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KIDNEY
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KIDNEY DISEASES' (For the See also:anatomy of the kidneys, see URINARY See also:SYSTEM.) The results of morbid processes in the kidney may be grouped under three heads: the actual lesions produced, the effects of these on the See also:composition of the urine, 1 The word " kidney " first appears in the See also:early See also:part of the 14th See also:century in the See also:form kidenei, with plural kideneiren, kideneris, kidneers, &c. It has been assumed that the second part of the word is " See also:neer " or " near " (cf. Ger. Niere), the See also:common See also:dialect word for "kidney" in See also:northern, See also:north midland and eastern counties of See also:England (see J. See also:Wright, See also:English Dialect See also:Dictionary, 1903, s.v. Near), and that the first part represents the O.E. cwi.6, belly, womb; this the New English Dictionary considers improbable; there is only one doubtful instance of singular kidnere and the See also:ordinary form ended in -ei or ey,. Possibly this represents M.E. ey, plur. eyren, See also:egg, the name being given from the resemblance in shape. The first part is uncertain. and the effects of the kidney-See also:lesion on the See also:body at large. Affections of the kidney are congenital or acquired. When acquired they may be the result of a pathological See also:process limited to the kidney, in which See also:case they are spoken of as See also:primary, or an See also:accompaniment of disease in other parts of the body, when they may be spoken of as secondary. Passive congestion of the kidneys occurs in See also:heart-diseases and See also:lung-diseases, where the return of venous See also:blood is interfered with. It may also be produced by tumours pressing on the vena cava. The engorged kidneys become brownish red, enlarged and fibroid, and they secrete a scanty, high-coloured urine. Active congestion is produced by the See also:excretion in the urine of such materials as See also:turpentine and See also:cantharides and the toxins of various diseases. These irritants produce engorgement and inflammation of the kidney, much as they would that of any other structures with which they come in contact. Renal disturbance is often the result of the excretion of microbic poisons. Extreme congestion of the kidneys may be produced by exposure to See also:cold, owing to some intimate relationship existing between the cutaneous and the renal vessels, the constriction of the one being accompanied by the See also:dilatation of the other. Infective diseases, such as typhoid See also:fever, See also:pneumonia, See also:scarlet fever, in fact, most acute specific diseases, produce during their height a temporary nephritis, not usually followed by permanent alteration in the kidney; but some acute diseases cause a nephritis which may See also:lay the See also:foundation of permanent renal disease. This is most common as a result of scarlet fever. See also:Bright's disease is the See also:term applied to certain varieties of acute and chronic inflammation of the kidney. Three forms are usually recognized—acute, chronic and the granular or cirrhotic kidney. In the more common form of granular kidney the renal lesion is only part of a widespread See also:affection involving the whole arterial system, and is not actually related to Bright's disease. Chronic Bright's disease is sometimes the sequel to acute Bright's disease, but in a See also:great number of cases the malady is chronic from the beginning. The lesions of the kidney are probably produced by irritation of the kidney-structures owing to the excretion of toxic substances either ingested or formed in the body; it is thought by some that the malady may arise as a result of exposure to cold. The See also:principal causes of Bright's disease are alcoholism, See also:gout, pregnancy- and the See also:action of such poisons as See also:lead; it may also occur as a sequel to acute diseases, such as scarlet fever. Persons following certain occupations are peculiarly liable to Bright's disease, e.g. See also:engineers who See also:work in hot shops and pass out into the cold See also:air scantily clothed; and painters, in whom the malady is dependent on the action of lead on the kidney. In the case of See also:alcohol and lead the See also:poison is ingested; in the case of scarlet fever, pneumonia, and perhaps pregnancy, the toxic See also:agent causing the renal affection is formed in the body. In Bright's disease all the elements of the kidney, the glomeruli, the tubular epithelium, and the interstitial See also:tissue, are affected. When the disease follows scarlet fever, the glomerular structures are mostly affected, the capsules being thickened by fibrous tissue, and the glomerular tuft compressed and atrophied. The epithelium of the convoluted tubules undergoes degeneration; considerable quantities of it are See also:shed, and form the well-known casts in the urine. The tubules become blocked by the epithelium, and distended with the pent-up urine; this is one cause of the increase in See also:size that the kidneys undergo in certain forms of Bright's disease. The lesions in the tubules and in the glomeruli are not generally See also:uniform. The interstitial tissue is always affected, and exudation, proliferation and formation of fibrous tissue occur. In the granular and contracted kidney the lesion in the interstitial tissue reaches a high degree of development, little renal secreting tissue being See also:left. Such tubules as remain are dilated, and the epithelium lining them is altered, the cells becoming hyaline and losing their structure. The vessels are narrowed owing to thickening of the subendothelial layer, and the See also:muscular coat undergoes hypertrophic and fibroid changes, so that the vessels are abnormally rigid. When the overgrowth of fibrous tissue is considerable, the See also:surface of the See also:organ becomes uneven, and it is for this See also:reason that the term granular kidney has been applied to the See also:condition. In acute Bright's disease the kidney is increased in size and engorged with blood, the changes described above being in active progress. In the chronic form the kidney may be large or small, and is usually See also: In addition, fatty and fibrous growths, the nodules of See also:glanders and the gummata of syphilis, may be mentioned. Tuberculous disease is sometimes primary; more frequently it is secondary to tubercle in other portions of the Benito-; urinary apparatus. The genito-urinary See also:tract may be infected by Congenital Affections.—The principal congenital affections are anomalies in the number or position of the kidneys or of their ducts; See also:atrophy; cystic disease and growths. The most common abnormality is the existence of a single kidney; rarely a supernumerary kidney may be present. The presence of a single kidney may be due to failure of development, or to atrophy in foetal See also:life; it may also be dependent on the See also:fusion of originally See also:separate kidneys in such a way as to lead to the formation of a See also:horse-See also:shoe kidney, the two See also:organs being connected at their See also:lower ends. In some cases of horse-shoe kidney the organs are See also:united merely by fibrous tissue. Occasionally the two kidneys are fused end to end, with two ureters. A third variety is that where the fusion is more See also:complete, producing a disk-like See also:mass with two ureters. The kidneys may be situated in abnormal positions; thus they may be in front of the sacro-iliac See also:articulation, in the See also:pelvis, or in the iliac fossa. The importance of such displacements lies in the fact that the organs may be mistaken for tumours. In some cases atrophy is associated with mal-development, so that only the medullary portion of the kidney is See also:developed; in others it is associated with arterial obstruction, and sometimes it may be dependent upon obstruction of the ureter. In congenital cystic disease the organ is transformed into a mass of cysts, and the enlargement of the kidneys may be so great as to produce difficulties in See also:birth. The cystic degeneration is caused by obstruction of the uriniferous tubules or by anomalies in development, with persistence of portions of the Wolffian body. In some cases cystic degeneration is accompanied by anomalies in the ureters and in the arterial See also:supply. Growths of the kidney are sometimes found in infants; they are usually See also:malignant, and may consist of a See also:peculiar form of sarcoma, which has been spoken of as rhabdo-sarcoma, owing to the presence in the mass of involuntary muscular See also:fibres. The existence of these tumours is dependent on anomalies of development ; the tissue which forms the See also:primitive kidney belongs to the same layer as that which gives rise to the muscular system (mesoblast). Anomalies of the excretory ducts: in some cases the ureter is See also:double, in others it is greatly dilated; in others the pelvis of the kidney may be greatly dilated, with or without dilatation of the ureter. Acquired Affections. Movable Kidney.—One or both of the kidneys in the adult may be preternaturally See also:mobile. This condition is more common in See also:women, and is usually the result of a severe shaking or other form of injury, or of the abdominal walls becoming lax as a sequel to abdominal distension, to emaciation or pregnancy, or. to the effects of tight-lacing. The more extreme forms of movable kidney are dependent, generally, on anomalies in the arrangement of the peritoneum, so that the organ has a partial mesentery; and to this condition, where the kidney can be moved freely from one part of the See also:abdomen to another, the term floating kidney is applied. But more usually the organ is loose under the peritoneum, and not efficiently supported in its fatty See also:bed. Movable kidney produces a variety of symptoms, such as See also:pain in the See also:loin and back, faintness, See also:nausea and vomiting—and the See also:function of the organ may be seriously interfered with, owing to the ureter becoming kinked. In this way hydronephrosis, or distension of the kidney with urine, may be produced. The return of blood through the renal vein may also be hindered, and temporary vascular engorgement of the kidney, with haematuria, may be produced. In some cases the movable kidney may be satisfactorily kept in its See also:place by a See also:pad and See also:belt, but in other cases an operation has to be undertaken. This consists in exposing the kidney (generally the right) through an incision below the last See also:rib, and fixing it in its proper position by several permanent sutures of See also:silk or silkworm gut. The operation is neither difficult nor dangerous, and its results are excellent. Embolism.—The arrangement of the blood-vessels of the kidney is peculiarly favourable to the See also:production of See also:wedge-shaped areas of See also:necrosis, the result of a blocking by clots. Sometimes the See also:clot is detached from the interior of the heart, the effect being an See also:arrest of the circulation in the part of the kidney supplied by the blocked artery. In other cases, the plug is infective owing to the presence of septic micro-organisms, and this is likely to lead to the formation of small pyaemic abscesses. It is exceptional for the large branches of the renal artery to be blocked, so that the symptoms produced in the ordinary cases are only the temporary See also:appearance of blood or albumen in the urine. Blocking of the See also:main renal vessels as a result of disease of the walls of the vessels may lead to disorganization of the kidneys. Blocking of the See also:veins, leading to extreme congestion of the kidney, also occurs. It is seen in cases of extreme weakness and wasting, sometimes in septic conditions, as in puerperal pyaemia, where a clot, formed first in one of the pelvic veins, may spread up the vena cava and secondarily See also:block the renal veins. Thrombosis of the renal vein also occurs in malignant disease of the kidney and in certain forms of chronic Bright's disease. tubercle in two ways; ascending, in which the primary lesion is in the testicle, epididymis, or urinary See also:bladder, the lesion travelling up by the ureter or the lymphatics to the kidney; descending, where the tubercle bacillus reaches the kidney through the blood-vessels. In the latter case, miliary tubercles, as scattered granules, are seen, especially in the cortex of the kidney; the lesion is likely to be bilateral. In primary See also:tuberculosis, and in ascending tuberculosis, the lesion is at first unilateral. Malignant disease of the kidney takes the form of sarcoma or carcinoma. Sometimes it is dependent on the malignant growths starting in what are spoken of as " See also:adrenal rests " in the cortex of the kidney. Sarcoma is most often seen in the See also:young; carcinoma in the See also:middle-aged and elderly. Carcinoma may be primary or secondary, but the kidney is not so prone to malignant disease as other organs, such as the See also:stomach, bowel orliver. Cystic Kidneys.—Cysts may be single—sometimes of large size. Scattered small cysts are met with in chronic Bright's disease and in granular contracted kidney, where the dilatation of tubules reaches a high degree. Certain growths, such as adenomata, are liable to cystic degeneration, and cysts are also found in malignant disease. Finally, there is a rare condition of general cystic disease somewhat similar to the congenital affection. In this form the kidneys, greatly enlarged, consist of a congeries of cysts separated by the remains of renal tissue. Parasitic Affections.—The more common parasites affecting the kidney, or some other portion of the urinary tract, and causing disease, are filaria, bilharzia and the cysticercus form of the See also:taenia echinococcus (hydatids). The presence of filaria in the thoracic duct and other See also:lymph-channels may determine the presence of chyle in the urine, together with the ova and young forms of the filaria, owing to the distension and rupture of a lymphatic See also:vessel into some portion of the urinary tract. This is the common cause of chyluria in hot climates, but chyluria is occasionally seen in the United See also:Kingdom without filaria. Bilharzia, especially in See also:Egypt and See also:South See also:Africa, causes haematuria. The cysticercus form of the taenia echinococcus leads to the production of hydatid cysts in the kidney; this organ, however, is not so often affected as the liver.
See also: They may give rise to no symptoms, or on the other See also:hand may cause distressing renal See also:colic, especially when they are small and loose and are passed or are trying to be passed. Serious complications may result from the presence of a stone in the kidney, such as hydronephrosis, from the urinary secretion being pent up behind the obstruction, or complete suppression, which is apparently produced reflexly through the See also:nervous system. In such cases the surgical removal of the stone is often followed by the restoration of the renal secretion. The symptoms of renal calculus may be very slight, or they may be entirely absent if the stone is moulding itself into the interior of the kidney; but if the stone is movable, heavy and rough, it may cause great See also:distress, especially during exercise. There will probably be blood in the urine; and there will be pain in the loin and thigh and down into the testicle. The testicle also may be See also:drawn up by its suspensory muscle, and there may be irritability of the bladder. With stone in one kidney the pains may be actually referred to the kidney of the other See also:side. Generally, but not always, there is tenderness in the loin. If the stone is composed of lime it may throw a See also:shadow on the See also:Rontgen See also:plate, but other stones may give no shadow. Renal colic is the acute pain See also:felt when a small stone is travelling down the ureter to the bladder. The pain is at times so acute that fomentations, morphia and hot See also:baths fail to ease it, and nothing See also:short of See also:chloroform gives See also:relief. For the operative treatment of renal calculus an incision is made a little below the last rib, and, the muscles having been traversed, the kidney is reached on the surface which is not covered by peritoneum. Most likely the stone is then felt, so it is cut down upon and removed. If it is not discoverable on gently pinching the kidney between the See also:finger and thumb, the kidney had better be opened in its See also:convex border and explored by the finger. Often it has happened that when a See also:man has presented most of the symptoms of renal calculus and has been operated on with a negative result as regards finding a stone, all the symptoms have nevertheless disappeared as the See also:direct result of the See also:blank operation. Pyelitis.—Inflammation of the pelvis of the kidney is generallyproduced by the See also:extension of gonorrhoeal or other septic inflammation upwards from the bladder and lower urinary tract, or by the presence of stone or of tubercle in the pelvis of the kidney. Pyonephrosis, or distension of the kidney with pus, may result as a sequel to pyelitis or as a complication of hydronephrosis; in many cases the inflammation spreads to the See also:capsule of the kidney, and leads to the formation of an See also:abscess outside the kidney—a perinephritic abscess. In some cases a perinephritic abscess results from a septic plug in a blood-vessel of the kidney, or it may occur as the result of an injury to the loose cellular tissue surrounding the kidney, without lesion of the kidney. Hydronephrosis, or distension of the kidney with pent-up urine, results from obstruction of the ureter, although all obstructions of the ureter are not followed by it, calculous obstruction, as already noted, often causing complete suppression of urine. Obstruction of the ureter, causing hydronephrosis, is likely to be due to the impaction of a stone, or to pressure on the ureter from a See also:tumour in the pelvis—as, for instance, a See also:cancer of the uterus—or to some abnormality of the ureter. Sometimes a kink of the ureter of a movable kidney causes hydronephrosis. The hydronephrosis produced by obstruction of the ureter may be intermittent; and when a certain degree of distension is produced, either as a result of the shifting of the calculus or of some other cause, the obstruction is temporarily relieved in a great outflow of urine, and the urinary See also:discharge is re-established. When the hydronephrosis has long existed the kidney is converted into a See also:sac, the remains of the renal tissues being spread out as a thin layer. Effects on the Urine.—Diseases of the kidney produce alterations in the composition of the urine; either the proportion of the normal constituents being altered, or substances not normally present being excreted. In most diseases the quantity of urinary See also:water is diminished, especially in those in which the activity of the circulation is impaired. There are diseases, however, more especially the granular kidney and certain forms of chronic Bright's disease, in which the quantity of urinary water is considerably increased, notwithstanding the profound anatomical changes that have occurred in the kidney. There are two forms of suppression of the urine: one is obstructive suppression, seen where the ureter is blocked by stone or other morbid process; the other is non-obstructive suppression, which is See also:apt to occur in advanced diseases of the kidney. In other cases complete suppression may occur as the result of injuries to distant parts of the body, as after severe surgical operations. In some diseases in which the quantity of urinary water excreted is normal, or even greater than normal, the efficiency of the renal activity is really diminished, inasmuch as the urine contains few solids. In estimating the efficiency of the kidneys, it is necessary to take into See also:consideration the so-called " solid urine," that is to say, the quantity of solid See also:matter daily excreted, as shown by the specific gravity of the urine. The nitrogenous constituents—See also:urea, uric acid, creatinin, &c.—vary greatly in amount in different diseases. In most renal diseases the quantities of these substances are diminished because of the physiological impairment of the kidney. The See also:chief abnormal constituents of the urine are serum-albumen, serum-globulin, albumoses (See also:albuminuria), blood (haematuria), blood pigment (haemoglobinuria), pus (pyuria), chyle (chyluria) and See also:pigments such as melanuria and urobilinuria. Effects on the Body at large.—These may be divided into the persistent and the intermittent or transitory. The most important persistent effects produced by disease of the kidney are, first, nutritional changes leading to general See also:ill See also:health, wasting and cachexia; and, secondly, certain cardio-vascular phenomena, such as enlargement (See also:hypertrophy) of the heart, and thickening of the inner, and degeneration of the middle, coat of the smaller arteries. Amongst the intermittent or transitory effects are See also:dropsy, secondary inflammations of certain organs and serous cavities, and uraemia. Some of these effects are seen in every form of severe kidney disease, and uraemia may occur in any advanced kidney disease. Renal dropsy is chiefly seen in certain forms of Bright's disease, and the cardiac and arterial changes are commonest in cases of granular or contracted kidney, but maybe absent in other diseases which destro the kidney tissue, such as hydronephrosis. Uraemia is a toxi condition; and three varieties of it are recognized—the acute, the chronic and the latent. Many of these effects are dependent upon the action of poisons retained in the body owing to the deficient action of the kidneys. It is also probable that abnormal substances having a toxic action are produced as a result of a perverted See also:metabolism. Uraemia is of toxic origin, and it is probable that the dropsy of renal disease is due to effects produced in the capillaries by the presence of abnormal substances in the blood. High arterial tension, cardiac hypertrophy and arterial degeneration may also be of toxic origin, or they may be produced by an See also:attempt of the body to maintain an active circulation through the greatly diminished amount of kidney tissue available. Rupture of the kidney may result from a kick or other direct injury. Vomiting and collapse are likely to ensue, and most likely blood will appear in the urine, or a tumour composed of blood and urine may form in the renal region. An incision made into the swelling from the loin may enable the surgeon to see the torn kidney.. An attempt should be made to See also:save the kidney by suturing and draining; unless the damage is obviously past repair, the kidney should not be removed without giving nature a See also:chance. (J. R. B. ; E. Additional information and CommentsThere are no comments yet for this article.
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