Symptoms

Acute nephritis is an inflammation of the kidneys, which is principally caused by exposure to cold and wet, by certain medicinal poisons, or by the toxins developed in the course of acute infectious fevers, especially the exanthemata and diphtheria. It is unnecessary to discuss its varieties here, as the dietetic treatment is the same for all.

Among the important symptoms are anaemia and a scanty secretion of urine containing abundant albumin with casts and blood. Anasarca and effusion into various serous cavities, such as those of the pleura and peritonaeum, may occur. The arterial tension is increased. The patient must be kept in bed to insure a uniform temperature of the body, and facilitate the use of measures to promote perspiration.

Dietetic Treatment

The dietetic treatment must be adapted to prevent overloading the digestive organs, which are easily deranged, and to prevent overworking the kidneys. A light diet is therefore necessary. The patient will do best to live exclusively upon milk for some days, until the functional activity of the kidneys is restored. The importance of this should be explained to him and insisted upon. Between four and seven pints are to be taken daily, diluted with Vichy or carbonic-acid water. If the bowels are loose, lime water may be added instead; or if constipated, magnesia solution. If the liver seems inactive, skimmed milk or buttermilk may agree better. Milk sometimes causes gastric oppression. If sipped slowly, or taken with a teaspoon, this may be overcome, for it is then diluted with the saliva.

If milk is strenuously objected to or actually disagrees with the patient, other simple foods may be allowed, such as koumiss, buttermilk, and gruels of oatmeal, groats, rice, barley flour, or arrowroot. These forms of starchy food should be prepared without much sugar, but a little cream may be added or, if preferred, the juice of a lemon, but no vegetables are permitted. If the patient is feeble, strong beef tea or beef or chicken broth are sometimes to be recommended, but, in general, so long as the symptoms are at all acute it is necessary to withhold all meat preparations from the diet. This is especially true in the case of young children. Animal broths dissolve substances from meat which may develop into toxins and irritate the kidneys.

When the kidneys become more active and the character of the urine improves, the diet may be increased by such articles as bread and butter, plain puddings, lettuce, or water cress with plain French dressing, stewed apples, grapes, oranges, etc., but whenever possible the food should consist largely of milk for a long period. Later, eggs and even meat broths may be allowed, and finally a little white meat of poultry.

Any return of the albuminuria should be immediately met by a reduction in the diet to its original simplicity - chiefly milk.

A patient may lose thirty or forty grains of albumin in twenty-four hours without serious harm, but if three hundred to four hundred grains are lost the condition is in itself alarming, for he is losing from one fifth to one fourth of his total albuminous food through leakage of the kidneys - i. e., he is passing daily in the urine one twelfth of the nutrient matter of his blood (Granger Stewart). A pint of milk supplies about an ounce of albumin and casein, thus replenishing the waste.

The lactose of milk is sometimes given separately for its diuretic action. See gives it up to three ounces in twenty-four hours, to be drunk in two quarts of water, and he believes it acts best when cardiac dropsy is also present and the quantity of albumin is not large. I have found it difficult to push its use to such a degree without causing dyspepsia and a decided dislike for it. Milk is undoubtedly a good mild excitant of renal activity, but this is due to its water as much as to any other ingredient, and the diuretic effect of lactose is much overrated.

Should vomiting occur at any time, the diet must be again reduced, or it may be advisable to give the stomach complete rest for ten or twelve hours. To increase the activity of the skin and wash the casts and debris of granular matter and blood corpuscles from the renal tubules, the blood volume must be raised by the ingestion of abundant fluid, provided the tendency to dropsical effusions is not great. Water, alkaline, mineral, or effervescing waters, soda lemonade, or cream-of-tartar lemonade should be drunk freely, the latter especially if there is constipation (Dickinson). Osier recommends the following: A drachm of cream of tartar in a pint of boiling water with the addition of the juice of half a lemon and a little sugar. To be drunk cold.

It is a general rule to exclude all foods and drinks which may in any way irritate the kidneys, and the following are especially forbidden: Grills, roasts, sauces, pastry, spices, very acid foods, strong alcoholic drinks, tea and coffee. Strong wines, sweet wines, and all sorts of liquors are absolutely prohibited. If alcohol seems necessary for the stimulation of the heart, a little weak claret, white wine, or diluted whisky and some effervescing water may be given.

Acute Nephritis In Children

When the disease occurs in children, as often happens during or after acute infectious diseases, such as scarlatina and diphtheria, the diet must consist wholly of milk. During the most acute stage of nephritis the milk may be diluted one half with Vichy or water for its diuretic influence. It should be given in moderation, but often - say at least once in two hours. As the acute symptoms subside milk is to be ordered in full strength.

Gradually other articles may be added, such as crackers, toast, porridge, rice pudding, cornstarch, junket, and blancmange. Orange juice may be taken freely, and an occasional baked apple with cream or a few stewed prunes will act favourably upon the bowels.

It is best, as in the case of adults, to forbid meat broths, and eggs and meat in any form must be withheld for three or four weeks after the urine has regained its normal composition. Subsequently a menu may be composed from such articles as a chop, the breast of a chicken or partridge, a little broiled whitefish, a poached egg, oysters, custard, a baked mealy potato with fresh butter, stale bread, wine jelly, and fresh ripe fruits.