The Toxaemia Of Renal Disease shows itself not only in the development of uraemia, but also by other manifestations, as, for instance, the well known gastro-enteritis that is so frequently present in these diseases. There is some evidence to show that where the excretory efficiency of the kidney is impaired, excretion of some of the urinary constituents, as, for example, urea, may take place from the gastric and intestinal mucosa and be-associated with symptoms of severe vomiting and diarrhoea.

The presence of toxaemia as the result of renal disease must necessarily be a factor of considerable importance in regulating dietetic treatment.

Malnutrition, shown by wasting, anaemia, and frequently the development of a regular cachexia, is the frequent accompaniment of the more serious, and especially the chronic, forms of renal disease. This malnutrition is doubtless in part dependent on mere loss of appetite and on the gastric and intestinal complications that are so often present. But great wasting may be seen as the result of chronic renal disease, and especially, perhaps, as the result of certain forms of chronic nephritis and granular kidney, without the presence of marked vomiting or other gastro-intestinal symptoms. This malnutrition, together with such a phenomenon as pigmentation, which is also not uncommon in chronic renal disease, would also seem to show that these maladies produce in some ill-understood manner grave disturbances of the nutritive processes of the body. The importance of considering these factors in the treatment of the disease, and especially in the dietetic treatment, cannot be overestimated. There is often a tendency to regulate the treatment by considerations based largely, and sometimes entirely, on the state of the urine. Thus the diet may be cut down, owing to a high degree of albuminuria present, and this notwithstanding the fact that the patient's aspect and body weight may show grave impairment of nutrition. Very often much better results are obtained by not concentrating the attention solely on the state of the urine, but rather by directing the treatment, and especially the diet, to remedying if possible the malnutrition.

Albuminuria in greater or less degree is usually present in renal disease, and in some renal lesions the quantity of albumin lost daily is very considerable, and may amount to as much as 40 grms. per diem. In most diseases, however, the loss is much less than this, but still, inasmuch as many of these maladies are of very prolonged duration, there is a considerable wastage of the proteins of the body. That this is the case is shown by the low percentage of protein matter present in the blood of patients suffering from chronic renal disease, even where dropsy is absent, and there is no fallacy owing to the presence of hydraemic plethora.

The large amount of albumin present in the urine has often led to attempts being made to restrict the loss by diet and by medicine. In some instances dietetic treatment, and especially perhaps the administration of a milk diet, is followed by an apparent great diminution in the daily loss. In some instances this diminution is more apparent than real, and is really dependent on an increased flow of urine due to the liquid diet and large quantity of fluid ingested causing a percentage diminution, but the total quantity lost in the twenty-four hours may remain much the same as with a drier and more solid diet.