Tartrate Nephritis, with Especial Reference to Some of the Conditions under Which It May Be Produced

Salts of tartaric acid administered subcutaneously to fasting phlorhizinized animals exert a markedly detrimental influence upon the secretory efficiency of the kidney, which is indicated by a greatly lessened output of certain typical urinary constituents. A histological study of the nephritic kidney demonstrates that the salts act specifically upon the epithelium of the convoluted tubules, and to a less extent upon the tubules of the loops of Henle, the glomerules, and interstitial tissue remaining unharmed. In the disintegrative process taking place, vacuolation first occurs, is rapidly followed by necrosis, and finally the dead cells or their debris may entirely fill the lumina of the tubules and form granular and hyaline casts. There is no strict relation between the dose of tartrate and the extent of damage inflicted. While large doses invariably induce a well marked response small doses may at times produce effects equally significant. Tartrates introduced into fasting animals call forth symptoms practically identical with those observed in fasting phlorhinized animals. It is therefore apparent that in the establishment of the pathological condition under discussion phlorhizin is without significant influence. Neither the liver nor the adrenal exhibits any detrimental effect from the injection of tartrates. The introduction of tartrates by way of the mouth to fasting rabbits is not nearly so effective in the production of nephritic symptoms as the administration of much smaller doses subcutaneously. In general, under the former circumstances the initial stages only of epithelial disintegration of the convoluted tubules obtain, which, however, are scarcely sufficient to account for the rapidity with which death usually ensues. Although in well fed animals distinct pathological changes in the kidney are induced by the introduction of tartrates per os, these abnormalities are less in degree, but similar in kind, than those provoked under like conditions in the fasting animal. When tartrates are given subcutaneously to well fed rabbits the effects evoked are somewhat less pronounced than when the salts are injected into fasting animals. From these facts it is evident that the state of nutrition plays a part in the development of tartrate nephritis. It is indicated that the introduction of a sufficiency of alkali to animals in a state of fasting permits a greater elimination of urinary constituents during tartrate nephritis than obtains under similar circumstances when the alkali is omitted. Histologically there is evidence that the administration of alkali exerts a slight modifying action.