The Plasma Cholesterol in Nephritis: Observations on a Short Series of Cases

Fleming, Christian M (1930) The Plasma Cholesterol in Nephritis: Observations on a Short Series of Cases. MD thesis, University of Glasgow.

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Abstract

1. While the majority of workers consider the normal range of the cholesterol content of the plasma to lie between 130 and 200 mgms. per 100 ccs. , the results of this investigation suggest that the upper normal limit frequently exceeds the accepted figure. 2. In acute nephritis the main findings ares (a) While the level of cholesterol may or may not be unduly high, recovery is accompanied by a decrease. (b) A tardy fall is associated with a slow or incomplete recovery. (c) The degree of oedema is not proportional to the amount of cholesterol in the plasma. (d) The onset of convulsions is not closely related to an abnormal cholesterol content; where nitrogen retention is present (one case) the cholesterol content is normal. 3. Chronic Interstitial nephritis. (a) In this type of nephritis, the plasma cholesterol is within normal limits, unless very pronounced arterial degeneration is present. b) The onset of uraemia is accompanied by a fall in the cholesterol level. (c) Recovery from uraemia is attended by a rise in the cholesterol content. 4. Arterio Sclerosis. (a) In this condition, where a renal lesion is present, the cholesterol value is constantly high. 5. Chronic Parenchymatous Nephritis. (a) The plasma cholesterol is raised to a greater degree in this type of nephritis than in any other. (b) Oedema is usually associated with hypercholesterin-aemia, but occasional exceptions may occur. 6. The Mixed Type of Nephritis. No constant values are found in this group, but the average figure is above normal. 7. In Renal Conditions other than nephritis, no hyper-cholesterinaemia is found. 8. Cardiac cases with oedema shew no increase in plasma cholesterol. The main diagnostic value of cholesterol estimations is in the differentiation between renal and cardiac oedema. In this connection, it should be noted that the differentiation is most certain in chronic cases, where a high value will almost certainly be obtained in the presence of a renal lesion. In acute cases, the test is not so trustworthy, but a high value favours the diagnosis of nephritis. In almost all cases, the necessary differentiation can be made from a single estimation. In the second place, a single estimation is of value in establishing a diagnosis of uraemia but it is obviously necessary to consider this finding in conjunction with the other clinical features of the case. The test is of value, in the third place, in that it supplies an aid to prognosis in renal cases. For this purpose, a single estimation is insufficient and a series of observations must be made. In interpreting the behaviour of the cholesterol, the type of nephritis must be borne in mind. Thus in an acute nephritis a fall in the cholesterol level is a favourable sign, whereas in chronic nephritis, a fall is generally unfavourable, and associated with the onset of uraemia. Conversely, a rise in cholesterol in acute nephritis suggests the development of a more permanent lesion, while in chronic nephritis especially of the interstitial type, a rise frequently coincides with clinical improvement. Additional information can be obtained by noting the rate of fall in cases of acute nephritis, a slow fall indicating a tardy recovery. The above conclusions relate to the practical application of the test, but it is of interest to note the relationship of the cholesterol content of the plasma to nitrogen retention, and to oedema. The cholesterol value, in general, varies inversely with the nitrogen retention. As regards the relationship to oedema, this has been dealt with in detail in the different groups, but on the whole no direct proportion exists between the two. The results of this investigation shew that cholesterol estimations have a definite diagnostic and prognostic value in the study of nephritis.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1930
Depositing User: Enlighten Team
Unique ID: glathesis:1930-79860
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 03 Mar 2020 10:30
Last Modified: 03 Mar 2020 10:30
URI: http://theses.gla.ac.uk/id/eprint/79860

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