CHANGES IN THE URINE SUBSEQUENT TO 
NEPHRECTOMY-TWO CASES. 
Reported to the Cleveland Society of Medical Sciences, 
February 20, 1893. 
BY 
P. MAX FOSHAY, M.S., M.D., 
CLEVELAND, OHIO. 
Reprinted from the International Medical Magazine for November, 1893. CHANGES IN THE URINE SUBSEQUENT TO NEPHREC- 
TOMY-TWO CASES. 
The published records of the changes in the urine following nephrectomy 
are very scant and very incomplete; hence it is thought the following re- 
port will be of some general interest. In each of the cases here reported 
Dr. Dudley P. Allen, of this city, was the operating surgeon, and it was 
through his kindness that the writer was enabled to make the extended ob- 
servations recorded in the subjoined tables. In the first case, one of float- 
ing kidney with calculi, the observations were, unfortunately, not begun 
until a week after the operation. The second case was one of sinus follow- 
ing nephrotomy, and the observations began upon the day of operation. 
The following tables present the result of the examinations of the urine 
from day to day, in each case for a period of nearly six weeks after the 
operation. 
TABLE I. 
The results of the daily examination of the urine of Case I. 
Date. 
Total 
urine. 
Specific 
gravity. 
Solids. 
Reaction. 
Urea 
in 1 c.c. 
Urea in 
24 hours. 
Ratio of 
urea to 
solids. 
Indican. 
Clinical notes. 
Nov. 
c.c. 
gm. 
gm. 
gm. 
7 
74fi 
0 019 
14.27 
8 
119/S 
0.013 
15.13 
9 
645 
0.0215 
13.87 
Headache. 
10 
955 
0 0175 
16 71 
11 
1930 
0 0115 
17.25 
12 
1310 
0.010 
15.60 
13 
560 
1020 
25.10 
Alkaline. 
0.0235 
13.16 
1:1.9 
Bad headache. 
14 
1680 
Acid. 
0 0105 
17 64 
15 
1200 
1017 
47.53 
0.0145 
17.40 
1:2.7 
16 
1000 
1017 
39.61 
“ 
0.019 
19.00 
1 :2.1 
Slight. 
17 
1410 
1008 
26.28 
“ 
0.012 
16.92 
1: 1.6 
18 
1100 
1017 
43.56 
44 
0.0165 
18.15 
1:2.4 
44 
19 
1155 
1012 
32.29 
“ 
0.013 
15.02 
1:2.2 
Increased. 
20 
1330 
1012 
37.19 
44 
0.011 
14.63 
1:2.5 
44 
Headache. 
21 
1375 
1025 
80.10 
Alkaline. 
0.011 
15.13 
1:5.3 
Slight. 
44 
22 
900 
1020 
41.94 
44 
0.013 
11.70 
1:3.6 
Gt. incr. 
23 
1160 
1015 
40.54 
44 
0.011 
12.76 
1:3.2 
Slight. 
24 
470 
1025 
27.38 
Acid. 
0.027 
12.69 
1:2.2 
Increased. 
Slight fever. 
25 
485 
1026 
29.38 
“ 
0.0275 
13.84 
1:2.2 
Gt. incr. 
26 
585 
1022 
29.99 
Alkaline. 
0.0225 
13.16 
1:2.3 
Slight. 
« II 
27 
575 
1026 
34.83 
Acid. 
0.0255 
14.66 
1:2.4 
44 
II II 
28 
775 
1022 
39.73 
44 
0.017 
13.18 
1:3.0 
41 
II II 
29 
575 
1019 
25.46 
44 
0.0155 
8.91 
1:2.9 
44 
30 
725 
1020 
33.79 
44 
0.016 
11.60 
1:2.9 
44 
/vftfooc L 
Dec. 
1 
900 
1018 
37.75 
44 
0.018 
16.20 
1:2.3 
2 
1055 
1018 
44.25 
44 
0.016 
16.88 
1:2.6 
| / i 
3 
1475 
1015 
51.55 
44 
0.010 
14.75 
1:3.5 
4 
1375 
1014 
44.90 
44 
0.012 
16.50 
1:2.7 
\ 
5 
1100 
1017 
43.57 
44 
0.012 
13.20 
1:3.3 
\\>\ 
6 
425 
1018 
22.02 
“ 
0.021 
8.93 
1:2.5 
Very poorly. 
7 
455 
1019 
20.14 
44 
0.024 
10.92 
1:1.8 
Nvys 
8 
320 
1025 
18.64 
44 
0.023 
7.36 
1:2.5 
Quite ill. 
9 
515 
1020 
24.00 
Alkaline. 
0.017 
8.72 
1:2.8 
10 
840 
1014 
28.50 
Acid. 
0.012 
10.08 
1:2.8 
11 
1050 
1014 
34.25 
44 
0.011 
11.55 
1:2.9 
12 
1065 
1013 
32.26 
44 
0.013 
13.85 
1:2.3 
13 
810 
1017 
32.08 
44 
0.014 
11.34 
1 :2.9 
14 
800 
1015 
27.96 
44 
0.0145 
11.60 
1:2.4 
15 
1100 
1010 
25.63 
44 
0.0115 
12.65 
1:2.0 
16 
720 
1018 
30.20 
0.0175 
12.60 
1:2.4 
Patient went home. 
1450 
1013 
43.90 
“ 
0.010 
14.50 
1:3.0 
Urineof February 27,1893. 2 
P. MAX FOSHAY, M.S., M.D., ON 
TABLE II. 
Result of the daily examination of the urine of Case II. 
tOtO*-**-*-**-*-**-*^-*-*^ 
- s 
©©ae^i©c^*.coto>— 
2SS83 
24 
25 
26 
Jan. 
19 
20 
21 
22 
Date. 
1100 
170) 
1500 
1000 
1200 
1300 
1000 
950 
800 
1400 
1150 
900 
1300 
1250 
1275 
1050 
1000 
950 
1100 
1200 
1800 
1000 
1300 
1600 
1350 
1450 
1400 
900 
iliii 
r 
950 
1140 
930 
S 
+ 
o>o>*.©rs 
8SS3? 
+ + 
Total 
urine. 
o o o o o o 
<5o>oo^icio5 
222222222§l 
coootooiGcroaoifr.O'icfo 
1011 
1015 
1012 
1020 
1016 
1013 
1013 
1015 
1013 
1015 
©: coo 
CO* CT 30 
1016 
1015 
1018 
1033 
1030 
1030 
1027 
1025 
Specific 
gravity. 
71.30 
62.91 
39 61 
50.33 
48.46 
46.60 
26.56 
41.00 
48.93 
37.51 
37.75 
36.35 
37.86 
44.46 
44.04 
41.94 
28.78 
28.19 
41.94 
50.33 
46.60 
48.46 
48.46 
40.79 
60.68 
45.67 
31.46 
00 : O' ►— QO 
£j SE8 
882 
8fc'B 
41.52 
Solids. 
Alkaline. 
Acid. 
J... 
P*i 
► 
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~2 
Alkaline. 
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8K 
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Reaction. 
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2222222222 
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©: ©’©'© 
a>: C7 5 
0.0156 
0.014 
0.0165 
0.0245 
© © © ©__ 
§§£§1 
© © to c* • 
Urea 
in 1 c.c. 
5555:22 
8g88sfc! 
8^588888888 
58888888^8 
19.60 
18.00 
25.60 
26 40 
14.73 
15.96 
! 15.35 
13.23 
® 3 £ ?"n 
£388- 
Urea in 
24 hours. 
►* *- »- ►- ►- ►- 
1 
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1 
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1 
1 
1 
1 
1 
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Ratio of 
MIOUMWM 
'•d c b) c *■ 
totGootototototocotcto 
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b» to «e 
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urea to 
solids. 
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§« 
jj-if r 
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£7 s® S3 
f h 
Indican. 
r: r 
| 
& 
s 
p* 
® .fi p 
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H 
SjS 
I 
3 
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TABLE III. 
Weekly averages of quantity, solids, and urea {of Case I.), deduced from 
TabU I. 
Week. 
Urine. 
Solids. 
Urea 
Ratio of 
urea to 
■olida. 
c.c. 
949 
gna. 
gm. 
15.14 
“ 14-20 
1208 
37.78 
17.25 
1:2.7 
“ 21 27 
793 
47.70 
13.35 
1 :3.0 
11 28-December 4 
983 
45.33 
14.00 
1:2.8 
December 6-11 
684 
27.30 
10.10 
1 : 2.4 
“ 12 18 
919 
29.63 
12.41 
1:2.4 CHANGES IN THE URINE SUBSEQUENT TO NEPHRECTOMY. 
3 
TABLE IV. 
Total averages of quantity, solids, and urea at the end of each week (of Case 
I.), deduced from Table III. 
Date. 
Urine. 
Solids. 
Urea. 
Ratio of 
urea to 
solids. 
c.c. 
949 
gm. 
gm. 
15.14 
“ 20 
1108 
37.78 
16.19 
1:2.7 
“ 27 
" 1003 
42.74 
15.25 
1:2.9 
December 4 
993 
44.03 
14.62 
1:2.9 
“ 11 
839 
35.66 
12.36 
1 : 2.7 
“ 16 
879 
32.65 
12.39 
1:2.6 
TABLE V. 
Weekly averages of quantity, solids, and urea (of Case II.), deduced from 
Table II. 
Week. 
Urine. 
Solids. 
Urea. 
Ratio of 
urea to 
solids. 
January 19—25 
c.c. 
690 
gm. 
36.99 
gm. 
16.03 
1:2.3 
“ 26—February 1 
1271 
43.72 
19.98 
1:2.2 
February 2- 8 
1385 
50.77 
18.05 
1:3.1 
“ " 9-15 
1071 
38.41 
14.76 
1: 2.6 
“ 16-22 
1275 
38.91 
14.44 
1: 2.7 
“ 23-28 
1283 
53.20 
18.29 
1:2.9 
TABLE VI. 
Total averages of quantity, solids, and urea at the end of each week (of Case 
II), deduced from Table V. 
Date. 
Urine. 
Solids. 
Urea. 
Ratio of 
urea to 
solids. 
January 25 
c.c. 
690 
gm. 
36.99 
gm. 
16.03 
1:2.3 
February 1 
981 
40.36 
18.00 
1:2.2 
“ 8 
1183 
45.56 
18.03 
1:2.5 
“ 15 
1127 
41.99 
16.40 
1:2.6 
“ 22 
1201 
40.45 
15.42 
1 :2.8 
“ 28 
1242 
46.83 
16.86 
1:2.9 
It is unsafe to generalize from two cases, and the writer has been unable 
to find any record of similar analyses, hence only a few brief comments upon 
these tables will be made. It seems entirely probable that in all cases of 
long-standing disease of one kidney, as were the two here reported, the re- 
moval of the diseased organ must free the remaining one from the strain of 
eliminating the poisons absorbed from its neighbor, and that there should 
be a better performance of natural function by the remaining organ after 4 
CHANGES IN THE URINE SUBSEQUENT TO NEPHRECTOMY. 
nephrectomy. An hypersemia of the single organ is said to always follow 
a nephrectomy, but why this should be, in the face of the presumption just 
stated, is difficult to see, especially in view of the fact that the organ has 
had months of training for the extra burden, during the time that its fellow 
was doing a continually decreasing proportion of excretory work. Never- 
theless the tables would seem to distinctly indicate such an hypersemia in 
each of these cases, in that the maximum daily quantities of solids and urea 
were produced in the second, third, and fourth weeks after the operation. 
In the first case a period when the urine was alkaline occurred in con- 
nection with a protracted and severe headache at about the same time as 
noted by Graves1 in his cases. The only period of alkaline urine in the 
second case occurred in the sixth week. 
In both cases the maximum daily average of quantity excreted occurred 
in the third week. 
It will be seen that the maximum daily amount of solids was reached 
in the fourth week of the first case and third week of the second, the maxi- 
mum in the sixth week of the latter case merely indicating the re-establish- 
ment of normal diet and function. 
The maximum of urea will be found in the third week of the first case 
and second week of the second case. In each case the urea reached its 
maximum one week before the total solids attained a maximum,—an interest- 
ing fact but difficult of explanation. 
In both cases pus and epithelial cells occurred in considerable amounts 
for the first week and continued in gradually decreasing amount. In Case 
II., during the second and third weeks the urine contained blood in sufficient 
quantity to color it very markedly. 
Both patients recovered completely and are now in excellent health. 
1 Two cases of nephrectomy reported by S. C. Graves, of Grand Rapids. Medical 
News, vol. lxi. pp. 349 and 612. International 
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