The Purbis oration on some points in the diagnosis and treatment of granular kidney : delivered before the West Kent Medico-Chirurgical Society / by Samuel West, M.D. Oxon., F.R.C.P. Lond., consulting physician to St. Bartholomew's Hospital, etc.

  • West, Samuel
Date:
[1913?]
Catalogue details

Licence: In copyright

Credit: The Purbis oration on some points in the diagnosis and treatment of granular kidney : delivered before the West Kent Medico-Chirurgical Society / by Samuel West, M.D. Oxon., F.R.C.P. Lond., consulting physician to St. Bartholomew's Hospital, etc. Source: Wellcome Collection.

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    importance, and life run its ordinary course to its usual span. As the amount of albumin lost is so small, it is too little in itself to have any effect upon the health, and if the health suffer it is the result of other causes. The albuminuria need not, therefore, be drastically treated. Moreover, the strictest dieting often produces no effect upon it, though it may have a disastrous effect upon the health. Even if the albuminuria could be made to dis¬ appear, its disappearance would not show that the disease was cured, but a useful clinical indication would have been lost. As a matter of fact, treat¬ ment in these cases has little effect or none at all. As with raised arterial tension, so with albuminuria treat it if need be, but beware of over-treatment. Albuminuric Retinitis. Of albuminuric or renal retinitis there are two forms—the one pathognomonic of granular kidney, the other not. The one is inflammatory, and might continue to be called retinitis. It is associated with much swelling of the disc and retina, and might therefore be called exsudative. It is exactly the same as other forms of exsudative or inflammatory retinitis, and cannot be distinguished from them, and so it comes that mistakes in diagnosis have been made, for example, between granular kidney and cerebral tumour, especially when headache has been the prominent symptom. The other form is degenerative and not inflam¬ matory. It would be better to describe it as renal retinal degeneration. This is sui generis, and pathognomonic of granular kidney. I do not know of any retinal change like it, and when it is present granular kidney may be diagnosed with certainty. The acute exsudative form is probably toxic in origin. It is met with in acute nephritis as well as in chronic. In acute nephritis it may resolve and completely disappear, leaving no defects of vision behind. In chronic nephritis it is more serious, and does not as a rule resolve because the renal condition has got beyond the stage of recovery.