As the result of past metabolic studies, especially those of Henderson and Palmer (12) it is known that the non-volatile acids produced in excess of fixed base by human metabolism are excreted in the urine in two forms, viz., as free acids, and as ammonium salts.Since the kidney is unable to form urine with a pH much lower than 5.0, it can excrete, in significant amounts, free acids of only the weak buffer type. In this class fall acid phosphates and the various organic adds. It appears, however, that free acid excretion may assist also in elimination of strong acids, which can react with buffer salts (e.g., HC + Na2HPO4 = H(NaHPO4) + NaCl), the free buffer acid being excreted in place of the strong acid. Thus Marriott and Howland (19)
In the absence of data on subjects differing greatly in size, Austin, Stillman, and Van Slyke (1) adopted, as the simplest premise, the assumption that blood urea clearance, urine volume, and augmentation limit vary directly as the body weight.However, Addis (8) has found that his "urea excretion ratio," which is the "maximum clearance," defiied in our preceding paper (6), parallels more exactly the body surface area than it does the weight. Such a relation might be anticipated, if one considers that the rate of general metabolism, and hence probably the outputs of urea and water, parallel the body surface, and that Dreyer (3) has shown that the blood volume also parallels the surface area. The kidney weights, furthermore, were shown by Taylor, Drury, and Addis (8), to vary in rabbits in proportion to the body surface rather than to the total body weights. The clearance values observed in the animals examined before autopsy paralleled the kidney Weights and skin areas. Hence these authors were led to correct their urea excretion ratios observed in patients by multiplying the observed ratios by the factor average normal surface area area of subject Our experience confirms that of Addis and his colleagues. More constant normal values are obtained if one substitutes A (= surface area) in place of W in the clearance formulae. We have found it convenient to use as a unit the surface area 1.73 square meters, which is the mean of the areas of men and women of 25, estimated from the adjusted medico-actuarial tables of Baldwin and Wood published by Fiske and Crawford (5).When corrected for body size, the formulae for standard blood urea 467
The present work was undertaken in order to ascertain whether the nature of the protein mixture excreted in the different types of nephritis is related to the type and severity of the disease.
I. HISTORICALA summary of the early literature on the relation of albumiin to globulin excretion in the urine of nephritic patients has been given by Senator (1) and by Cloetta (2). A general survey of the literature has been given given more recently by Gemll (3). Hoffman was the first to take up the work in detail. Using the early gravimetric methods in 1882 (4) he reported that any albumin: globulin ratio may occur in any type of nephritis, and the value of the ratio is dependent not upon the type of change in the kidney, but on the intensity of the disease processes. A low ratio signified a severe condition, a high ratio a mild one. The ratio was found to rise with recovery in acute nephritis. Lecorche and Talamon (5) found the ratio to decrease with increased severity of the disease. CsatAry (6) found great fluctuations in the albumin: globulin ratio, but made a general statement that he found ratios below 1 in cases of amyloid kidney and above 10 in cases of contracted kidney. In severe cases the ratio fell. Cloetta (2) confirmed the work of Csatiry and reported low ratios in acute nephritis, with rise on recovery, and ratios usually over 10 in chronic nephritis. He found no relation between the albumin: globulin ratios in urine and in sernm. Joachim (7) reported a low ratio in amyloid kidney, a high ratio in contracted kidney. A rise in the ratio signified a good prognosis while a fall signified a poor prognosis. Paton (8) reported albumin fractions high in chronic nephritis and low in acute cases. He was unable to find high globulins in amyloid kidney, and was unable to form any conclusions on the relation of the urinary ratio to that of plasma. Dreser (9) reported that the ratio has no diagnostic importance. Gross (10) reported that the ratio varied and had no prognostic or diagnostic value. Strauss (11) reported that the ratio had no diagnostic value, and that it was mostly so different from that of serum that one would be led to believe that the protein excretion is a selective process of the glomerulus. Wallis (12) re-235
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