Renal Function Tests in Nephritis

'IFIIERE iS mlluChi truth in the statenient that the laboratory is the pacemaker of me(lical progress, but yet, when we come to critically exaninle our knowledge of impaired renal function, we realize that, at least as far as the study of renal disease is concerned, the advance has not been very great. It is from the standpoint of reviewing the problems that confront us when we are asked to examine a renal case from the biochemical standpoint, rather than reporting any results, that I have writteni this article at the request of your editor. It is now over a century since there was admitted into Guy's Hospital an ~itemperate sailor, John King. He was placed under the care of Richard Bright. The patient presented the features, so common to us now, of cdema with pleural effusioni and ascites, enlarged heart with pericarditis, and scantv urine with albuminiuria. The kidneys were small and granular, and it was this organ that Bright described as being the seat of primary disease. He published his observations in 1827. Since then an enormnous amount of work has been lonc, with but little advanice. In 1914 the modern trend( of thought began to crystallize out with the publication of the work of Vollard and Fahr, an-d their introduction of an anatomical and pathological classification consisting of three main types-glomerulo-nephritis, nephrosis, andinephrosclerosis. This was followed by Addis's work, in which he trie(l to correlate clitnical findinigs xwith a quantitative study of the formed elemlenits in the uriniary sediiment. Another step forward was made in 1930, when Van Slyke and his co-workers published their monogram, in which they called attentioni olnce again to their test of renal function which they had published several years before. TIhe modern classification of Bright's disease is as follows T. Inflammatory group: 1. Acute nephritis. 2. Subacute nephritis. 3. Chronic nephritis. I he patient has anl attack of acute nephritis, which may be so severe that he dies or on the other hand may be subclinical. His recovery from the acute attack may be complete, or he may pass into the subacute stage with cedemia, and finally, if he lives long enough, end ulp as the chronic neplhritic With urwmic symptomns.