(RENAL HYPEREMIA)
=Definition.=—An increase in the amount of blood to the vessels of
the kidney. It is active hyperemia when there is arterial congestion,
passive hyperemia when there is venous congestion.
=Osteopathic Etiology and Pathology.=—Active hyperemia may be caused
by injuries to the renal splanchnics, especially the tenth to twelfth
dorsal segments; injuries over and to the kidneys; exposure to cold
when the body is very warm; poison given, as diuretics; eruptive fevers
and pregnancy, or follow genito-urinary operations. Passive hyperemia
may be caused by obstructive diseases of the general circulation, as
chronic heart, lung and liver diseases, or by pressure on the renal
veins by tumors, growths and the pregnant uterus. Thrombosis of the
renal veins may produce passive hyperemia, but rarely.
=Pathologically=, in active hyperemia the kidney is swollen and
slightly enlarged. Upon removal of the capsule, the kidney is found to
be brown and mottled. On section the parts bleed freely, the Malpighian
bodies are distended, and microscopical examination shows a cloudy
swelling of the renal epithelium. In passive hyperemia the kidney
is swollen, hard, firm and of a bluish red color. Later there is an
overgrowth of connective tissue and some infiltration between the
tubules. The Malpighian bodies occasionally become shriveled and the
renal epithelium fatty.
=Symptoms.=—In =active hyperemia= the urine is scanty, of high specific
gravity and of high color, containing some albumin and casts. Pain is
experienced over the loins, following the course of the ureters, and
the bladder is irritable. There are headache, nausea and vomiting. When
from infection, fever may be present.
In =passive hyperemia= the symptoms are primarily those caused by the
disease producing the disorder. There is weight over the loins and
dropsy. The urine is diminished, of high specific gravity, highly
colored, albuminous and occasionally shows a few hyaline casts.
=Prognosis.=—=Active hyperemia.=—Usually favorable if it can be
treated in time. If prolonged, acute nephritis may develop. =Passive
hyperemia.=—Depends on the cause. If the disease is prolonged, it
terminates in interstitial nephritis.
=Treatment.=—=Active hyperemia.=—Absolute rest and thorough treatment
to the renal splanchnics and treatment over the abdomen to the kidneys
directly by carefully raising them. Adjust the lower ribs if found
lesioned. Water should be drunk liberally and the patient encouraged to
use vapor baths. Favorable hygienic surroundings, warmth and good food
are indispensable. Warm applications over the loins are helpful.
=Passive hyperemia=.—The treatment largely depends upon the cause, but
too much importance cannot be given to the treating of the vasomotor
fibers of the kidneys from the eighth dorsal to the first lumbar.
Textbooks state that the vasomotor fibers to the kidneys are from
the ninth to the twelfth dorsal vertebræ, inclusive, but osteopathic
experience shows we can affect vasomotor fibers slightly higher.
Treatment here has a distinct effect on the blood pressure within the
glomeruli. The renal epithelium is extremely sensitive to circulatory
changes. Even the compression of a renal artery for only a few minutes
causes marked disturbances. Hence any irritation or obstruction to the
vasomotor innervation of the renal blood-vessels may result in serious
conditions. The superior cervical ganglion of the sympathetic and the
sciatic center have important bearing on the secretions of the kidney,
through vasomotor fibers. Due attention should be paid to the bowels,
and the patient required to take plenty of rest and a light diet.