PLATE XIV. CASTS OF THE URINIFEROUS TUBES. Fig. 1. Epithelial casts commonly present in the Urine in cases of acute dropsy. Fig. 2. Casts containing fat cells and oil globules, from the Urine of a case of fatty degeneration of the kidney. Fig. 3. Granular casts from the Urine of a patient suffering from chronic inflammation of the kidney. Fig. 4. Darkly granular casts, some of them containing a deposit of urates. Fig. 5. Large casts, some containing many cells, others consisting of a perfectly tranparent wax-like material,— characteristic of "desquamative nephritis." * 66 Fig. 6. Small waxy casts, found in the Urine of cases of non desquamative nephritis.' * On Diseases of the Kidney, Dr. George Johnson. PLATE XV. CASTS FROM CASES OF ACUTE AND CHRONIC Casts resembling those delineated in fig. 1 are often found in cases of acute inflammation of the kidney coming on from exposure to cold, or following scarlatina. It will be observed, however, that there are several different forms of casts which might give rise to some confusion in the mind of an observer endeavouring to form an opinion as to the acute or chronic nature of the case. of one No conclusion can be based upon the presence or two casts of a particular kind, but it is to the general characters of the deposit we must direct our attention. Thus we may find in the deposit from the Urine in acute cases which completely, and may be very rapidly, recover, one or two cells containing oil, and one or two casts containing a few oil globules. Now, we must not, from the presence of these, be led into the error of concluding that the case is one of fatty degeneration of the kidney; but if there were numerous cells and casts containing oil, such an inference would undoubtedly be correct. We must not therefore expect to find in one case, epithelial casts alone, in another granular casts alone, in a third fatty casts only, in a fourth none but large waxy casts, and so on; but we must be prepared to meet with several varieties in one case, and must ground our opinion, in great measure, upon the relative number of any particular kind of cast, and upon the circumstance of other deposits being associated with the casts. For instance, the presence of uric acid crystals and blood corpuscles would render it very probable that the case was acute, and of short duration. The absence of these deposits, and the presence of a number of granular or perfectly transparent casts, which can only be seen when the greater part of the light is cut off from the field of the microscope, or the existence of a C PLATE XV. CASTS OF ACUTE AND CHRONIC NEPHRITIS. Fig. 1. Epithelial and granular casts from the Urine of a woman suffering from Acute Nephritis, with Dropsy, of a fortnight's duration. a. Epithelial casts. The cells of renal epithelium are very distinct, and their nuclei well defined. b. Casts containing brown granular matter and blood corpuscles. c. Granular casts of a brown colour, many of them containing a few oil globules. The long cast near * is much twisted. d. Squamous epithelium from the vagina. e. Epithelium from the bladder. The outline is too thick. f. Cell containing oil globules. g. Portion of a cast containing oil globules. h. Circular granular cells, probably renal epithelium altered. Blood corpuscles are seen scattered about in various parts of the field. i. Fibre of flax of accidental presence. Fig. 2. Casts from a case of chronic nephritis. a. Dark granular casts. b. Casts containing small granular cells of epithelium. c. Waxy casts, consisting of a perfectly clear, glistening material. d. Large cast, flattened by pressure, containing altered epithelium. e. Portion of a cast containing a large cell filled with oil globules. f. Pus corpuscles, probably derived from the bladder. g. Collection of small oil globules. h. Large cell containing smaller cells in the interior. Of the nature of cells of this kind I am ignorant; but I have observed them in several specimens of Urine. i. Portion of cotton fibres. k. Piece of a very thin human hair. |