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In America 100 years ago, the leading clinician pathologists had an understanding of nephrology comparable to that in Europe. Emphasis was on clinical observations devoid of modern clinical laboratory assistance, but verified or disproved at autopsy. The clinician often functioned as the pathologist for his own patients, and although microscopy had been introduced a few decades earlier and many had the benefit of some training in Germany or elsewhere in Europe, diagnostic capabilities remained limited. Renal physiology and pathophysiology were at best embryonic in the United States and elsewhere. The frequency and severity of medical renal diseases maintained the interest of some of the most astute physicians of the late 19th century; however, they had to remain frustrated by their inadequate diagnostic and, especially, therapeutic ability.

Pleural abnormalities of uremia have been recognized for many years but have been given little attention despite their high incidence. Mechanisms underlying pleural effusion relate to filtration forces across subpleural capillaries and lymphatic absorption, either of which can be abnormal in patients with renal failure. Uremic patients have increased susceptibility to many causes of pleural exudate. In addition, a specific uremic pleuritis has been characterized as necrotizing fibrinous sterile exudate that is often hemorrhagic. Spontaneous remission, often with recurrences, or constrictive pleural thickening requiring surgical decortication may occur. Neither the pathogenesis nor the appropriate treatment of uremic pleuritis has been established definitively.

In rabbits undergoing peritoneal dialysis, hypertonic (6% dextrose) dialysis solution increased the net ultrafiltration rate (UF) from 233 to 462 microL/kg/min, which was not proportional to the increment in the osmotic gradient, so the ultrafiltration coefficient decreased. As intraperitoneal dwell of hypertonic dialysate was prolonged, the gross and net UFs and ultrafiltration coefficients decreased, and the UF per dextrose absorption declined. The decrement in UF was multifactorial, including a component of fluid and solute stagnation, increasing the distance over which osmotic forces must exert their effects. Excessively hypertonic dialysis fluid should be used only briefly to achieve ultrafiltration efficiently and to avoid the high dextrose loading.

An epidemic of nephritis occurred among soldiers in World War I, predominantly those in the trenches. Characterized by the sudden onset of albuminuria, hypertension, edema, and dyspnea, atypical features such as bronchitis, an evanescent course, low early mortality, and frequent relapses distinguished it from poststreptococcal glomerulonephritis. Pathologic features included glomerular ischemia, capillary thrombi, endocapillary proliferation, and frequently epithelial crescents, suggesting an underlying vasculitis. The cause was not established, but a postinfectious, possibly postviral, etiology seems most plausible. Trench nephritis was the major nephrologic problem of World War I, accounting for 5% of medical admissions and more than 10% of military hospital bed occupancy at that time.

Kimura's disease consists of lesions that appear as single or multiple red-brown papules or as subcutaneous nodules with a predilection for the head and neck region. Although it principally affects the skin and soft tissues, there is a high prevalence of associated renal disease. We report a case of nephrotic syndrome associated with Kimura's disease. Our patient is distinctive in that his disease first manifested while residing in the Western hemisphere; the renal disease was characterized as mesangial proliferative glomerulonephritis with renal impairment, and his nephrotic syndrome remitted with standard doses of prednisone.

Because amphotericin B is known to affect transport rates across biologic membranes, the effects of this agent on transport parameters in an animal model of peritoneal dialysis were investigated. When amphotericin B in doses ranging from 0.5 to 25 mg/kg was instilled intraperitoneally with commercial dialysis solution, diffusive clearances of phosphate and urea did not differ from control values measured in the same animals, and only a modest increase in potassium clearance was detected. Ultrafiltration due to the osmotic gradient induced by the dextrose content of the dialysis solution increased significantly to 0.31 mL/kg/min with amphotericin B, compared with control values of 0.18 mL/kg/min. The drug did not affect dextrose transport and the osmotic gradient did not differ in the two groups. Hence, the ultrafiltration coefficient was higher with amphotericin B (14 microL/kg/min/mosm), than during control dialyses (6 microL/kg/min/mosm). Increased water flux was detected at the lowest dose and there was no dose relationship over the range studied. Amphotericin B may be the type of agent that will be clinically useful in patients with reduced peritoneal ultrafiltration capacity, and safer analogues should be explored.