The Number of Formed Elements in the Urinary Sediment of Patients Suffering from Heart Disease, with Particular Reference to the State of Heart Failure.

It is well known that casts, red blood cells and white blood cells may be present in the urinary sediment of patients suffering from heart failure. In the manner that specimens of urine are usually obtained it is not possible to gain an accurate notion of the numbers of cells which are present, since variations in salt concentration and reaction of the urine may result in partial or complete disappearance of the formed elements of the urine. Addis (1) recommended a procedure which has for its object the secretion by the kidneys of urine of such high specific gravity and acidity that the integrity of the formed elements of the urine is maintained. By this means the number of elements in urinary sediment formed in a 12-hour period may be estimated. Addis (2) found that the number of casts passed in a 12-hour period varied in normal individuals between 0 and 4,270, the average being 1,040; the number of red blood cells between 0 and 425,000, the average being 65,700; the number of white blood and epithelial cells between 32,400 and 1,835,000, the average being 322,500. The casts were hyallne; granular casts were not observed. The present study is concerned with the estimation of the number of formed elements in the urines of patients suffering from chronic heart disease, especially of the so-called arteriosclerotic type, more particularly with reference to the state of heart failure of the congestive type. The patients were at rest in bed and were in water equilibrium. Observations were made in patients suffering from the congestive type of heart failure, and again in the same patients after the signs and symptoms of heart failure had disappeared. In others, observa-