This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
In a few cases of Bright's disease, narrated by Dr. C. Paul, albumen disappeared from the urine during treatment by oxygen. This occurred also in the often-quoted case observed by Kollman and Eckart (Schmidt's Jahrb., 1865). More recently, Dujardin Beaumetz reports a case "in the last stage," and in which every diuretic had proved useless, and yet, twenty-four hours after inhaling oxygen, the albumen disappeared, and was still absent twelve days afterward when the case was reported (Medical Record, March, 1879). Other physicians, while recording similar cases in their own experience, stated that the good result was not of long duration.
The prolonged administration of iodide of potassium in chronic Bright's disease is said to have retarded fibroid changes in the kidney, and induced general improvement in nutrition (Bartholow). Dr. Crequi (Brussels) recommends it for the second or parenchymatous stage. Using commonly 6 gr. or more daily, he has sometimes given as much as 6 dr. in the day, with bismuth or opium to control irritative effects. He presumes the iodide acts by limiting morbid secretion in the renal tubules (Lancet, i., 1871). In subacute cases, with dropsy, I have frequently used this remedy in doses of 3 to 4 gr., and have seen apparent advantage from it. I think it hastens absorption of inflammatory products, but, from what has been already stated as to the possibility of its causing renal congestion (v. p. 67), it must be considered unsuitable in acute nephritis, unless in fractional doses.
The drain of albumen in Bright's disease is practically equivalent to a loss by hemorrhage, and it has been sometimes restrained by the use of alum: thus, Oppolzer and Heller have reported benefit from it in chronic cases (quoted by Dr. W. Roberts), but after repeated trials I have not been able to verify their good results.
The influence of arsenic upon this condition is well worthy of further investigation. A case of "acute renal anasarca" in a woman, aged nineteen, is briefly recorded from Dr. F. Farre's practice
(Lancet, i., 1862); six weeks after the commencement of the attack she developed psoriasis, for which Fowler's solution was prescribed, and under its influence the albumen disappeared, and the patient gained flesh and strength. I have for many years used it in albuminuria following scarlatina; it removes the dry inactive condition of the skin, checks thirst, and causes a copious flow of urine, which gradually becomes less loaded with albumen; should dyspnoea be present, the remedy quickly relieves it, and the oedema of face and body disappears. In 1876 a case came under my care of chronic character, occurring in a builder, aged forty-three, of dissipated though hard-working habits; he had general anasarca and epileptiform convulsions, which were relieved for a time by laxatives, but the amount of albumen was uninfluenced by them, or by a long-continued use of iron. Fowler's solution was substituted, and the albumen diminished and soon ceased to appear; then, omitting the medicine, a relapse occurred; this again yielded on resuming the remedy, and the albumen, anasarca, and convulsions all disappeared, and in two to three months the patient's health was quite re-established, and he has since been quite well. I have also treated by liquor arsenicalis, with excellent results, numerous cases of temporary or intermittent albuminous urine dependent on imperfect digestion.
Dr. Brunton has discussed this subject in an interesting and scientific paper (Practitioner, June, 1877): he remarks on the important distinction between "true and false" albuminuria (Gubler), including under the latter term, not only the presence of albumen from pus or blood, but also the so-called Bence Jones' albumen, egg-albumen, the albumen absorbed from the intestine after imperfect digestion: it is a case of the latter kind that is recorded by him as being much benefited by arsenic, and it had several peculiarities. The patient was aged thirty-three, sallow and thin; the first symptom was great fatigue on exertion, then albuminuria was noticed (on examination for life insurance): it was at first present only during the summer; it came on after work and ceased on rest; it ceased also under strychnine (but this caused headache and sickness), and it ceased during quiet residence at the seaside. Fatty food brought it on, and meat taken in the morning, not when taken at night. Quinine and phosphoric acid at once increased the quantity, but rigid adherence to a farinaceous diet quite controlled it, and there were other evidences of its direct connection with digestion. After many years of treatment, including milk-diet, sea-voyages, digitalis, hydrarg. c. creta, etc., Dr. Brunton ordered 3 min. of Fowler's solution at meal-times, "and almost at once the albumen disappeared, and the patient was able to do much more work than usual, without its return." Later, the medicine was changed for hypophosphite of soda, and the albumen returned, to cease again on resuming arsenic. The whole case is very interesting, but we need only mention further that pancreatine, which increases pancreatic digestion and aids in the solution of albumen, was also found beneficial. This affection should be classed under faulty digestion or assimilation rather than as renal disorder. The special form of chronic albuminuria in which I have proved its value is that dependent upon venous congestion, mitral disease, or emphysema, after the right ventricle has begun to yield, but it deserves a trial also in cases where the actual kidney structure and epithelial lining are affected. I have carefully watched many of these latter cases in which the beneficial action of arsenic was very marked.
On account of the power of lime salts to dissolve organic membranes, they have been recommended in chronic Bright's disease, and in post-scarlatinal albuminuria "to dissolve proteinous infiltrations of the kidney." Kuchenmeister reports cases treated by large doses of lime-water and soluble lime salts, with immediate and marked increase in the quantity of urine passed, and with corresponding subsidence of the dropsy. The amount of albumen was lessened, but sometimes slight hemorrhage occurred (Ranking, 1869; Rev. Med., February, 1870). His results have not been widely corroborated, but Baudon reports a case in which the iodide of calcium seemed to succeed after iodide of potassium failed; quinine and iron were given also (Practitioner, i., 1869).
From our knowledge of the styptic properties of lime salts, we should rather expect them to restrain renal hemorrhage than to cause it, and Stromeyer and Caspari report the value of the phosphate for this purpose.
The astringent preparations of iron are often exceedingly useful in controlling the loss of albumen by the urine: we must remember, however, that it is also possible to do harm by these remedies in renal diseases, and I have seen congestion increased by recourse to them during the acute stage. The best effect is certainly obtained at the decline of this stage, when the urine is free from blood or inflammatory casts, when pain in the back, and in the head, and the general febrile conditions are relieved, but the patient is pallid, weak, and suffering from more or less anaemia and dropsy; then the value of such preparations as the perchloride or acetate is often very marked, both as regards the general health and the discharge of albumen. Dr. Hassall, indeed, attributes these good effects more to a reconstituent action on the blood, "than to any direct astringent power, because he could not detect either the metal, or the acid combined with it (hydrochloric), in his analysis of the urine" (Lancet, ii., 1864). Dr. Parkes was one of the first to show, by quantitative analysis, the gradual lessening and final cure of the discharge of albumen under the influence of perchloride; this was in a subacute case, when the early inflammation had subsided, and hospital nursing and the use of gallic acid had quite failed to relieve (Medical Times, ii., 1854). In all cases of this kind it is desirable to feel one's way with iron preparations, to begin at first with a small dose; and the recommendation of my late friend Dr. Basham, to combine with it the acetate of ammonia, is a very good one. The addition of ergot will increase the astringent effect (v. Gazette Med. de Lyon, October, 1862), and in albuminuria following scarlatina, especially when dropsy is present, tincture or infusion of digitalis, alternately with tincture of perchloride of iron, is a very valuable prescription: it increases the flow of urine, at the same time that by its action on the blood and the capillaries it restrains the transudation of albumen: Dr. Goodfellow and Dr. Cheadle have reported favorable results with it (Medical Times, 1871; Ranking, i., 1873).
In chronic forms of albuminuria iron will require consideration: it is often extremely useful, improving the blood-condition more than any other remedy, and Dr. Lionel Beale testifies to its good effects even in chronic structural change and fatty degeneration (Medical Times, i., 1865, p. 29), but the cases in which it does harm are those with granular kidney, when the heart is large, the pulse hard and of high tension, and when there is much tendency to headache (Dickinson: Lancet, i., 1876). Hirtz says that he has seen it hasten a fatal termination by uraemia, lessening the amount of urine, and increasing that of urea ("Nouv. Dict.," Art. Fer), so that its effects should always be carefully watched: a very important point when ordering iron in any case of albuminuria is to obviate constipation.