THE SYNDROME OF EXTRARENAL AZOTEMIA
Authors: Harold Jeghers, Henry J. Bakst
Journal: Annals of Internal Medicine (1938)

Article1 April 1938THE SYNDROME OF EXTRARENAL AZOTEMIAHAROLD JEGHERS, M.D., HENRY J. BAKST, M.D.HAROLD JEGHERS, M.D.Search for more papers by this author, HENRY J. BAKST, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-11-10-1861 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAzotemia signifies an abnormal increase in the non-protein nitrogen (NPN) level of the blood. Normally the blood of a fasting person contains from 25 to 35 mg. per cent of non-protein nitrogen; this includes urea, uric acid, ammonia, amino acid, creatine, creatinine and some nitrogenous substances known as undetermined nitrogen or rest nitrogen. Values for blood non-protein nitrogen over 40 mg. per 100 c.c. are considered abnormal.Theoretically an azotemia could be caused by an increase of any of these non-protein nitrogen constituents. The amounts of uric acid, ammonia, creatine and creatinine are so small that increases of even several...Bibliography1. BERGLUNDMEDES HG: The kidney in health and disease, 1935, Lea and Febiger, Philadelphia, p. 19-38. Google Scholar2. FISHBERG AM: Hypertension and nephritis, 3d ed., 1934, Lea and Febiger, Philadelphia, p. 104. Google Scholar3. CUBITT AW: The problem of anuria: A review of recent work on renal physiology, with reports of two cases, Brit. Jr. Surg., 1936, xxiv, 215-226. CrossrefGoogle Scholar4. LASSENHUSFELDT HCE: Kidney function and blood pressure, Jr. Clin. Invest., 1934, xiii, 263-278. CrossrefGoogle Scholar5. WILKNER : Quoted by Randall.100 Google Scholar6. BLUMGRABARVAN CAULAERT LPC: L'Azotemie par manque de sel, son mécanisme, Ann. de med., 1929, xxv, 34-42. Google Scholar7. PETERS JP: Salt and water metabolism in nephritis, Medicine, 1932, xi, 435-535. CrossrefGoogle Scholar8. KERPEL-FRONIUSBUTLER EAM: Salt and water losses in diuretin diuresis and their relation to serum non-protein nitrogen and electrolyte concentrations, Jr. Exper. Med., 1935, lxi, 157-172. CrossrefGoogle Scholar9. BROWNEUSTERMANHARTMANROWNTREE GEGBHRLG: Toxic nephritis in pyloric and duodenal obstruction. Renal insufficiency complicating gastric tetany, Arch. Int. Med., 1923, xxxii, 425-455. CrossrefGoogle Scholar10. HADENGUFFEY RLDC: A case of pernicious vomiting of pregnancy with low blood chlorides and marked response to sodium chloride therapy, Am. Jr. Obst. and Gynec., 1924, viii, 486-491. CrossrefGoogle Scholar11. MELLINGHOFF K: Über Urämie bei Kochsalzmangel, Deutsch. med. Wchnschr., 1934, lx, 1127-1129. CrossrefGoogle Scholar12. HADENORR RLTG: Chemical changes in blood after pyloric obstruction, Jr. Exper. Med., 1923, xxxvii, 377-381. CrossrefGoogle Scholar13. BINETRATHERY : Quoted by Meyler.27 Google Scholar14. GLASS J: Untersuchungen über die experimentelle Chlorverarmung ihre Folgen und die Ursache des Dechlorurationstodes, Ztschr. f. d. ges. exper. Med., 1932, lxxxii, 776-805. CrossrefGoogle Scholar15. LANDISELSOMBOTTSHIELS EMKAPAE: Observations on sodium chloride restriction and urea clearance in renal insufficiency, Jr. Clin. Invest., 1935, xiv, 525-541. CrossrefGoogle Scholar16. BORST JG: Üramie durch Kochsalzmangel, Ztschr. f. klin. Med., 1931, cxvii, 55-74. Google Scholar17. MCCANCE RA: Medical problems in mineral metabolism, Lancet, 1936, l, 643, 704, 765, and 823. CrossrefGoogle Scholar18. CLAUSEN J: Studies on the relation between hyperazotemia and NaCl deficiency, Acta med. Scandinav., 1937, xci, 523-540. Google Scholar19. GROAK B: Azotämie und Hypochlorämie, Ztschr. f. d. ges. exper. Med., 1936, xcvii, 823-825. CrossrefGoogle Scholar20. KERPEL-FRONIUS E: Zur Pathogenese der "hypochlorämischen" Azotämie, Ztschr. f. d. ges. exper. Med., 1936, xcvii, 733-748. CrossrefGoogle Scholar21. GÖMÖRIPODHRADSZKY PL: The mechanism of extra renal (hypochloremic) azotemia, Acta med. Scandinav., 1937, xcii, 347-356. Google Scholar22. GAMBLE JL: Dehydration, New England Jr. Med., 1929, cci, 909-917. Google Scholar23. GAMBLE JL: The extra-cellular body fluid, Internat. Clinics, 1936, II, series 46, 184-201. Google Scholar24. LASHMETNEWBURGH : Quoted by Coller and Maddock.26 Google Scholar25. NESBIT RM: Water metabolism in the surgical patient, Jr. Urol., 1937, xxxvii, 588-594. CrossrefGoogle Scholar26. COLLERMADDOCK FWG: A study of dehydration in humans, Ann. Surg., 1935, cii, 947-960. CrossrefGoogle Scholar27. MEYLER L: Uremia due to dehydration, Acta med. Scandinav., 1936, xc, 475-488. Google Scholar28. MACKAYMACKAY LLEM: Increased blood urea concentration of extra renal origin, Am. Jr. Physiol., 1924, lxx, 394-411. CrossrefGoogle Scholar29. MOON VH: Shock—a definition and differentiation, Arch. Path., 1936, xxii, 325-335. Google Scholar30. SURANYISONNAUER JP: Viskositätsstudien beim Säugling; die Viskositätskurven von Plasma und Serum bei normalen und atrophischen Saüglingen, Arch. f. Kinderheilk., 1932, xcvii, 230-236. Google Scholar31. MEDESHERRICK GJF: Blood flow to kidney and creatinine clearance, Proc. Soc. Exper. Biol. and Med., 1933, xxxi, 116-119. CrossrefGoogle Scholar32. JEGHERSSELESNICK HS: Hyperproteinemia: its significance, Internat. Clinics, 1937, iii (In press). Google Scholar33. MANN FC: The effects of complete and of partial removal of the liver, Medicine, 1927, vi, 419-512. CrossrefGoogle Scholar34. BOLLMANMANNMAGATH JLFCTB: Studies on the physiology of the liver. XV: The effect of total removal of the liver on deaminization, Am. Jr. Physiol., 1936, lxxviii, 258-269. Google Scholar35. STADIEVAN SLYKE WCDD: The effect of acute yellow atrophy on metabolism and on the composition of the liver, Arch. Int. Med., 1920, xxv, 693-704. CrossrefGoogle Scholar36. RABINOWITCH IM: Biochemical findings in a rare case of acute yellow atrophy, Jr. Biol. Chem., 1929, lxxxiii, 333-335. CrossrefGoogle Scholar37. STANDER HJ: A chemical study of a case of chloroform poisoning, Bull. Johns Hopkins Hosp., 1924, xxxv, 46-49. Google Scholar38. WAKEMANMORRELL AMCA: Chemistry and metabolism in experimental yellow fever in Macacus rhesus monkeys. I. Concentration of non-protein nitrogenous constituents in the blood, Arch. Int. Med., 1930, xlvi, 290-305. II. Nitrogen metabolism, Ibid., 1930, xlvi, 382-401. CrossrefGoogle Scholar39. PETERS JP: Critical estimate of laboratory procedures in disorders of metabolism, Bull. N. Y. Academy Med., 1934, x, 415-444. Google Scholar40 PETERSVAN SLYKE JPDD: Quantitative clinical chemistry, Williams and Wilkins, Baltimore, 1931 i, 266-304. Google Scholar41. LENNOXO'CONNORBELLINGER WGMM: Chemical changes in the blood during fasting in human subjects, Arch. Int. Med., 1926, xxxviii, 553-565. CrossrefGoogle Scholar42. MORGULISEDWARDS SAC: Chemical changes in the blood during fasting and subsequent refeeding experiments, Am. Jr. Physiol., 1924, lxviii, 477-497. CrossrefGoogle Scholar43. See reference 40, page 285. Google Scholar44. COOKEWHIPPLE JVGH: Proteose intoxications and injury of body protein. V. The increase in non-protein nitrogen of the blood in acute inflammatory processes and acute intoxication, Jr. Exper. Med., 1918, xxviii, 243-252. CrossrefGoogle Scholar45. WHIPPLEVAN SLYKE GHDD: Proteose intoxication and injury of body protein. III. Toxic protein catabolism and its influence upon the non-protein nitrogen partition of the blood, Jr. Exper. Med., 1918, xxviii, 213-221. CrossrefGoogle Scholar46. LURJE A: Protein metabolism, disturbances under conditions of shock and surgical interference, Am. Jr. Surg., 1936, xxxii, 313-317. CrossrefGoogle Scholar47. RACKEMANNLONGCOPEPETERS FMWTJP: The excretion of chlorides and water and the renal function in serum disease, Arch. Int. Med., 1916, xviii, 496-504. CrossrefGoogle Scholar48. HASHIMOTO H: Blood chemistry in acute histamine intoxication, Jr. Pharm. and Exper. Therap., 1925, xxv, 381-409. Google Scholar49. GRABFIELDPRENTISS GPAM: Further studies on the effect of iodides on human nitrogen metabolism, Jr. Pharm. and Exper. Therap., 1925, xv, 411-422. Google Scholar50. GRABFIELDALPERSPRENTISS GPBJAM: The effect of iodides on nitrogen metabolism, Jr. Pharm. and Exper. Therap., 1923, xxii, 393-399. Google Scholar51. MILLIKENKARR LFWG: The influence of the nerves on kidney function in relation to the problem of renal sympathectomy, Jr. Urol., 1925, xiii, 1-23. Google Scholar52. DEGOWINOSTERHAGENANDERSCH ELHFM: Renal insufficiency from blood transfusion. 1. Relation to urinary acidity, Arch. Int. Med., 1937, lix, 432-444. CrossrefGoogle Scholar53. STEWARTCANTAROW HLA: Renal lesions following injection of sodium dehydrocholate in animals with and without biliary stasis, Arch. Path., 1935, xx, 866-881. Google Scholar54. WINTON FR: The influence of venous pressure on the isolated mammalian kidney, Jr. Physiol., 1931, lxxii, 49-61. CrossrefGoogle Scholar55. VAN DYKE HB: The physiology and pharmacology of the pituitary body, 1936, University of Chicago Press, p. 354-356. Google Scholar56. LOEBATCHLEYSTAHL RFDWJ: The rôle of sodium in adrenal insufficiency, Jr. Am. Med. Assoc., 1935, civ, 2149-2154. CrossrefGoogle Scholar57. SIMPSON CK: Pathology of the adrenal gland in relation to sudden death, Lancet, 1937, i, 851-856. CrossrefGoogle Scholar58. STEINBERG CL: The prognosis of coronary thrombosis based on the non-protein nitrogen in the blood, Jr. Lab. and Clin. Med., 1934, xx, 279-287. Google Scholar59. FISHBERGHITZIGKING AMWMFH: Circulatory dynamics in myocardial infarction, Arch. Int. Med., 1934, liv, 997-1019. CrossrefGoogle Scholar60. JEGHERSLERNER HH: The syndrome of alkalosis complicating the treatment of peptic ulcer; report of cases with a review of the pathogenesis, clinical aspects and treatment, New England Jr. Med., 1936, ccxiv, 1236-1244. CrossrefGoogle Scholar61. STEELE JM: Renal insufficiency developing during prolonged use of alkalies; report of case, Jr. Am. Med. Assoc., 1936, cvi, 2049-2050. CrossrefGoogle Scholar62. SCHUTZHELWIGKUHN CBFCHP: A contribution to the study of so-called liver death, Jr. Am. Med. Assoc., 1932, xcix, 633-636. CrossrefGoogle Scholar63. Editorial: Liver death, a hepatorenal syndrome, Jr. Am. Med. Assoc., 1937, cviii, 301-302. Google Scholar64. BOYCEMCFETRIDGE FFEM: So-called "liver death," Arch. Surg., 1935, xxxi, 105. CrossrefGoogle Scholar65. LICHTMANSOHVAL SSAR: Clinical disorders with associated hepatic and renal manifestations, with special reference to the so-called "hepatorenal syndrome," Am. Jr. Digest. Dis. and Nutr., 1937, iv, 26-32. CrossrefGoogle Scholar66. TAYLORLEWIS AEHB: A study of protein metabolism under conditions of repeated hemorrhage, Jr. Biol. Chem., 1915, xxii, 71-76. CrossrefGoogle Scholar67. BUELL MV: Studies of blood regeneration. II. Effect of hemorrhage on nitrogen metabolism, Jr. Biol. Chem., 1919, xl, 63-77. CrossrefGoogle Scholar68. ALSTED G: Further studies on azotemia following hemorrhage in the digestive tract, Am. Jr. Med. Sci., 1936, cxlii, 199-208. CrossrefGoogle Scholar69. INGEGNO AP: The elevated blood urea of acute gastrointestinal hemorrhage and its significance, Am. Jr. Med. Sci., 1935, cxc, 770-774. CrossrefGoogle Scholar70. DEROW HA: Significance of postoperative rises of blood non-protein nitrogen, New England Jr. Med., 1935, ccxii, 509-511. CrossrefGoogle Scholar71. ROWNTREEFITZ LGR: Studies of renal function in renal, cardio-renal, and cardiac diseases, Arch. Int. Med., 1913, xi, 258-287. CrossrefGoogle Scholar72. MCLEAN FC: The numerical laws governing the rate of excretion of urea and and chlorides in man. II. The influence of pathological conditions and of drugs on excretion, Jr. Exper. Med., 1915, xxii, 366-388. CrossrefGoogle Scholar73. FOSTER NB: Uremia. III. The non-protein nitrogen of the blood, Arch. Int. Med., 1915, xv, 356-368. CrossrefGoogle Scholar74. GOLDRINGGRAEF WI: Nephrosis with uremia following transfusion with incompatible blood; report of seven cases with three deaths, Arch. Int. Med., 1936, lviii, 825-845. CrossrefGoogle Scholar75. HANSEN-PRUSSMILLER OCBN: Uremia following blood transfusion, Southern Med. Jr., 1936, xxix, 1033-1035. CrossrefGoogle Scholar76. HENCH PS: Usual and unusual reactions to protein (fever) therapy, Arch. Int. Med., 1932, xlix, 1-25. CrossrefGoogle Scholar77. JEGHERSHOUGHTONFOLEY HJDJA: Weil's disease; report of a case with postmortem observations and review of recent literature, Arch. Path., 1935, xx, 447-476. Google Scholar78. MARSHALDAVIS EKDM: The influence of the adrenals on the kidneys, Jr. Pharm. and Exper. Therap., 1916, viii, 525-550. Google Scholar79. ROWNTREE LG: Studies in Addison's disease, Jr. Am. Med. Assoc., 1925, lxxxiv, 327-335. CrossrefGoogle Scholar80. LOEB RF: Chemical changes in the blood in Addison's disease, Science, 1932, lxxvi, 420-421. CrossrefGoogle Scholar81. FARRABERNATHY LETJ: Renal physiology in lobar pneumonia, Jr. Clin. Invest., 1937, xvi, 421-429. CrossrefGoogle Scholar82. PEABODY FW: Studies of the inorganic metabolism in pneumonia with especial reference to calcium and magnesium, Jr. Exper. Med., 1913, xvii, 71-82. CrossrefGoogle Scholar83. ATCHLEY DW: Medical shock, Jr. Am. Med. Assoc., 1930, xcv, 385-389. CrossrefGoogle Scholar84. MANDELBAUM H: The syndrome of hemoconcentration, Internat. Clin., 1936, ii, 112-142. Google Scholar85. SUNDERMANAUSTINCAMAC FWJHJG: Studies in serum electrolytes. I. Concentration of electrolytes and non-electrolytes in the serum during lobar pneumonia, Jr. Clin. Invest., 1926-27, iii, 37-64. CrossrefGoogle Scholar86. LONGCOPERACKEMANN WTFM: Severe renal insufficiency associated with attacks of urticaria in hypersensitive individuals, Jr. Urol., 1917, i, 351-366. CrossrefGoogle Scholar87. MCCANCELAWRENCE RARD: The secretion of urine in diabetic coma, Quart. Jr. Med., 1935, iv, 53-79. Google Scholar88. PETERSBUGEREISENMANLEE JPHAAJCJ: Total acid-base equilibrium of plasma in health and disease. VI. Studies in diabetes, Jr. Clin. Invest., 1925-26, ii, 167-211. CrossrefGoogle Scholar89. ATCHLEYBENEDICT DWEM: Serum electrolyte studies in normal and pathological conditions; pneumonia, renal edema, cardiac edema, uremic and diabetic acidosis, Jr. Clin. Invest., 1930-31, ix, 265-294. CrossrefGoogle Scholar90. MOON VH: The shock syndrome in medicine and in surgery, ANN. INT. MED., 1935, viii, 1633-1648. Google Scholar91. DE TAKATSMACKENZIE GWD: Acute pancreatic necrosis and its sequelae, Ann. Surg., 1932, xcvi, 418-440. CrossrefGoogle Scholar92. O'SHAUGHNESSY WB: Experimental inquiries into the chemical pathology of cholera, Lancet, 1832, i, 704. Google Scholar93. TALBOTT JH: Heat cramps, Medicine, 1935, xiv, 323-376. CrossrefGoogle Scholar94. UNDERHILLCARRINGTONKAPSINOWRACK FPGLRGT: Blood concentration changes in extensive superficial burns and their significance for systemic treatment, Arch. Int. Med., 1923, xxxii, 31-49. CrossrefGoogle Scholar95. ROBERTSONBOYD BGL: Toxemia of superficial burns, Jr. Lab. and Clin. Med., 1923, ix, 1-13. Google Scholar96. DAVIDSON EC: Sodium chloride metabolism in cutaneous burns and its possible significance for a rational therapy, Arch. Surg., 1936, xiii, 262-277. Google Scholar97. See reference 2, page 141. Google Scholar98. HARRISONMORTON TRFM: The pathogenesis of the uremic syndrome, Medicine, 1937, xvi, 1-44. CrossrefGoogle Scholar99. SNAPPER I: Pathologic physiology functions of the kidney, Brit. Jr. Urol., 1937, ix, 1-25. Google Scholar100. RANDALL A: Pre-renal anuria, Jr. Urol., 1925, xiii, 257-264. CrossrefGoogle Scholar101. CAULK JR: Post-renal anuria, Jr. Urol., 1925, xii, 265-282. CrossrefGoogle Scholar102. HARTMAN AF: Treatment of severe diabetic acidosis; a comparison of methods, with particular reference to the use of racemic sodium lactate, Arch. Int. Med., 1935, lvi, 413-434. CrossrefGoogle Scholar103. ROOTHENSON HFPP: Postoperative suppression of urine relieved by the intravenous administration of hypertonic salt solution, Jr. Am. Med. Assoc., 1931, xcvii, 540-541. CrossrefGoogle Scholar104. MCCARTHYKILLIANCHACE JFJAAF: Reflex anuria—report of a case with unique blood chemistry findings and an unusual application of the duodenal tube, Jr. Am. Med. Assoc., 1923, lxxx, 1043-1047. CrossrefGoogle Scholar105. WEISSSOMAWILKINS RW: Syncope, collapse and shock; their medical significance and their treatment, Med. Clin. N. America, 1937, xxi, 481-510. CrossrefGoogle Scholar106. KEMP WN: The adrenal cortex; its supposed functions and suggested uses of cortical extracts, Brit. Med. Jr., 1937, i, 1194-1197. CrossrefGoogle Scholar107. DUNNDUNN ADFL: Observations on a patient with secretory anuria treated by decapsulation, Trans. Assoc. Am. Phys., 1933, xlviii, 268-275. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Received for publication August 24, 1937.From the Fifth (Boston University) Medical Service, Boston City Hospital; Evans Memorial, Massachusetts Memorial Hospitals and the Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. 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