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Appendix 2 Notes on Classifications and Drawings of Nephritic Kidneys in the Nineteenth Century

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With the advantage of hindsight it is tempting to postulate that Rayer's extra three forms were merely examples of the Bright three but at different stages of the disease process, for example sub-acute nephritis... This hypothesis cannot be proved as nowadays nephritic patients do not usually come to post mortem and it is difficult to compare present-day biopsies with the nineteenth-century morbid anatomical appearance of the kidney... He places a good deal of emphasis on lobulation, which we now know is a normal variant but which could have been accentuated in a swollen kidney... Although it can never be conclusively proven it is likely that as the chronic disease process progressed whether from a large white or red type, the kidney became more granular and smaller thus explaining the discrepancies between Rayer's six forms and Bright's three... The consistency of the kidneys is a little less solid... The lobes are often more pronounced than normal but what especially characterizes the form is the profound mixture of anaemia and hyperaemia; a mottled appearance on the surface of the kidneys produced by the pockets of red spread over a yellow base... On dissection the swollen cortical substance is pale yellow in colour pock-marked with red and is distinct from the tubular substance, which is a fairly vivid brownish-red in colour... The volume and weight is increased as in the preceding forms but one does not find the areas of red or the mottling; the cortical substance on the surface of the kidney and on dissection is of a fairly uniformly pale colour, of a whitish-pink slightly yellow or indeed an even paler colour analogous to that of eel flesh. (Pl... X, Fig. 5.) In some areas of these anaemic kidneys, one sees small blood injected vessels (Pl... X, Fig. 10) and more rarely small slate-coloured/brown or large white granulations coming from an old deposit of glutinous lymph (Pl... The small milky deposits (Bright's granulations), instead of being fairly rounded and separate from each other as usually seen on the external surface of the kidneys, (Pl... These small grains, quite distinct from the yellow sand which one sometimes sees in the cortical substance, are also the small granulations of plastic lymph which one encounters by chance in this and some other types of nephritis.  This appears to correspond to the third form described by Dr. Bright... I have also seen a kidney in this hardened condition and curiously deformed (Pl... VII, Fig. 6) showing a large number of Bright's granulations on the surface.

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Bright's equivalent small, contracted kidney is shown here—Plate III, Figs. 1 (top) and 3 (bottom left).
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fig6: Bright's equivalent small, contracted kidney is shown here—Plate III, Figs. 1 (top) and 3 (bottom left).

Mentions:  This appears to correspond to the third form described by Dr. Bright. The kidneys are rarely enlarged and indeed sometimes smaller than normal (Pl. VI, Fig. 5; Pl. VIII, Fig. 6; Pl. X, Fig. 10); are hard and show irregularities or nodules on their surface. One encounters few if any milky deposits (Bright's granulations) but on dissection one usually discovers a certain number in the thickened cortical substance. I have also seen a kidney in this hardened condition and curiously deformed (Pl. VII, Fig. 6) showing a large number of Bright's granulations on the surface.


Appendix 2 Notes on Classifications and Drawings of Nephritic Kidneys in the Nineteenth Century
Bright's equivalent small, contracted kidney is shown here—Plate III, Figs. 1 (top) and 3 (bottom left).
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2630039&req=5

fig6: Bright's equivalent small, contracted kidney is shown here—Plate III, Figs. 1 (top) and 3 (bottom left).
Mentions:  This appears to correspond to the third form described by Dr. Bright. The kidneys are rarely enlarged and indeed sometimes smaller than normal (Pl. VI, Fig. 5; Pl. VIII, Fig. 6; Pl. X, Fig. 10); are hard and show irregularities or nodules on their surface. One encounters few if any milky deposits (Bright's granulations) but on dissection one usually discovers a certain number in the thickened cortical substance. I have also seen a kidney in this hardened condition and curiously deformed (Pl. VII, Fig. 6) showing a large number of Bright's granulations on the surface.

View Article: PubMed Central

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

With the advantage of hindsight it is tempting to postulate that Rayer's extra three forms were merely examples of the Bright three but at different stages of the disease process, for example sub-acute nephritis... This hypothesis cannot be proved as nowadays nephritic patients do not usually come to post mortem and it is difficult to compare present-day biopsies with the nineteenth-century morbid anatomical appearance of the kidney... He places a good deal of emphasis on lobulation, which we now know is a normal variant but which could have been accentuated in a swollen kidney... Although it can never be conclusively proven it is likely that as the chronic disease process progressed whether from a large white or red type, the kidney became more granular and smaller thus explaining the discrepancies between Rayer's six forms and Bright's three... The consistency of the kidneys is a little less solid... The lobes are often more pronounced than normal but what especially characterizes the form is the profound mixture of anaemia and hyperaemia; a mottled appearance on the surface of the kidneys produced by the pockets of red spread over a yellow base... On dissection the swollen cortical substance is pale yellow in colour pock-marked with red and is distinct from the tubular substance, which is a fairly vivid brownish-red in colour... The volume and weight is increased as in the preceding forms but one does not find the areas of red or the mottling; the cortical substance on the surface of the kidney and on dissection is of a fairly uniformly pale colour, of a whitish-pink slightly yellow or indeed an even paler colour analogous to that of eel flesh. (Pl... X, Fig. 5.) In some areas of these anaemic kidneys, one sees small blood injected vessels (Pl... X, Fig. 10) and more rarely small slate-coloured/brown or large white granulations coming from an old deposit of glutinous lymph (Pl... The small milky deposits (Bright's granulations), instead of being fairly rounded and separate from each other as usually seen on the external surface of the kidneys, (Pl... These small grains, quite distinct from the yellow sand which one sometimes sees in the cortical substance, are also the small granulations of plastic lymph which one encounters by chance in this and some other types of nephritis.  This appears to correspond to the third form described by Dr. Bright... I have also seen a kidney in this hardened condition and curiously deformed (Pl... VII, Fig. 6) showing a large number of Bright's granulations on the surface.

No MeSH data available.


Related in: MedlinePlus