Diurnal Variation in Excretion Rate of Formed Elements in Urine in Hemorrhagic Bright's Disease

Abstract

The enumeration and differential counting of the formed elements in the urine forms the basis of the most useful clinical methods for distinguishing the different types of Bright's Disease and yields valuable information concerning prognosis. The usual method consists in examining a fairly concentrated specimen of urine collected over 9 or 12 hours during the night. Frequently it becomes desirable to examine specimens of urine over a shorter period and in the daytime, often without any particular precautions of diet. To this end the diurnal variation in the rate of excretion of the formed elements in the urine was made in 2 patients with hemorrhagic Bright's Disease. Two observations were made upon each of these subjects. They were both young adult males (case 1 was 28 years old and case 2, 20 years old). The specific gravity of the specimens (1.012-1.018) was frequently not so high as is desirable, but this was compensated for in large degree by the prompt examination of the specimens shortly after they were voided. The formed elements were counted by the method devised by Addis. Urine was collected over 2-hour periods from 6 A.M. to 10 P.M. and then the 8 hours night urine collected in a single specimen. In the first experiment on both patients they remained in bed all day while in the second experiment they were up and about during the day. The second experiments were made 5 days (case 1) and 2 days (case 2) respectively after the first ones. Both patients had a mild hypertension but no anemia or nitrogen retention. The renal function in case 1 was 60% and in case 2 about 45% of normal. Both patients were recovering from the initial stage of hemorrhagic Bright's Disease. The results in Fig. 1 (the significance of the various lines on the charts is indicated by the legends used in the ordinate scales, e. g., the heavy continuous line is urine volume rate, etc.) show a considerable degree of uniformity in the several experiments.