RENAL DEFICIENCY ASSOCIATED WITH SHOCK

Abstract

Many writers¹ have noted that the development of shock is accompanied by oliguria or anuria and by the retention of nitrogenous wastes, often leading to uremia if the subject survives a few days. This feature is not one of the debatable aspects of shock, yet its mechanism and significance are not adequately discussed in medical literature. It has been shown² that shock is accompanied regularly by severe parenchymatous degeneration, especially pronounced in the kidneys; often this produces necrosis of the tubular epithelium. The possibility that these changes are related to the functional deficiency deserves thoughtful consideration. In some instances a state of sublethal shock continues for several days; then renal deficiency often dominates the clinical picture. The urine is dark, smoky in color and has a high specific gravity. It contains albumin, hemoglobin, débris, epithelial cells, erythrocytes and casts, both granular and hyaline; frequently the casts are deeply