Hematuria : a study from the practitioner's standpoint / by Victor Cox Pedersen.

  • Pedersen, Victor Cox, 1867-1958.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Hematuria : a study from the practitioner's standpoint / by Victor Cox Pedersen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the kidney with necrosis and erosion of bloodves- sels; but the engorgement due to the infiltration of tuberculosis and new growth may also cause hem- orrhage. It matters little whether the type of the tumor is hypernephroma, cancer, or sarcoma. The nonoperative or medical causes of hemature- sis embrace the various manifestations of acute and chronic nephritis; while the operative factors are lithiasis, tuberculosis, neoplasm, traumatism, and hydronephrosis. On the borderline are the con- gestive cases, especially those of movable kidney. The diagnosis of the fact and focus of renal bleeding, with or without ureteral bleeding, or ure- teral hemorrhage without kidney involvement, does not permit in the light of modern methods the ap- plication of any rules, respecting, for example, the character, quantity, and color of the blood. The absence of the following data on laboratory investi- gations is without value as a negative proof of renal hematuria. Their presence on the other hand is very frequently helpful. Such data are cylindroid clots pointing to the ureter as their source, clotted blood casts of the ureter of unmistakable size, renal blood casts, and renal casts with densely adherent red cells. Pain in the kidney zone without, before, during, or after the bleeding is not more than suggestive, because vesical conditions may so alter the course and calibre of a ureter as to excite referred pain in a normal kidney. The diagnosis really depends on objective exam- ination with cystoscopy, ureteral catheterization, and radiography. Urinary segregators are of doubtful reliability. Cystoscopy is competent to de- cide as a rule in a few moments whether the blad- der or the ureter and kidney are the source of the blood. If all three are involved, as is sometimes true in tuberculosis, ureteral catheterization is un- avoidable. Ureteral catheterization is also necessary to determine the source of small hemorrhage from the kidney with a normal bladder. If the quantity