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Hosenstein calls it the third stage of diffuse nephritis. 4. They describe a form of disease in which the Malpighian tufts and the vessels are the seat of waxy degeneration. Johnson describes, under this name, large white kidneys, of which the tubes are filled with " waxy " casts. Stewart describes three stages : First, waxy degeneration of the vessels; second, degeneration of the Avandia Online epithelium; third, atrophy of the organ. Dichinson calls it " depurative infiltration." The first change is in the Malpighian tufts and vessels ; afterward there is formation of new interstitial tissue and degeneration of the epithelium ; lastly, atrophy of the organ. He considers the waxy material to be dealkalized fibrine, and to follow chronic suppuration. Avandia Canada Klebs does not speak very decidedly as to the connection between the waxy degeneration of the vessels and the inter- stitial and parenchymatous changes. He admits that the interstitial nephritis may be the first change, and that it may begin and go on at the same time as the waxy degeneration. Jxindfleisch assumes that the w^axy degeneration takes place first, and that the interstitial and parenchymatous changes are secondary to it. JRosenstein regards the degeneration of the vessels only as a complication of the parenchymatous and interstitial changes. 5. Chronic congestion of the kidneys from heart-disease is not described as a separate lesion by the English authors. Klebs and Rosenstein describe it in the same wa}'. Avandia 8 Mg Glomerulo-nephritis is only described by Klebs. Catarrhal nephritis, as described by Rosenstein, is not exactly described by the other authors. It will be seen that the principal points of difierence arc in relation to the comparative importance of the changes in the interstitial tissue and the epithelium of the tubes, Avandia 4 Mg and whether the latter are inflammatory or degenerative. The chronic diseases of the kidney, which I have met with in the Bellevue Dead-house, may be conveniently classed under three heads : ♦ CHEOI^IC DIFFUSE NEPHRITIS. 251 I. Chronic Congestion of the Kidney. II. Chronic Diffuse Nephritis. III. Chronic Parenchymatons ISTephritis. I. Chronic Congestion of the Kidney.— I have nothing to add Order Avandia to the descriptions given of this form of disease by Rosenstein and Klebs. The Avandia Price lesion is a very common accompaniment of heart-disease ; its gross appearances are very characteristic ; it may pass into Purchase Avandia Online either of the forms of chronic diffuse nephritis which will be presently described. II. Chronic Diffuse Nephritis. — To speak of this disease as the Order Avandia Online latter stages of an acute inflammatory nephritis, seems to me to be in the highest degree erroneous. Neither the clini- cal histories nor jpost-mortem appearances give any good grounds for such Avandia Tablets an opinion. It seems to be rather the result of a wish for a systematic division into a first, second, and third stage, than of observation, which has engrafted this idea into the descriptions Avandia Cost of nearly all authors. The disease is, as a rule, from its beginning to its close, a chronic affection. In many cases it is impossible to fix the period at which the disease commenced, so insidious is its approach, and, in autopsies of persons dying at all stages of the disease, no first stage of congestion and inflammation is to be observed. The disease may begin as a chronic difl'use nephritis ; may succeed chronic congestion of the kidney ; or may follow the acute lesions of the kidney which occur with scarlatina and Avanafil Buy after exposures to cold. The Purchase Avandia first Avandia Mg course is the ordinary one. The lesions of chronic diffuse nephritis are : 1. Granular and fatty degeneration of the epithelium of the tubes, espe- cially in the cortex. To judge of the condition of the epithe- lium of the tubes, it is necessary to Cheap Avandia remember its normal char- acter. The tubes commence at the papillae as Buy Cheap Avandia ducts of largo size, which soon divide and subdivide into smaller tubes. These smaller tubes run in Generic Avandia straight bundles nearly to the sur- face of Buy Avandia Online the cortex. At that point they bend downward, and run back in a straight line to a variable depth in the pyramids. Here they again curve upward, run into the cortex, become convoluted, and terminate in Malpighian bodies. The epithelium varies in the different portions of this long course of Buy Avandia the tubes. The papillse arc covered with Buy Avanafil cylindrical 252 CHKONIC DIFFUSE NEPHRITIS. epithelium. This epithelium dips into the open mouths of the tubes, and forms a continuous layer with their epithelium. The epithelium of the large tubes has the same appearance as that covering the papillae, except that the long axes of the cells are shorter, and the cells have consequently a more cuboidal shape. As these large tubes divide and subdivide in the pyra-

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