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dc.contributor.authorMoir, Kenneth Toleen
dc.date.accessioned2019-02-15T14:37:36Z
dc.date.available2019-02-15T14:37:36Z
dc.date.issued1929en
dc.identifier.urihttp://hdl.handle.net/1842/35379
dc.description.abstracten
dc.description.abstractHaving endeavoured to fulfil the intention expressed in the Introduction to collect, and to give a complete and orderly description of all that is of importance in the work and conclusions of investigators on the subject of "uraemia" from its earliest days up to the present time, and also to discuss the modern theories in the light of recent researches with a view to indicating in which direction future investigation is most likely to prove profitable, I propose, in conclusion, to recapitulate concisely the main opinions expressed in the course of the Thesis.en
dc.description.abstract1. The terms "Uraemia" and "Latent Uraemia" should be discarded, and, as at present conceived, there is no necessity for the continued description of "uraemia" as a separate entity. 2. "Anephrexia" is suggested as a name for the syndrome which may occur as the result of suppression of urine unassociated with active disease of the kidneys. The symptoms are due to the retention in the body of the substances normally excreted in the urine - "urinary poisoning." 3. "Dysnephrexia" is suggested as a term to indicate the state of the kidneys in all conditions, whether primarily renal or not, in which their excretory functions are impaired, but in which the disability is only partial. This state and that of "Anephrexia "' should be clearly differentiated, and no attempt should be made to attribute them to a common cause. 4, Many of the described symptoms of "uraemia" may be explained as being due to efforts at vicarious excretion. The "uraemic syndrome" may be restricted to the Cerebral and Respiratory groups of symptoms. 5. General vascular changes and chronic renal disease, probably the result of the simultaneous action of a toxin, occur concurrently, though not to the same degree. Clinical "uraemia" may thus occur in two forms. In the first form, cardio-vascular changes are marked and renal function is but little impaired; the acute cerebral symptoms are due to mechanical causes of vascular origin, the chronic symptoms to changes in the cerebral vessels, and the paroxysmal dyspnoea to changes in the vessels of the respiratory centre in the medulla oblongata. In the second form, impairment of renal function is predominant; the cerebral symptoms are due to unidentified toxins, and the paroxysmal dyspnoea to acidaemia; as vascular change is also present this may be an additional factor. 6. The residual nitrogen of the blood in "uraemia" contains toxic products of abnormal - metabolism capable o`f producing "uraemic" symptoms, although none of the suggested substances can be regarded as the specific toxin of "uraemia." The liver may be concerned in the production of these toxins but their origin cannot be entirely attributed to hepatic insufficiency. 7. It would appear to be quite possible for the manifestations of "uraemia" to be produced, in certain cases, by the known nitrogenous substances which the kidneys have failed to excrete. Further investigations are required as to the effects of substances maintained in the blood for long periods at the concentrations found in "uraemia." 8. There is no reason to suppose that either the loss of an hypothetical internal secretion of the kidney, or the production of nephrolysins, is in any way concerned in the causation of "uraemia." 9. In view of the varied symptomatology of "uraemia," it is highly probable that several causes may act in combination. In one case there may be a toxic factor, which in another may be complicated by the effects of acidaemia or of high blood pressure; the diminished calcium content of the blood may increase the excitability of the nerve cells, or the retaine3 products of metabolism may reduce the impermeability of the cerebral vessels to toxins. All possible variations of co- operating influences may be expected to occur in the varied circumstances which lead to the "uraemic state."en
dc.publisherThe University of Edinburghen
dc.relation.ispartofAnnexe Thesis Digitisation Project 2019 Block 22en
dc.relation.isreferencedbyen
dc.titleAn historical and critical study of uraemiaen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD Doctor of Medicineen


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