Flocculation Reaction as Test of Liver Function

Abstract

MERITISHhas persisted. When a large amount of fluid was drunk it was excreted too slowly and the specific gravity of the urine failed to fall as low as it should have done, indicating abnormal glomerular filtratio&n. Neither did water deprivation raise the specific gravity to the levels which ought to have been reached -an indication of impaired tubular absorption.The transient albuminuria in this case was almost certainly due to sulphanilamide poisoning: it coincided with the discovery of crystals and red cells in the urine and heralded the appearance of agranulocytosis. (Incidentally this emphasizes once again the danger of uncontrolled application of sulphanilamide powder to ulcers; the response of the severe leucopenia to massive doses of pentnucleotide is also worthy of notice.) If the albuminuria had been due to the effects of the original injury, as was presumably the case in the second patient, it should have been evident when the blood urea 4was at its maximum. During the post-traumatic period neither patient passed red cells in excess, no casts were found, and spectroscopic examination for haemoglobin and muscle pigments was negative.The kidneys of the'second patient were examined post mortem and were similar to those already described (Darmady et al., 1944), the pathological lesions being comparable to those of the crush syndrome and largely confined to the tubules. In addition a few sulphanilamide crystals were present. The changes were certainly insufficient to explain urea retention on the pLurely mechanical basis of tubular obstruction, and the glomeruli were comparatively healthy. The blood urea does not rise in nephrosis in which pathological changes are confined to the tubules. It therefore seems more likely that the cause of renal failure and of the damage to the tubules is anoxia resulting from vasoconstriction of the renal arteries during the stage of shock, aggravated by blood loss, a fall in blood pressure, and dehydration. This supposition is favoured by the demonstration of similar alterations in the tubules after temporary clamping of the renal vessels (McEnery et al., 1927) and by the theory propounded by Maegraith and Findlay (1944) that peripheral vascular atony with redistribution of renal blood flow explains the suppression of urine in blackwater fever. The action of myotoxin may be accounted for in a similar manner. Oedema of the kidneys and rupture of some of the renal capillaries occur during the anoxic period, and may be responsible for the slow recovery of renal function after the systemic blood pressure has risen to normal. It has not yet been decided how these cases should be treated. Arguing on purely theoretical grounds, which may be fallacious, the best hope of improvement should lie in the early restoration of an adequate blood flow to the kidneys. Caffeine is said to dilate the renal vessels, and although its effectiveness in these cases is doubtful it can certainly be administered in full doses without harm. Giving oxygen in high concentrations might also be of value,...

Differential Diagnosis of Jaundice by Flocculation Tests

“…The cephalin was used immediately, without a period of storage, to make the stock emulsion. This showed no change in sensitivity when kept as long as three months in a refrigerator, as Dick (1945) has recorded. The test was read at 24 hours.…”

“…These tests are more popular in the U.S.A., and although they have been used in this country, particularly by Maclagan (1944aMaclagan ( , 1944bMaclagan ( , 1947 and by Dick (1945) and Maizels (1946), it appears from comment in a leading article (Lancet, 1946) that their application is still not widely appreciated here. For that reason this report on the results obtained with the cephalin-cholesterol flocculation and serum-colloidal-gold tests has been drawn up.…”

Flocculation Tests in Rheumatoid Arthritis

“…The percentage of positive reactions in the latter disease, however, has been small. Dick (1945) obtained complete flocculation in only two out offorty-one patients with rheumatoid arthritis, the remaining thirty-nine failing to show any flocculation. Maizels (1946) noted a weakly positive result in one out of five cases of rheumatoid arthritis.…”