Glomerulo-Nephritis
Authors: D. J. Leech
Journal: BMJ (1881)

FOR many years it has been known that the glomeruli are a special seat of lesion in certain cases of post scarlatinal nephritis; and Klebs separated the form in which this was the case from other forms of nephritis under the head of glomerulo-nephritis. lIe found here, accumulated between the capsule and the glomerulus, angular nuclei embedded in a finely granular mass, and the vessels of the glomeruli covered by nuclear masses.Dr. Klein, in his well known account 'of the minute anatonmy of scarlet fever, has shown that glomerular changes not only play a very important part in the tissue-alterations met with in the kidney in this disease, but occur at a very early stage.Like Klebs, he found an accumulation of nuclei between the glomerulus and the capsule, and an increase in the nuclei in the glomerulus itself; but, whilst Klebs attributed the cell- growth to proliferation of the connective tissue between the capillaries forming the glomerulus, Dr. Klein looked upon it as due to the proliferation of the epithelium lining the capsule and the glomerulus, and to a germination of the nuclei in the walls of the capillary vessels.Very recently, it has been pointed out that glomerular changes very similar to, if not identical with, those observed in the scarlatinal kidney are met with in other forms of nephritis.Langhans, in the seventy- sixth volume of Virchowv's Ar-chiv, has described several cases of the kind; and Dr. Greenfield, under the head of subacute interstitial, de- scribes a form of nephritis in which the clinical symptoms are those of acute desquamative nephritis, but to the naked eye the kidney resenmbles the large white, or the kidney of scarlatinal nephritis; whilst, on micro- scopic examination, interstitial change with affection of the glomeruli is found.HIe states, however, that the changes do not so distinctly com- mence in and arouind the Malpighian bodies, but more generally throughout the intertubular spaces.During the past eighteen months, three cases have come under my notice which, in most respects, cor- respond to those included by Dr. Greenfield under the head of interstitial nephritis, but in which, it seems to me, the glomerular change, as ih post-scarlatinal nephritis, is the most prominent and'essential feature of the lesion.I have ventured to allude to them as cases of glomerulonephritis, in order to indicate this prominence, though I know that objection may be taken to this term, for, in all three, interstitial and tubular changes, as well as glomerular, were present.I will briefly state the leading features of the cases, together with the pathological changes found after death.CASE I.-J.E. L., a boy aged i7, was admitted into the 'Manchester Royal Infirmary on April 28th, 1879, suffering from albuminuria and excessive anasarca.No history could be obtained of previous syphilis, excess of alcohol.or infectious disorder.Fourteen weeks before ad- mission, after a fall on the ice, an abscess formed in the left gluteal region, which discharged for some time after it was opened.Eight weeks before he came under my care, he noticed, for the first time in his life, a swelling of his feet, which soon spread to the legs, arms, and face.He lost ground very rapidly; the anasarca became very pronounced, the anamia very marked, and he suffered from vomiting.On admission, he was extremely white, and the tissues of his body were enormously distended with fltuid.The area of superficial cardiac dulness was slightly enlarged, but there werc no indications of consider- able cardiac hypertrophy.Ile coughed frequcntly, anid expectorated a little mucus.The scanty urine had a specific gravity of ioiS ; it con- tained much albumen and a little blood.In the deposit from it were found epithelial and granular casts.He died somewhat suddenly, apparently fromii lung-cedema, four days after admission.The average daily excretion of urine whilst he was in hospital was only twenty-six ounces.