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with little rounded nodules. The cortex is thin. Cysts are often found in the cortex and cones. There is an increase of fibrous tissue around the Malpighian bodies and vessels, Purchase Trihexyphenidyl and beneath the capsule and deeper in the cortex. The 244 CHEONIC DIFFUSE NEPHRITIS. cortical tubes are atrophied or dilated, but many tubes may Buy Trihexyphenidyl remain unchanged. The tubes may be filled with epithelium, or with Artane Online transparent, fibrinous material. In the majority ol cases the epithelium is exactly such as is found in normal kidneys. When changed, it is by an alteration in its regular- ity of form, becoming somewhat angular, as if cramped in growing space. The circulation through the blood-vessels is much obstructed. The formation of cysts is due to dilatation of the tubes, or of the Malpighian capsules. 4. Depurative Infiltration. — The kidney is at first of normal size, pale, and its surface smooth. The only change is in the Malpighian tufts, which Order Artane react with iodine. As the dis- ease goes on, the kidney becomes larger and its capsule ad- Order Trihexyphenidyl Online herent. The cortex is of a pale, opaque fawn-color, or has a pinkish or gray translucency. Afterward the kidney atrophies and its surface becomes nodulated. There Order Trihexyphenidyl may be small cysts. In cases of long standing, almost the entire organ gives the Buy Cheap Artane characteristic reaction with iodine. The first change is the infiltration of the Malpighian bodies and vessels. After- ward new fibrous tissue is formed between the tubes, the epithelium degenerates ; the Generic Artane tubes are dilated and contain fibrinous casts. It will be seen that the name of " depurative infiltration " is given to the same form of kidney-disease which is called by others waxy or amyloid. This is done to carry out the au- thor's hobby, as to the nature of the waxy change. Purchase Trihexyphenidyl Online Klebs describes : 1. Diffuse Granular Degeneration of the Buy Trihexyphenidyl Online Epithelium. — ■This condition is found by itself, and in connection witli lesions, in the interstitial tissue. By itself, it occurs with pyaemia, phthisis, rheumatism, typhoid and typhus Order Artane Online fevers, the malarious fevers, the acute exanthemata, extensive burns, poisoning with phosphorus, and the mineral acids. During life the urine may contain granular casts and albumen. The kidney is somewhat enlarged, the cortex grayish yellow, the pyramids bluish red. There may be little extravasations of blood in the convoluted tubes. The epithelium of the tubes is granular and Artane 1 Mg may distend them. The tubes may contain casts. These changes are most frequent in the convoluted CHRONIC DIFFUSE NEPHRITIS. 245 tubes, but are sometimes confined to the straight tubes of the pyramids. The entire process is a degenerative and not an inflammatory one. 2. Cyanotic Induration of the Kidneys. — This condition is produced by any long-continued obstruction to the escape of venous blood from the kidneys, most frequently by heart-dis- ease. The kidneys are increased in size, the surface smooth, the capsule not adherent. The organ is hard, the cortex and pyramids congested, and of a dark-red color. The epithelium of the tubes .is not altered. The interstitial tissue is harder, but not increased in amount. The continued congestion may, after a time, produce further changes. The epithelium of the convoluted tubes may undergo granular degeneration, and the cortex becomes paler. Or there may be an increase of inter- stitial tissue, and the surface becomes nodular. 3. Interstitial Nephritis. — This has two stages Purchase Artane : (1.) That of cell-infiltration ; (2.) That of atrophy, («.) The Stage of Cellular Infiltration of the Interstitial Connective Tissue. — The kidney is increased in size. The sur- face is smooth, the capsule not adherent. The cortex is of a whitish or yellow color, the pyramids red. In Artane Tablets the cortex the tissue between the tubes is everywhere increased from two to four fold. This increase is due to the pressure of lymphatic elements and of clear serum. There is at first an exudation of Ij^mphatic fiuid, which dilates the lymphatic vessels of the interstitial Buy Artane tissue, and is accompanied by an emigration of white blood-globules, which finally fill all the spaces in the interstitial tissue. The epithelium of the convoluted Buy Artane Online tubes imdergoes granular degeneration in consequence of its dis- turbed nutrition. The increased pressure of Artane Price blood causes an exudation of the elements of the blood from the Malpighian tufts, namely, fibrinogenic material which coagulates in the tubes, albumen, and red blood-globules. The lymphatic cells perforate the basement membrane of the tubes, and become adherent to the fibrinous casts. (J.) The Stage of Atrophy.— The preceding stage may terminate in resolution and recovery. If it does not, it is succeeded either by a hyperplasia of connective Artane 2 Mg tissue or by granular atrophy. h 246 CHROl^IC DIFFUSE NEPIIEITI3. If there is a lijperplasia of connective tissue, the kidneys are of normal size, or slightly atrophied. The capsule is some- what adherent. The cortex is whitish, yellowish, or Purchase Artane Online mottled.

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