=Definition.=—A chronic inflammation of the kidney in which there is
reduction in its size due to an extensive destruction of the tubular
substance, with an overgrowth, and later a contraction, of the
connective tissue elements. Cardio-vascular changes, arteriosclerosis
and cardiac hypertrophy are usually associated.
=Osteopathic Etiology and Pathology.=—Osteopathic lesions to the
renal splanchnics are important predisposing causes. The disease may
follow parenchymatous nephritis; or it may be caused by a continued
passive congestion due to valvular heart disease. Gout; cystitis
(often following gonorrhea), the inflammation extending up the ureters
to the kidney; heredity; old age; long continued worry, anxiety or
grief; chronic alcoholism, overeating; syphilis; tuberculosis; focal
infections, especially of streptococci; chronic mineral poisoning (as
from lead), and alterations in the renal ganglionic centers are causes.
It chiefly occurs in males during middle life.
=Pathologically=, both kidneys are involved (although one may be more
affected than the other), and reduced in size, often to less than half
their normal size. After removing the capsule, which is thickened
and adherent, the surface is found to be uneven, or granular and
containing small cysts. The kidney is hard, tough and resistant, the
color varying from a darkish brown to a yellowish gray. The cortical
portion is especially reduced in size. On microscopic examination,
the connective tissue appears greatly increased; this contracts,
compressing the tubules and blood-vessels, causing their destruction.
There is general arterial sclerosis, and the left side of the heart is
hypertrophied. There are frequent nasal and retinal hemorrhages, due to
the brittleness of the arterial walls which predispose them to rupture;
hence, apoplexy is a frequent termination. The ganglionic centers,
being interfered with, undergo fatty degeneration and atrophy. There
are marked retinal changes—retinitis, fatty degeneration of the retinal
tissues and sclerosis of the nerve fiber layers.
=Symptoms.=—The onset is insidious. In most cases the symptoms
are latent. The general health is disturbed; there are frequent
micturition, gastric disturbances, tense and bounding pulse,
hypertrophy of the left ventricle, high blood pressure, disorders
of vision, sleeplessness, headache, furred tongue, slight swelling
of the feet, dry skin, scurvy and shortness of breath. The urine is
increased in quantity, of acid reaction, light in color, low specific
gravity, with a small amount of albumin, a few hyaline casts, and some
epithelial cells. There is increased thirst and the patient may have
to urinate two or three times during the night. There is well marked
mucous cloud, slight sediment, and as the disease advances the urine
may be diminished, the albumin increased and the casts become more
numerous, while occasionally blood cells will be found.
Much importance should be attached to the blood pressure condition.
=Diagnosis.=—The early stages are not always recognizable. Later, while
there is high arterial tension, thickening of the arterial walls and
marked hypertrophy of the heart, the urine should be examined very
carefully both night and morning, as the diagnosis will greatly depend
upon the condition of the urine, which is increased in quantity, of
low specific gravity, with a trace of albumin, narrow hyaline and pale
granular casts, making the diagnosis usually easy.
=Prognosis.=—It is generally incurable, but favorable so far as the
power to prolong life is concerned, provided the diagnosis be made
early in the case, and the patient lives a quiet life. The case usually
terminates with convulsions, coma and death. Apoplexy is frequently
associated with chronic nephritis. In all forms of chronic nephritis
some intercurrent infectious disease is quite possible, which is apt to
be serious owing to the cachectic state.
=Treatment.=—The dietetic and hygienic treatment is the same as in
chronic parenchymatous nephritis. The nerve and vascular supply to the
kidneys should be treated as in acute parenchymatous nephritis. Freedom
from worry and overwork, and if possible change of climate, should be
prescribed. Frequent bathing, with friction of the skin, should be
insisted upon and the bowels kept regular by a treatment of alkaline
water. In all kidney cases special attention should be given the liver.
The alkaline water is a good diuretic; besides it flushes the kidneys
and helps to remove the debris.
These cases invariably present a rigid spine which should be carefully
but thoroughly treated, traction being one of the methods that
give comparatively quick and excellent results. Overcoming spinal
immobility, correction of the dorsal area, attention to the chest
rigidness, and frequently raising the abdominal organs will often
considerably reduce the blood pressure.
The accidents and complications which so often endanger the patient,
must be treated as they arise.