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.