more irritating ingredients than that of herbivora, and that owing to the slight activity of his perspiratory apparatus he can obtain less relief from the skin, and we find a substantial ground for the prevalence of chronic nephritis in this animal.

Disease of the valves of the right heart or dilatation with insufficiency of the auriculo-ventricular valves is a potent cause of nephritis, the reflux of blood into the veins and the increased venous tension, speedily producing passive congestion and a slow type of inflammation in the kidney. This factor is especially liable to operate in dogs, which are particularly obnoxious to rheumatism and valvular ulceration, and are very subject to nervous cardiac disorders; in horses that have contracted heaves; and in beef breeds of cattle which suffer from fatty degeneration of the heart with dilatation.

The influence of calculi must not be overlooked, whether they are lodged in the pelvis, the chalices, or the uriniferous tubules. Their tendency is to induce local irritation and exudation, with fibroid degeneration and thickening of the walls of the tubules or pelvis and of the adjacent tissue.

When to one or more of the above conditions there are added overfeeding or what is worse a low condition from starvation or unwholesome food (permeated by bacteria or cryptogams or containing vegetable acids), and when to crown all there are frequent exposures to cold or wet, we have a vicious combination especially conducive to kidney trouble.

Habitual retention of urine in mares in harness, in house dogs, or in horses in railway cars, and violent exertion, or sprains of the back are among the remaining accessory causes.

_Symptoms._ These are often slight or obscure, so that not only owners and attendants but even veterinarians are liable to overlook them. Loss of flesh, flabbiness of the muscles and a lack of spirit and energy are among the first symptoms. The _horse_ appears stiff, especially in his loins and hind limbs, and fails to advance the hind feet as far under the belly as formerly, and straddles more. When put to work he is early fatigued and appears unfit for sustained exertion. His movements are slow and if urged to a trot he may even groan with every step and quickly settles back to his sluggish pace. If turned sharply round on himself he does so with difficulty and often groans. When he is mounted or when the loins are pinched he may droop to excess. If you come on him lying down, and urge him to rise he may rise on his fore limbs and sit on his haunches until urged before he makes any attempt to raise himself on his hind. The _dog_ may spend most of his time in the kennel, and show little disposition to run, play or hunt. On the contrary the owner may have to call him several times before he will come out and then he moves listlessly, wearily and even weakly.

In all animals the appetite is poor or capricious, and the patient gradually loses condition, at first slowly and later, after a few weeks or months, more rapidly. The advance of anæmia is also steadily progressive.

Dropsical effusion is not uncommon. It is often prominent in the horse as stocked limbs, but may be absent for a length of time. In other animals it is more likely to appear later in the disease and under the chest or abdomen or in one of the internal serous cavities. Trasbot has found it absent for months in the nephritic dog.

The exploration of the kidney through the flaccid abdominal walls in small animals, and through the rectum in small horses and cattle, may reveal renal tenderness and even swelling. If there is a tendency to frequent passage of urine in small quantities, or to straining without micturition, the indication is of value.

There may be little or no fever, and, when left at rest, little evidence of discomfort.

Any indication of urinary trouble, and especially with dropsy, weakness, flabbiness and anæmia and a subnormal temperature, should lead to examination of the urine, as a crucial test. A high density is good ground for suspicion. But this is not constant. In advanced cases (chronic interstitial nephritis, small white kidney, atrophic nephritis) it may be 1015 to 1025, in exceptional advanced cases with polyuria, it may be 1010, 1005, or even 1001. With such a condition, however, there is great anæmia, pallor of the mucosæ, and prostration. Tested with nitric acid and heat, the urine throws down an abundant precipitate of albumen. Under the microscope it shows a profusion of granular, degenerating epithelial cells, and casts of the uriniferous tubes.

_Progress._ The course of the disease is usually slow, extending over several months, but with a tendency to constant advance. The thirst increases and the urine increases in amount, clearness and levity. There may supervene extreme sluggishness, dropsies, anæmia, and weakness, irritability of the heart, and palpitations on slight exertion. So long as the heart’s action is strong, elimination may be maintained and life prolonged for months (in cow, Dickinson), or years (Friedberger and Fröhner). When the heart’s action becomes weak, elimination is rendered imperfect and the animal shows catarrh of the lungs or bowels (common in dogs), local inflammation of the lungs, pleura or pericardium, or œdemas, or hæmorrhages. The toxic effect on the nerve centres is shown by stupor or lethargy, or vertigo. When an abscess forms it is associated with a temporary rise of temperature (Trasbot). The patient may die in convulsions, in a state of coma, or by gradually advancing debility and failure of the heart.

_Lesions._ In cases of comparatively =short standing= the kidney is usually of full size, or somewhat enlarged, with firmly adherent capsule and rough or even nodular surface. The surface of the cortex may be red or grayish or parti-colored, pink and gray. The cortical portion is firm and it may even be attenuated somewhat, while the medullary portion, naturally lighter, has often grayish streaks converging toward the hilus. When the gray streaks are scraped with the knife a serous fluid, mixed with fatty granules or globules, is obtained. The glomeruli may be still about the normal size with some increase of the epithelial tuft cells. The tubules contain casts (colloid, hyaline, granular), and their epithelium normally columnar, are flattened down to cubes and are swollen, granular or fatty.

In cases of =older standing= the connective tissue has usually undergone a marked increase. The capsule is thick, dense and adherent. The cortical substance is shrunken with a great increase of the fibrous elements, and the same holds true of the medullary portion. In consequence of this, even in the cortical substance the white or gray color predominates. The parenchymatous tissue (glomeruli, tubules) have greatly shrunken. In connection with the contraction of the forming fibrous hyperplasia, there is a general shrinkage of the kidney in size, it may be to one-half its original volume. Trasbot reports a case of nephritis, of 8 months standing, in the dog, with a kidney half the normal size. In the end the parenchyma may have practically disappeared, and the kidney may have shrunken to a small, firm, white, fibrous mass. Abscess of the kidney is exceptionally met with (Laurent, Lafosse).

_Lesions of distant organs_ are not uncommon. Bronchitis, pneumonia, pleurisy, insufficiency of the tricuspid or mitral valves, dilated heart, hypertrophied or fatty heart, congested or fibroid liver, arteritis, and dropsies are among such morbid conditions.

_Prognosis._ This is almost always unfavorable. Death may be delayed for months or years, and partial transient recoveries may take place but a restoration to normal structure and function is not to be looked for.

_Treatment._ This cannot be expected to be much more than palliative. The avoidance of overwork, and of the exposure to cold and wet, and the securing of a free action of the skin by warm buildings and clothing, are essential. The diet should be easily digested and non-stimulating, for _herbivora_ green food, carrots, roots, apples, silage, with a moderate allowance of oats to counteract weakness and anæmia; and for _carnivora_, milk, buttermilk, mush made of oat, wheat or barley meal, with, if necessary, a slight allowance of tender raw meat. Tonics fill a similar need. Iron and bitters may be combined. Or hydrochloric acid or nitromuriatic acid with bitters (nux, calumba, salicin, quassia) may be tried. These acids are especially valuable when the case has originated in or is maintained by calculi, indigestion or hepatic disorder. When the heart is defective in tone, it may be stimulated by small doses of digitalis, strophanthus, sparteine, caffein, or nitro-glycerine, or to a certain extent by strychnia or nux. These, however, must be used with judgment, if it is found that they aggravate the case by increasing the arterial tension. In those cases in which there is an excessive secretion of watery urine, the possible source of this in musty aliment should be avoided, and the flow checked by nux vomica, in moderate doses, and bromide or iodide of potassium in full doses. When, on the other hand, the urine becomes scanty and dense, the great danger of a toxic action must be met by agents that favor excretion. Pure water at will is perhaps the least objectionable of such agents, but potassium or sodium acetate or citrate, or even sodium chloride, in weak solution, may be given. In some cases benefit will come from a moderate use of the balsam of copiaba, or the leaves of buchu, which may improve the tone of the secretory elements. The most promptly effective of these agents is pilocarpin (Friedberger and Fröhner), but it has the serious drawback of inducing profuse and dangerous depletion and debility. Yet in careful hands, and with good cardiac tone, it may often be used to advantage.

Fomentations over the loins, warm baths and mustard embrocations, may at times be beneficial. Attempts have been made to check the hyperplasia by the use of arsenic, mercury or the compounds of iodine, but their use in such cases is based on theory rather than accomplished results.

HYPERTROPHY OF THE KIDNEY.

Hypertrophy of both kidneys has not been recorded in domestic animals. On the other hand the extraordinary development of one in compensation for the loss or atrophy of the other is not uncommon. In this the organ follows the general law of adaptation, seen in the double symmetrical organs (testicle, etc.) and the more so that its functional activity is indispensable to life. Among _causes_ are: blocking of an ureter by calculus, worms, neoplasm, nephritic abscess, gangrene, etc. The enlargement of the remaining kidney is a vicarious act and essentially a physiological one.

If compensation is perfect, it may be impossible to detect symptoms apart from those of the primary disease.

_Prognosis._ Life is endangered in case of any subsequent kidney disease.

ATROPHY OF THE KIDNEY.

Result of hyperplasia of connective tissues and compression and
absorption of parenchyma. Unilateral or partial. Causes: chronic
productive inflammation, calculus in tubes, ureter, or pelvis, tumor,
retention cyst, embolism. Lesions: sclerosis of kidney, firmness,
pallor, anæmia, lack of glomeruli and tubules, cysts, congenital,
urinous retention, colloid. Symptoms: reduced secretion, palpation of
kidney. Treatment: Prevention: arrest conditions, abundance of water,
succulent food, parasiticides, operation on cysts, counteract
nephritis.

Unlike hypertrophy, this is constantly the result of a pathological process. So long as a normal functional activity of the secreting elements is carried on, such parts must maintain their size and healthy characters. But with the compression of such secreting elements (glomeruli and convoluted tubes) by a hyperplasia of connective tissue, by pressure from without or from the damming back of the urine in the pelvis and tubes, the secretory elements are absorbed and removed, and the final result is a general atrophy. If such atrophy appears in both kidneys at once it can only be very partial in extent, as extreme atrophy of both, with loss of their secretory function, would entail poisoning and death from the retained urinary products. The comparative frequency of the disease may be inferred from the reports of the numbers of specimens found by Barrier and Moussu in old horses in the dissecting rooms. The latter observed a dozen cases in a single winter, other examples are recorded by Cadeac (horse), Soula (swine) and Trasbot (in various animals).

_Causes._ The most common source of the condition is the occurrence of chronic productive inflammation. The new product in such cases, if not pus, or a growth that rapidly passes into fatty or granular degeneration, or into gangrene, tends to form tissue of a low organization, especially fibrous. The resulting increase of the fibrous trabeculæ, in undergoing subsequent contraction necessarily compresses the secretory tissue and the final result is a visible and, it may be, extreme wasting. Hence any slowly advancing productive inflammation is liable to result in absorption and removal of the kidney parenchyma, and distinct atrophy of the gland.

Again the obstruction of the ureter by a calculus in the pelvis which falls into the infundibuliform entrance, or a stone arrested at any part of the duct (or even of the urethra) or by worms, hydatids, cysts or tumors, throws back on the kidney the secreted urine, which distending the pelvis and uriniferous tubes leads to direct compression and absorption of the secretory parenchyma. Direct compression of the kidney by an adjacent tumor will act in a similar manner. Retention cysts by their gradual increase and augmenting pressure cause absorption of the gland tissue.

The blocking of individual uriniferous tubules by minute calculi, which is so often seen in cattle, kept on dry feeding in winter, is a cause of partial nephritis, and absorption, as noted by Röll.

A somewhat rare cause of atrophy is the diminution of the blood supply by arteritis and embolism of the renal artery, or by pressure of tumors on that vessel. Arteritis and blocking suggests at once the possible agency of the strongylus (sclerostoma) armatus in the horse. Trasbot records a striking instance of compression of the renal artery and kidney by an enormous sublumbar melanoma. This occurred in an aged horse and led to atrophy.

_Lesions._ In cases due to productive inflammation with sclerosis of the kidney, the firmness, pallor and bloodlessness of the organ is a marked feature. When incised it is found to be composed mainly of fibrous tissue, while the glomeruli and tubuli have to a large extent disappeared.

If there has been simple lack of circulation the kidney becomes flaccid, pale and small in size. The secretory elements (glomeruli and uriniferous tubes) are first absorbed, leaving the fibrous network, which tends to shrink and form a hard resistent mass. In extreme cases there may be absolutely no glandular tissue left, and the dense shrunken mass represents only the hyperplasia of the original fibrous network. In the different successive stages of this process the glomeruli and tubules become flattened, the epithelial cells become granular, or contain colloid casts and refrangent elements like oil globules and finally they are represented by a small mass of fibrous material.

Of all the atrophies caused by the pressure of tumors perhaps that caused by cysts is the most characteristic. There may be a single cyst or they may be multiple; they may range in size from a pea to the size of the two fists the total size exceeding that of the normal kidney. In all such cases the cysts project visibly from the surface of the organ. They vary according to their origin and nature. Congenital cysts are said to have resulted from distension by retained urine of the capsule of the glomerulus. The arterial tuft is atrophied and flattened against the wall. Serous cysts with clear contents are found in the old. Urinous cysts again form by distension of the tubules that are obstructed by cysts or minute calculi. Colloid cysts are found in certain forms of nephritis formed by the dilatation of the capsule of the glomerulus or of the uriniferous tubules. The liquid often contains leucin, tyrosin and cholesterine. In all such cases the walls of the cyst become thick, and the glandular parenchyma is compressed leading to progressive degeneration and atrophy.

_Symptoms_ of atrophy of the kidney are necessarily those of suppression of urine, with, in certain cases, the passage of casts of the uriniferous tubes and of crystals of salts. There are, however, no absolutely pathognomonic symptoms. When the kidney can be reached through the flaccid walls of a comparatively empty abdomen, or through the rectum, its hard, shrunken condition may assist in diagnosis.

_Treatment_ is not successful in advanced cases. _Prevention_ is to be sought by obviating or treating the conditions on which the atrophy depends. Nephritis must be treated on general principles. Calculi must be avoided by a liberal supply of water, by soiling, or by pasturage. Strongylus parasitism should be dealt with by destroying the parent worms in the bowels, and by securing pure drinking water free from their eggs and embryos. Cysts, and tumors are only amenable to surgical measures and not often open even to these.

FATTY DEGENERATION OF THE KIDNEY: STEATOSIS OF THE KIDNEY.

Causes: age, overfeeding, idleness, atony, retention of urine.
Lesions: kidney enlarged, pale yellow, capsule loose, cut surface
glistening unctuous, oil globules in scrapings, granules soluble in
ether. Symptoms: in idle, overfed, obese, improved meat producing
breeds, closely confined, starchy or saccharine food, fatty granules
in urine, finally dropsies, anæmia, debility, sluggishness. Prognosis
unfavorable in advanced stage. Treatment: butcher, restricted regimen,
open air exercise, nitrogenous diet, crossing, diuretic food or drugs,
oil of turpentine, balsam copiaba. Palliation only.