XVII. THE TREATMENT OF CHRONIC NEPHRITIS
Published Sep 1, 1933 · E. Russell
Medical Journal of Australia
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Abstract
CHRONIC NEPHRITIS is one of the most difficult and very often one of the most disappointingconditions with which a practisingphysicianhas to deal. It is unfortunatethat chronic nephritis lends itself very poorly to any accurate or even dogmatic treatment,becausethe knowledge that the diseasehas reacheda stage of chronicity very often gives the therapeutista feeling of hopelessnesswhich is harmful both to himself and to the patient. It would be a very pleasantprospect if it were posstble to imagine that chronic nephritis could be cured by any tedious or lengthy experiment, but one has to admit that most patientsare either limited in their expectationof life or doomed to an early extinction. It would be a very fine gesture on the part of the public health authorities if they were able to indicatesomemeansby which nephritis of any kind could be prevented, and it would further absolve them from the accusatlonof a seriousdereliction in duty if they could indicate.some'meansof prophylaxis. Thereexists in the minds of a great many peoplean idea that nephritis is the result of neglect-neglecteither on the part of the iIidividual who contractsit, or neglect on the part of the medical profession who allow them to contract it and develop it, to the destruction of the individual. In Queenslandthere is an hypothesisthat a great many casesof nephritis are due to lead poisoning, so-called lead nephritis, and there is something to be said for the zeal, enthusiasmand pertinacity of those protagonistsof this theory. It is common to regard nephritis in young children in a great many cases as being due to absorption of lead from the paint of housesin Queensland,but as far as I am aware it has never been convincingly proved that such is the case, and as far as I know there is no adequate experimental evidence to support the assumption that thesecasesare due to lead poisoning. Quite recently one of my colleaguestold me that he had records of eight hundredcasesin which lead had been found in the urine, and in none of these cases was there any evidence of nephritis. It is, however, a 'fact that chronic nephritis does occur at an early age amongst the denizens of Queensland,but there is considerablework to be done before it can be accepted as establishedor proved that these cases are due to plumbism. If the establishment ,of plumbism as a cause of nephritis were proved a scientific fact, then the prophylaxis of nephritis in children in Queenslandcould be obviated by a mere stroke of the legislative pen, that is, by definitely and irrevocably abolishingthe use of lead paint on housesin Queensland. We will have to call, however, more and incontestable scientific evidencebefore the authoritiescan be arraigned on what appearsto be in the minds of some a criminal neglect. Further prophylactic measurescan be undertaken in casesof children where definite infection exists, in tonsils -which ought to be removed,in adenoidsand, in carious or infected teeth,but a word of warning ought to be sounded "80 that supposititious foci of infection are not removed from innocent mouths and throats. Particularly would one say that wholesaleand indiscriminateremoval of teeth without evidenceof guilt, just becausethey are suspected, is to be condemned. . There seemsto be in my experiencequite definitely a familial tendency to nephritis, and I think that in these cases,when one is certain that the stock are born with ll:idneys susceptibleto kidney Infection, the very greatest care should be taken to remove all possible foci of infection, and the greatestcheckshould be madeon the possible developmentof nephritis with intercurrentdiseases. There are really, broadly speaking,only two classesof chronic nephritics Which are worth considering,and they are those who are chronic nephrtttcs with ooiIema and those who are chronic nephritics without redema. It so happensat the momentof writing that 1 have under my care in the Brisbane Hospital in my male ward seven patients with ehronie nephritis, and o'f these five are Of the type of chronic nephritis with <edema.