Text-book of diseases of the kidneys and genito-urinary organs / by Paul Fürbringer ; translated from the German with annotations by W.H. Gilbert ; commendatory letter from Sir Thomas Grainger Stewart.

  • Fürbringer, Paul W., 1849-1930.
Date:
1895-1898
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of diseases of the kidneys and genito-urinary organs / by Paul Fürbringer ; translated from the German with annotations by W.H. Gilbert ; commendatory letter from Sir Thomas Grainger Stewart. Source: Wellcome Collection.

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    painful feeling of tension, rigor and vomiting. Should the passage become free again, the severe symptoms rapidly pass off, whilst the urine again becomes clouded with pus. This clinical picture of an intermittent pyonephrosis may be repeated again and again (c/. Hydronephrosis ). It is easily understood how alarmed the patient becomes at the appearance of clear urine, knowing so well what it forbodes, and how anxiously he awaits the reappearance of the deposit of pus. Like conditions in the behaviour of the pus may occasionally be produced by the alternate shutting off and communication of real nephritic abscesses and perinephritic collections of pus with the renal pelvis. Complete obstruction of both ureters of course produces anuria and, as the case may be, urEemia; the same will result from unilateral obstruction, if, unfortunately, the patient be blessed with only one kidney. General Symptoms.—So much for the conditions of the urine. As to general symptoms, the development of acute pyelitis is generally marked by fever, with rigors, and even, may be, vomiting. In some cases the patients further complain of pain in the loin, which radiates in the characteristic manner already mentioned, especially down the ureter of the affected side. This pain, at one time moderate and bearable, at another time scarcely noticed, is not uncommonly first detected on palpation of the abdomen, more or less definitely localized. It may, how- ever, reach such an intensity as to call to mind renal colic, especially as Ebstein found in the course of the idiopathic form of this disease occurring during the puerperal state. For the pain produced by pyelitis calculosa, and its origin, see the corresponding chapters. In very chronic cases the patient may make no complaint of pain, and there may be no tenderness on pressure, in spite of obstruction to the flow and decomposition of the urine. The above-mentioned initial rise of temperature must be entirely distinguished from the grave, more or less continuous hectic fever, interrupted by rigors, which often, but by no means always, accompanies pyelonephritic abscess, as it generally does sup- purative nephritis. Hectic fever often enough occurs with a typhoid condition, small, frequent pulse, vomiting, drowsiness. This condition is also described under various terms, such as urajmic, ammoniiEmic, pycEmic, septic ; but we have already dealt with it in sufficient detail. In a case of pyelonephritis with alkaline fermentation of urine, observed by us during a long period, quiet delirium lasted for several weeks, with well-marked dropsy of the upper part of the trunk; the significance of the uroseptic symptoms was strongly suspicious of uraemia.