TRANSIENT ALBUMINURIA, AS IT OCCURS, 
PARTICULARLY IN CHILDREN AND ADO- 
LESCENTS, IN APPARENT HEALTH 
, BY 
FRANCIS P. KINNICUTT, M.D. 
PHYSICIAN TO ST. LUKE'S HOSPITAL AND TO THE OUT-PATIENT DEPARTMENT, 
NEW YORK HOSPITAL, ETC. 
[Reprinted from the Archives of Medicine, February, 1882] 
NEW YORK 
G. P. PUTNAM’S SONS 
27 & 29 West 23D Street 
1882 TRANSIENT ALBUMINURIA, AS IT OCCURS, 
PARTICULARLY IN CHILDREN AND ADO- 
LESCENTS, IN APPARENT HEALTH.* 
By FRANCIS P. KINNICUTT, M.D., 
PHYSICIAN TO ST. LUKE?S HOSPITAL AND TO THE OUT-PATIENT DEPARTMENT, NEW YORK HOS-' 
PITAL, ETC. 
THE occurrence of a transient albuminuria in persons 
in apparent health, and particularly in children and 
adolescents, is a subject which has attracted the attention 
of numerous clinical observers and pathologists during the 
past few years, and is certainly one of much practical im- 
portance. Cases have been reported by the English physi- 
cians Sir William Gull, Drs. George Johnson, Moxon,- 
Saundby, Dukes, and T. Morley Rooke, and by Leube, 
Fuerbringer, Edlefsen, and Ultzmann among other German 
observers. 
Before further reference to and analysis of their observa-- 
tions and a number of my own, I shall briefly review the 
various theories which have been advanced in explanation 
of the conditions which govern this form of albuminuria. 
Accepting Nussbaum’s1 conclusions, based upon experimen- 
tal research, that the site of transudation of albumen in the 
* Read before the New York Academy of Medicine, Dec. 15, 1881. 
1 Nussbaum, M.: Fortgesetzte Untersuchungen iiber die Secretion der Niere; 
Pjluger's Arch. f. d. gesammte Physiologic der Menschen und der Thiere 
1878, xvii, 581. Ueber die Entstehung der Albutninurie ; Deutsche Arch. f. 
Klin. Med., 1879, xxiv, 248. 
Reprinted from the Archives of Medicine, Vol. vii, No. i, February, 1882. 2 
TRANSIENT ALB UMIN UR I A. 
kidney is in the glomerular vessels, Runeberg' maintains, 
as the result of numerous experiments by himself, that the 
filtration of albumen is dependent upon an increased per- 
meability of the walls of these vessels, due to a condition 
of diminished or low blood pressure. The filtration mem- 
branes used by Runeberg in his experiments were dogs’ 
sheeps’ and rabbits’ intestines, suitably prepared. Heiden- 
hain asserts that Runeberg’s conclusions are untenable in 
view of the demonstrable faultiness of his experiments. 
He shows by an analysis of his results, “ that while the 
percentage of albumen in the filtrate diminishes by increased 
pressure, the absolute quantity of albumen is actually in- 
creased. With increased pressure both more albumen and 
more water are filtered, but the albumen stream increases 
more slowly than the water stream, so that the percentage 
of albumen in the filtrate relatively decreases with height- 
ened pressure.”2 
He also shows that the membranes used by Runeberg 
differ in their filtration properties from the glomerular 
membranes, and that in other respects there is an essential 
difference between “ the physical experiment and the physi- 
ological process.” 
Wittich has advanced the theory that the urine which 
passes through the glomerular capillaries constantly con- 
tains albumen, but that this albumen serves the purpose of 
nourishing the epithelium of the urinary tubules, and that 
the residue passes back into the circulation. In a diseased 
condition of the epithelium, or in its removal from any 
cause, albuminuria would occur. An objection which has 
been urged against this hypothesis, is that it assumes a 
different mode of nourishment of the renal epithelium from 
1 Runeberg, J. W. : Die Filtration von Eiweisslosungen durch thierische 
Membranen ; Arch. f. Heilk., 1877, xviii, 1. Albuminurie bei gesunden 
Nieren ; Arch. f. Path. Anat., 1880, lxxx, 175. 
2 tieidenhain, R. : Hermann’s “ Handbuch der Physiologie,” 1880, Bd. v, 
367. FRANCIS P. KINNICUTT. 
3 
all other epithelium, while it fails to satisfactorily explain 
the transient albuminuria following an epileptic attack, oc- 
casionally cold bathing, and occurring in the cases recorded 
in the present paper. Rosner, moreover, has adduced an 
experimental objection to this theory. By placing fresh 
bits of kidney in boiling water, he was able to fix the albu- 
men in the situation in which it was produced. In diseased 
kidneys coagulated albumen was found in the urinary tu- 
bules, but never in healthy organs. Another explanation, 
which has been suggested, is that the epithelial covering of 
the smallest capillaries prevents the transudation of albu- 
men; denuded of their epithelium, albumen escapes. 
The experiments of Stokvis and others would seem1 to 
demonstrate the incorrectness of the theory that the filtra- 
tion of albumen is dependent solely upon a condition of in- 
creased or high pressure in the glomerular vessels. Stokvis 
has shown that when the pressure is increased in the 
renal arteries either by ligating the aorta below their ori- 
gin, or through the extirpation of one kidney, albuminu- 
ria does not occur until the degree of pressure is such 
as to rupture the vessels and permit of the admixture of 
blood with the urine. The clinical observations that in 
the case of the small kidney, which is so constantly as- 
sociated with high arterial tension, albuminuria as a rule 
occurs only occasionally and to a limited degree2; and, 
again, that in those forms of heart disease attended with 
obstructed venous circulation, albumen does not appear in 
the urine until the general arterial tension, and, conse- 
quently, that in the glomerular vessels, is lowered, through 
failure in the heart’s action, while remedies which directly 
1 “Cyclopaedia of the Practice of Medicine,” Ziemssen, Supplement, 1881, 
p. 661. 
2 Mahomed’s explanation of the diminished filtration of albumen in this con- 
dition, on the ground of a maintenance of balance between thickness of vessel 
walls and arterial pressure (.Lancet, vol. i, p. 76, 1879), I cannot accept without 
reservation, in view of some personal observations, which I hope, at another 
time, to report. 4 
TRANSIENT ALBUMINURIA. 
tend to increase its force diminish or arrest the albuminu- 
ria, are in accord with the physiological experiment. 
Other theories to which the transudation of albumen 
have been referred are a retardation of the blood current 
in the renal vessels1 (Heidenhain and others), and Leube’s 
hypothesis2 of an individual permeability of membrane. It 
was shown in the experiments of Heidenhain and Rune- 
berg (/. c.) that the filtration of albumen through animal 
membranes goes on very slowly; in other words, that it is 
an essential condition of such filtration, that the albumen 
should remain a comparatively long time in contact with the 
vessel wall. A vaso-motor disturbance within the kidney 
(either a paralysis of the vaso-constrictors or an irritation of 
the vaso-dilators), by producing a dilatation of the vessels, 
would fulfil this condition, viz., a retardation of the blood 
current. That this condition should alter the nutrition of 
the glomerular epithelium, and, when temporary, should 
produce a transient disturbance of the functions of the lat- 
ter, is readily conceivable. It has seemed to me that the 
above theory, viz., a slowing of the blood current in the 
glomerular vessels, dependent upon a temporary vaso-mo- 
tor disturbance, with a resulting alteration (also temporary) 
in the functions of the glomerular epithelium, may be re- 
garded as the most probable explanation of the mode of 
production of transient albuminuria in persons presumably 
healthy. It remains for us to seek for the cause of such a 
vaso-motor disturbance. Inasmuch as my observations have 
been confined chiefly to children and adolescents, in whom, 
from the time of life, apparent health, and disappearance of 
the albuminuria (in the cases recorded), structural disease 
of the kidney may reasonably be excluded, I shall not vent- 
ure to extend my conclusions to a later period in life. 
i 1 Loc. cit. 
2 Leube, W.: Ueber die Ausscheidung von Eiweiss im Ham des gesunden 
Menschen ; Virchows Archiv, 1878, lxxii, 145. 5 
FRANCIS P. KINNICUTT. 
From a careful analysis of cases recorded by other ob- 
servers and a study of my own, I have been led to believe 
that the source of irritation, in a large number of instances, 
is to be found in the temporary presence of imperfectly oxi- 
dized nitrogenous matters in the renal circulation ; in other 
words, to a transient oxaluria or lithuria, which, clinically, 
may be regarded as identical. The marked derangements 
of the nervous system in more or less chronic lithzemia in 
adults are well recognized; many of the symptoms which 
Dr. Da Costa1 has recently made the subject of a very in- 
teresting monograph indicate the degree to which the vaso- 
motor system is affected. In children, the general nervous 
symptoms attending the lithaemic state are equally pro- 
nounced, though hitherto not as well recognized. To this 
fact my attention was first drawn by Dr. Wm. H. Draper, 
and my experience since has fully corroborated it. That 
the nervous symptoms are directly dependent upon the 
presence in the blood of the irritating products of imperfect 
oxidation of nitrogenous matter can hardly be doubted, al- 
though different views may be held as to the system which 
is primarily concerned in the production of this state. 
With these facts before us we may reasonably believe 
that a more or less transient oxaluria or lithuria may be ca- 
pable of producing a correspondingly temporary irritation 
of the nervous system. A ti'ansient general nervous dis- 
turbance, in which the vaso-motor system would necessarily 
share, may be supposed, or one confined to the vaso-motor 
system of the kidney in its excretion of a large amount of 
irritating matter, and resulting in a temporary albuminuria. 
A similar albuminuria which follows an epileptic at- 
tack, may presumably be referred to the disturbance 
which affects the general nervous system, and consequently, 
the vaso-motor system of the kidney. 
1 Da Costa, American Journal of the Med. Sciences, Oct., 1881. 6 
TRANSIENT ALBUMINURIA. 
Again, in the temporary albuminuria which has been 
observed in cases of exophthalmic goitre,1 we have a prob- 
able instance of retarded blood current in the renal ves- 
sels, the result of dilatation dependent upon the affection 
of the general vaso-motor system. 
The apparently more frequent occurrence of temporary 
albuminuria, without structural change in the kidney, in 
children and adolescents, than at a later period, I would ex- 
plain on the ground of the greater mobility of the nervous 
system which obtains at these periods of life. 
Its occurrence in only a comparatively small proportion 
of cases of lithaemia at these ages may be referred to an in- 
dividual mobility of the nervous system in such cases. (In 
another group, the skin or the mucous membranes may be 
the most vulnerable portions of the organism.) In my 
own experience, a transient albuminuria in connection with 
the lithaemic state has been observed, as a rule, in children 
and youths of nervous temperament ; in the latter instance, 
in active brain-workers, frequently during periods of unusu- 
al mental worry or strain; under conditions where the 
general nervous tone was below par. (In this connection a 
simple reference to the clinical fact of the influence of pro- 
found mental emotion in temporarily increasing the albu- 
minuria in chronic Bright’s disease is suggestive.) Leube’s 
hypothesis of an individual permeability of membrane (/. c.) 
may also be considered as a possible etiological factor in 
these cases. 
In illustration of the subject which we have been con- 
sidering, I shall now briefly review the cases of transient 
albuminuria which have been recorded by various observers. 
In a discussion before the Royal Medical and Chirurgical 
Society of London in 1873, on albuminuria,2 Sir William 
Gull mentioned that in his experience “ it occurred in 
1 Dr. Begbie, Edinburgh Med. Journal, April, 1874. 
2 Lancet, 1873, i, 808. FRANCIS P. KINNICUTT. 
7 
young and growing men and boys, almost as frequently as 
spermatorrhoea,” and that it might presumably be referred 
to an atony of vessels and nerves. In a paper by Dr. 
Moxon (“Guy’s Hospital Reports,” 1878) 19 cases of inter- 
mittent albuminuria occurring in adolescents in apparent 
health are reported. The symptoms presented by the 
patients were of an indefinite character, consisting in listless- 
ness, languor, occasional headache, unrefreshing sleep, with 
little disposition for cheerful company. In the majority of 
cases no complaint was made by the patients, but advice 
was sought through the anxiety of friends. Dr. Moxon 
says: “ I have not met with this set of conditions at other 
periods of life, and I have so frequently met with them in ado- 
lescents, that I cannot but believe that it is a disordered 
state proper to that term of life, and that it is deserving of 
recognition and receiving a name.” He further mentions 
that careful examination, in his cases, of the various organs 
of the body gave negative results, and that, moreover, he 
was able to exclude scarlatina and diphtheria, which might 
leave a sequel of albuminuria and lead to fallacy. Many of 
the cases were kept under observation for several years, the 
urine being repeatedly examined, with the result of finding 
that the albuminuria had wholly disappeared, and that ex- 
cellent health was maintained. 
In the history of the various cases, whenever the result of 
the examination of the urine, aside from the existence of 
albumen, is recorded, the presence of a large amount of 
oxalate of lime, or a combination of uric acid and oxalate of 
lime, is mentioned. Their presence, and in large quantity, 
was so commonly observed as to attract Dr. Moxon’s atten- 
tion. He does not, however, express any positive opinion 
as to their causal relation to the albuminuria. It may be 
mentioned that small oxalate of lime calculi were subse- 
quently passed by one of his patients. 8 
TRANSIENT ALBUMINURIA. 
In the British Medical Journal of Nov. io, 1878, ten cases 
of intermittent albuminuria in adolescents from 13 to 17 
years of age are reported by Dr. Clement Dukes. In three 
of the cases there is presumptive evidence of the existence 
of structural change in the kidney. In Case 1 the albumin- 
uria followed an acute attack of nephritis with bloody urine, 
and occurred at intervals for the subsequent eight months, 
when the record ceases. 
In Case 2 albumen was detected in the urine immediately 
subsequent to an attack of scarlatina, and it continued to 
appear from time to time up to the date of publication of 
Dr. Dukes’ article. 
Finally, in Case 10 it is stated that with pallor and a 
feeling of faintness on severe exertion, high arterial tension 
existed, and an examination of the heart revealed a heav- 
ing, hard impulse—suspicious symptoms certainly in con- 
nection with albuminuria. Inasmuch as in only three of 
the remaining cases had the albuminuria disappeared at the 
date of record, and in these for a comparatively short time, 
we are hardly warranted in positively assigning them to the 
group which we have under consideration. They certainly 
differ in many respects from the cases described by Dr. 
Moxon, and from my own. The symptoms consisted of 
furred tongue, headache, disinclination for work or play, 
irregular or constipated bowels; often there was anaemia, 
and occasionally a slight cold, facial dropsy, and slight syn- 
copal attacks. The microscopic examination of the urine is 
not given. In Dr. Dukes’ opinion the albuminuria is the 
result of a temporary hyperaemia of the kidneys, super- 
added to an habitual increased arterial tension, which he 
claims obtains at puberty, basing this opinion upon Beneke’s 
researches. Mahomed, on the contrary, asserts that the re- 
sult of his personal experience is to the effect that a condi- 
tion of low tension exists at this period of life.1 
1Lancet, 1879, vol. i, p. 76. FRANCIS P. KINNICUTT. 
9 
In an article in the British Medical Journal of Nov. 12, 
1881, Dr. Dukes reverses his former opinion, stating that as 
the result of further observation he is forced to regard 
the albuminuria of adolescents not only as pathological, 
but as representing the beginning of true Bright’s disease. 
He adds, however, that he has been unable to observe his 
cases in its further development. 
In a single case of transient albuminuria recorded by 
Dr. Yeo (British Med. Journal, Oct. 26, 1878), the presence 
of albumen in the urine alone being mentioned, an expla- 
nation of the symptom is sought in the hypothesis of a 
temporary vascular asthenia, dependent upon a possible 
deficiency or disturbance of nerve force of transient dura- 
tion. 
In an intermittent albuminuria in a young girl, disappear- 
ing during rest in bed,1 Dr. T. Morley Rooke seeks to ex- 
plain the condition on mechanical grounds. He says that 
“when the body is in the upright position the weight of the 
column of blood is too great for the weakened vessels,”—a 
theory which requires further demonstration. 
In a very interesting paper in the British Med. Journal 
of Dec. 13, 1879, 011 “ Latent Albuminuria, its Etiology 
and Pathology,” Dr. George Johnson mentions the fre- 
quency with which albumen is found in the urine of per- 
sons in apparent health, and terms it “ latent albuminuria.” 
He maintains that although unassociated with any evidence 
of functional or structural disease, it may, by careful in- 
quiry, be traced back, in a very large proportion of cases, 
to some possible exciting cause, i. e., to an attack of scarlet 
fever or diphtheria, or a cold, etc. ; moreover, “ that even 
the smallest trace of albumen in the urine is always patho- 
logical, never physiological ; and that the neglect of a path- 
ological condition and tendency, especially such negligence 
1 British Med. Journal, Oct. 19, 1878. IO 
TRA NS/ENT A LB UMINURIA. 
as involves repeated exposure to the exciting cause, may 
convert a temporary and occasional into a persistent al- 
buminuria, which sooner or later, though it may be after 
many years, will result in a fatal disintegration of the kid- 
neys.” Admitting the frequent dependence of albuminuria 
upon dyspepsia, he believes that the chain of events is rep- 
resented by an irritation of the gland cells of the kidney 
in the process of excretion of ill-digested matter, through 
which they later undergo structural changes, while at the 
same time the imperfectly assimilated albuminous materials 
pass more readily by exosmosis through the Malpighian 
bodies. An additional factor is found in the general ner- 
vous exhaustion, with loss of vaso-motor force, which ac- 
companies chronic dyspepsia, leading to a diminution of 
tone and contractile power in the muscular walls of the 
arterioles generally, including those of the kidney. Ad- 
mitting, therefore, the irritating effect of the products of 
mal-assimilation upon the kidney, as well as a vaso-motor 
disturbance accompanying their presence in the blood, he 
believes apparently that the gland cells are primarily af- 
fected, undergoing structural change with a continuance of 
the irritation, rather than that such irritation may be con- 
fined to the vaso-motor system within the kidney, with 
resulting temporary disturbance in the nutrition and 
functions of the glomerular epithelium, and consequent 
transient albuminuria. 
In an examination of the urine of 145 male patients by 
Dr. Saundby, taken seriatim as they presented themselves 
at the General Hospital in Birmingham, England, albumen 
was discovered in no less than 1051; 67 of these cases are 
tabulated by Dr. Saundby under the head of chronic 
Bright’s disease; five cases, occurring in patients between 
1 Saundby, R. : The Diagnostic Value of Albuminuria ; Brit. Med. Journ., 
1879, i, 699. FRA NCIS P. KINNICUTT. 
11 
ten and twenty years of age, are attributed to simple de- 
bility ; two, at a similar period of life, to dyspepsia.1 Of 
these a portion, he says, resembled Dr. Dukes’ cases, a 
portion Dr. Moxon’s. 
No evidence of organic disease could be detected. The 
examination of the urine is not given in full, but it is 
stated that in a few instances oxalate of lime was present. 
In Dr. Saundby’s opinion a temporary hyperaemia may be 
regarded as the source of this form of albuminuria, and he 
believes that it is in no respect inconsistent with an in- 
tegrity of renal structure. 
In a case of intermittent albuminuria, in a physician, 
29 years of age, in good health, which finally disappeared 
after an interval of eight months, reported by Fuerbringer,2- 
there are several points of interest. The albumen was first 
accidentally discovered in a morning specimen of urine, 
passed after an hour of great mental anxiety. The noon 
urine of the same day contained less, and the evening 
water, after the mental depression had passed away, was 
entirely free from albumen. During the following week 
occasional traces of albumen were detected. After a sec- 
ond period of great anxiety and depression a small quan- 
tity of dark, clear, highly acid urine was passed, of a sp. gr. 
1,030, containing 31 per cent, of albumen and a large 
amount of uric acid. Under similar circumstances, on two 
subsequent occasions the same symptoms occurred. At 
other times, when the amount of albumen was less, uric 
acid, or oxalate of lime, or both, with amorphous urates, 
Avere commonly present. No effect upon the albuminuria 
was produced by diet. The ingestion of eggs in large num- 
ber, strong spices and liquors, were followed by negative 
results. Severe physical exercise produced a temporary in- 
1 In one of the cases classed under the head of debility, the albuminuria fol- 
lowed typhoid fever. 
2 Zeitschrift fiir Klinische Medicin, 1880, i, p, 340. 12 
TRANSIENT ALBUMINURIA. 
crease in its amount. A very careful examination of the 
patient failed to reveal any organic disease. Fuerbringer 
would explain the phenomena on Runeberg’s theory of 
diminished pressure in the glomerular vessels, produced by 
general arterial ischaemia, the result of profound emotional 
disturbance of a depressing character. The influence, how- 
ever, of similar causes in exciting a temporary lithaemia is 
well recognized, and I would therefore suggest that pro- 
found mental depression, lithaemia, albuminuria constituted 
the probable sequence of events in the above case. 
The following cases have come under my personal notice. 
Within the past few years the number of such observations 
has been comparatively large, but as they have all been made 
in private practice, the opportunities for carefully tracing the 
greater number of cases have been wanting. I shall, there- 
fore, with a single exception, confine my remarks to such 
as I have been permitted to keep under constant obser- 
vation, and where the albuminuria has now been absent for 
many months. In all of them careful inquiries were made 
in regard to previous illnesses, which might have a bearing 
upon the subject under consideration, with results which 
will be stated in the individual cases. The possible exist- 
ence of affections of the bladder and urethra were carefully 
investigated, but they were invariably found to be absent. 
In this connection Simon’s researches, to the effect that 
neither the prostatic nor seminal fluids contain any bodies 
which are coagulable by heat, may be mentioned. “Casts” 
were never found in the urine, although careful search was 
made for them. In none of the cases was the amount of 
urinary water apparently decreased, although the quantity 
passed in the 24 hours was not measured. 
Sphygmographic tracings, which were taken whenever 
possible, showed either normal or slightly lowered arterial 
tension. In all the cases the amount of albumen in the FRANCIS P. KINNiCUTT. 
13 
urine was very considerable. In all, the microscopic exam- 
ination was made within twelve hours; in many of the 
cases, as soon as two hours after the passage of the 
urine. 
At the period when the following case was observed my 
attention had not been directed either to the occurrence of 
transient albuminuria in health or to its association with a 
temporary oxaluria or lithuria. I believed it, at the time, to 
be one of latent Bright’s disease. 
Case i.—Mr. A., aged 23. The patient is of nervous temper- 
ament. While in New York on a visit in the winter of 1874, in 
apparent health, his urine was examined by me in a non-profes- 
sional capacity. To my surprise and concern it was found to con- 
tain a large amount of albumen, together with much uric acid and 
oxalate of lime. Without mentioning the matter to Mr. A., I im- 
mediately wrote to his family physician in regard to the result of 
my examination. I received in reply a communication to the 
effect that the urine had been examined by him on Mr. A’s. return 
home, two days later, and was found to be wholly free from al- 
bumen. His water has been very frequently examined since with 
a similar result, and his health has continued to be excellent. 
Case 2.—Mr. B., medical student, aged 21. Is of nervous 
temperament. Had scarlet fever without albuminuria during 
childhood. Has never had diphtheria. Has been under my ob- 
servation for the past five years, during which period he has en- 
joyed excellent health. In February, 1881, while engaged in 
active brain work, taking little exercise or recreation, but eating 
largely, he began to complain of lassitude, weariness after exer- 
tion, either mental or physical, and slight morning headache. An 
examination failed to reveal any evidence of organic trouble. Exam- 
ination of the urine gave the following results : React, highly acid ; 
sp.gr. 1,030; albumen, both by heat and nitric acid. Acidulated with 
a few drops of acetic acid, boiled, and allowed to stand, albumen 
Microscopic examination showed the presence of a large 
amount of uric acid and oxalate of lime, but was otherwise nega- 
tive. Hunyadi janos water on rising, with alkalies before meals, 
a regulation of the diet, and exercise in the open air were pre- 
scribed. The urine continued to contain albumen in diminished 
amount for the three following days, when the record of the exam- H 
TRA NSIEN T ALB UMIN UR I A. 
ination is as follows : React, neutral; sp. gr. 1,020; no trace of albu- 
men obtained either by heat or nitric acid. Microscopic examina- 
tion negative. There was accompanying improvement in the gen- 
eral symptoms. During the past ten months the urine has been 
repeatedly examined (last date Dec. 1, 1881), but never at any 
time has it contained albumen ; uric acid and oxalate have also 
been constantly absent. 
Case 3.— Mr. B., student, aged 17. Has never had diphtheria. 
Had scarlet fever five years ago, without albuminuria. The urine 
was repeatedly examined by me during and subsequent to his ill- 
ness, and at no time contained a trace of albumen. Has always 
enjoyed excellent health. Is a large eater. In Oct., 1880, while 
in apparent perfect health, on account of a remark that there was 
a sediment in his water, the urine was examined. The record is 
as follows : React, highly acid ; sp. gr. 1030 ; albumen, both by 
heat and nitric acid. Acidulated, boiled, and allowed to stand, 
albumen y Microscopic examination : A large amount of uric 
acid and oxalate of lime present; otherwise negative. A saline 
cathartic, alkalies, regulation of diet, and out-door exercise were 
prescribed. An examination of the water 36 hours later showed 
a normal sp. gr. and acidity, an entire absence of albumen, of uric 
acid, and oxalate of lime. The urine has been repeatedly examined 
since (last date Nov. 25, 1881), but albumen has never been 
found ; neither has it contained uric acid or oxalate of lime. The 
patient’s health has continued excellent. 
In the above cases the marked degree of the albuminuria, 
its very transient nature, its constant association with uric 
acid and oxalate of lime are noteworthy. 
Case 4.—Mrs. D., aged 22. Patient is of nervous tempera- 
ment and lithmmic diathesis. Has never had diphtheria. Had 
scarlet fever, without any evidence of renal trouble during child- 
hood. Has been under my observation for several years, during 
which time she has enjoyed excellent health. 
The usual routine examination of the water was made on sev- 
eral occasions during this period, in trifling ailments, but albumen 
was never found. Late in the past autumn my advice was 
sought for the relief of morning headache and general lassitude. 
The patient also complained of moderate constipation, flatulence 
after meals, and a coated tongue. There was no fever or other FRANCIS P. KINNICUTT. 
15 
evidence of more than a temporary functional disturbance of 
health. For several weeks previous she had been living a very 
luxurious life, eating heartily and taking little exercise. 
An examination of the urine, an after-breakfast specimen, 
showed a highly acid reaction, with a sp. gr. 1030 ; very consid- 
erable albumen both by heat aud nitric acid, and oxalate of lime 
in large amount. An evening specimen of the same date re- 
sembled the morning’s in all respects, with the exception of pos- 
sessing a higher sp. gr., viz., 1032. Advice, similar to that which 
has been mentioned in the previous cases, was given and adopted, 
with the result of speedily relieving the subjective symptoms. Ex- 
amination of the urine four days later showed a diminution in 
the acidity, lower sp. gr., and a mere trace of albumen in the 
evening specimen only. Uric acid was also found in the evening 
water alone and in small quantity. Examination of the urine on 
the fifth subsequent day : react, acid ; sp. gr. 1022 ; no trace of 
albumen on very careful testing with both heat and nitric acid, in 
either a morning or evening specimen. Microscopic examination, 
negative. Two weeks later the examination was repeated. The 
record is as follows : After-breakfast specimen, react, acid ; sp. 
gr. 1025 ; albumen absent, also uric acid and oxalate of lime. 
Evening specimen, react, highly acid ; sp. gr. 1034; albumen, both 
by heat and nitric acid ; urates precipitated by nitric acid ; acidu- 
lated, boiled, and allowed to stand, albumen . Microscopic ex- 
amination : very numerous oxalate of lime crystals. 
The patient had discontinued her medicine, and had taken little 
exercise during the previous week. She had, moreover, been suf- 
fering from much mental anxiety. Greater care in diet and more 
vigorous out-door exercise were urged and adopted, and on the 
following examination, Dec. 10th, a week later, the urine was 
found to be entirely normal. The points of especial interest in 
the above case are the transient character of the albuminuria, its 
invariable appearance and disappearance in the presence and ab- 
sence of uric acid and oxa,late of lime. The patient has not been 
under my observation for a sufficiently long period to express a 
positive opinion in regard to the absence of structural kidney 
change, but the symptoms certainly very closely resemble those 
observed in the group which I have described. 
Case 5.—Ethel M., aged 4 years. Has never had diphtheria or 
scarlet fever. The urine was examined on account of advice be- 
ing sought for incontinence of water, the patient being in excel- 
lent health at the time. It was found to be markedly acid, of 16 
TRANSIENT ALBUMINURIA. 
high sp. gr., to contain albumen and uric acid with oxalate of 
lime in large amount. Two days later the urine was free from 
albumen and the above salts. The patient has been under my 
observation up to the present date, three years from the first ex- 
amination ; her health has been unusually good, and in frequent 
examinations (last date Nov. 12, 1881) the urine has been invariably 
normal. 
Case 6.—Ethel W., aged 9 years. Had scarlet fever without 
albuminuria when 4 years old. Has never had diphtheria. The 
patient has a neurotic family history. In July, 1880, had a con- 
vulsive attack, which was attributed to indigestion. Subsequent 
attacks demonstrated their epileptic nature. Under treatment 
further paroxysms have not occurred. The record of an examina- 
tion of the water, Oct. 8, 1880, is as follows : Evening specimen, 
react, acid; sp. gr. 1031 ; distinct amount of albumen both by 
heat and nitric acid. Microscopic examination : a large amount 
of uric acid present. 
An examination of an after-breakfast specimen of the same date 
gave similar results, differing only in having a lower sp. gr. Ex- 
amination a few days later, morning specimen : react, acid ; sp. 
gr. 1014 ; free from albumen ; microscopic examination, negative. 
Evening water, same date : react, acid ; sp. gr. 1026 ; trace of al- 
bumen, with few uric acid crystals present. On the following ex- 
amination, although the sp. gr. of the urine was 1033, it was 
wholly free from uric acid and oxalate of lime, and did not con- 
tain a trace of albumen. 
Very frequent examinations have been made up to the present 
date, and the records show the invariable absence of any trace of 
albumen ; also the absence of uric acid and oxalate of lime. It 
may be mentioned that the diet has been most strictly regulated 
during this period, and careful attention given to all other hygi- 
enic measures. 
Case 7.—Florence T., aged 4 years. The patient has a lithse- 
mic diathesis. Has never had diphtheria or scarlet fever. During 
the winter of 1880 advice was sought for an attack of urticaria. 
The tongue was coated, the bowels disordered, and the cutaneous 
symptoms very pronounced. There was no fever. Examination 
of the urine : react, acid ; sp. gr. not recorded ; a considerable 
amount of albumen both by heat and nitric acid ; urates precipi- 
tated by the addition of acid ; microscopic examination, amor- 
phous urates. 
The following examinations gave entirely negative results. The FRANCIS P. KINNICUTT. 
i7 
child has continued to be in excellent health up to the present 
date. 
Urticaria is now universally ranked among the neuroses, 
and it is a neurosis in which the vaso-motor system is pre- 
eminently affected. 
Moreover, a temporary lithaemic state is recognized as a 
frequent factor in its genesis. The above case may there- 
fore not unreasonably be regarded as lending support to 
the theory of transient albuminuria occurring in apparent 
health, which has been suggested in this paper. I possess 
the notes of two other cases of temporary albuminuria in 
children of 4 and 5 years of age respectively, associated 
with transient lithsemia, but as they closely resemble the 
cases already narrated, their recital is unnecessary. I 
have at present under observation four additional cases 
in adolescents, but as they have only recently come under 
my notice, I do not feel warranted as yet in including them 
among the above. 
Inasmuch as it has been wisely said “ that much of that 
which each man thinks that he observes is but a part of 
himself,” it may be mentioned that Dr. Draper kindly con- 
sented, at my request, to repeat the examination of the 
urine in many of the cases which 1 have recorded, with the 
result of corroborating my observations. 
The presence of uric acid, either in the crystalline or 
amorphous form, even in large quantities, in a concentrated 
and highly acid urine, cannot be accepted as a demonstra- 
tion of its excessive elimination from the body. Oxalate 
of lime, however, is present in the normal urine only in 
minute quantity (Schultzen1) if at all (Neubauer2); urine, 
therefore, found to contain a large amount of oxalate of 
lime within two or three hours after its passage, may fairly 
1 Archiv f. Anat. und Physiol., 1868, p. 719, et seq. 
2 “ Analysis of the Urine,” Neubauer and Vogel, p. 168. 18 
TRANSIENT ALBUMINURIA. 
be judged to indicate an excessive elimination of this im- 
perfectly oxidized nitrogenous matter. 
In my own cases the urine in several instances was exam- 
ined two hours after being passed, and showed the presence 
of a large quantity of oxalate of lime crystals alone. 
Moreover, in the majority of all the cases the constitu- 
tional symptoms were of a character usually present in lith- 
aemic patients. 
The very constant association of imperfectly oxidized ni- 
trogenous matter in the urine and albuminuria, especially 
in Dr. Moxon’s and my own cases, cannot reasonably, it 
seems to me, be regarded as a simple coincidence ; in the 
latter observations we find an additional argument against 
such an hypothesis in the disappearance of the albuminuria 
pari passu with the lithaemia. Dr. Murchison1 maintained 
that such an association, at a later period in life, not only 
was to be regarded in the light of a causal relation, but he 
also agreed with Dr. George Johnson in believing that 
“ renal degeneration may be a consequence of the long-con- 
tinued elimination of products of faulty digestion through 
the kidneys.”2 That temporary albuminuria in children and 
adolescents in apparent health is invariably dependent upon 
a transient oxaluria or lithuria, I do not maintain. The ob- 
servations of Leube, Ultzmann, Fuerbringer,3 and others 
would seem to show that prolonged and vigorous physical ex- 
ercise is capable of occasionally producing, though in an as 
yet unsatisfactorily explained manner, a slight transient albu- 
minuria in presumably healthy persons. I have not referred 
to the theory of chemical or “ food albuminuria ” in explana- 
tion of the condition which is the subject of this paper, for the 
reason that careful investigations and experiments leave it 
extremely doubtful whether albuminuria (the presence in 
1 “ Clinical Lectures on Diseases of the Liver,” Araer. edition, pp. 572, 573. 
2 Brit. Med. Journ., 1872, vol. 1, pp. 161-191. 3 Loc. cit. FRANCIS P. KINNICUTT. 
19 
the urine of a body coagulated by heat or precipitated by 
neutralization—Saundby) is ever due to the transudation of 
a modified or more easily diffusible form of albumen. Dr. 
Saundby has shown, by a series of very interesting observa- 
tions and experiments,1 that the several tests, viz., an in- 
crease of albumen after food, a greater diffusibility of such 
albumen (Parkes, Pavy), and a difference in the coagulation 
temperature (Lauder Brunton and D’Arcy Power), which 
have been used by different investigators in their attempt 
to prove this point, are not to be relied upon. 
In conclusion, my observations would seem to show that 
temporary albuminuria, as it occurs in children and adoles- 
cents in apparent health, may be traced in a large number 
of instances to a transient oxaluria or lithuria, and I would 
suggest that the sequence of events in the causation of the 
albuminuria is as follows: 
1. The temporary presence of a large amount of imper- 
fectly oxidized matter in the circulation. 
2. A disturbance of the general nervous system, in which 
the vaso-motor system of the kidney shares, or one confined 
to the vaso-motor system of the kidney in its elimination of 
these products of a faulty digestion. 
3. A transient dilatation of the blood-vessels of the kid- 
ney and a retardation of the blood current in the glomerular 
vessels, with a consequent possible alteration in the func- 
tions of the glomerular epithelium, also of a temporary na- 
ture. 
1 Brit. Med. Journ., vol. i, 1880, p. 841 ; Birmingham Med. Review, July, 
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