1907 Journal of the American Medical Association  
The following case of persistent hematuria from the left kidney of sixteen months' duration, which was cured by the injection of adrenalin in the renal pelvis through a ureter catheter, seems of sufficient interest to warrant publication. It is interesting because of supposed traumatic origin, an injury having been received ten days before the hematuria began; because pain was constantly present in the side injured, but the hemorrhage came from the opposite side; because of the absence of any
more » ... he absence of any signs of nephritis which is held to be generally present in such cases, and because no previous publication of the use of adrenalin for such purpose has been found in the literature. Patient.\p=m-\R.H. D., single, aged 36, admitted Dec. 3, 1906, complaining of blood in urine. History.\p=m-\Hisfamily history was negative, as was also his past history. Patient had never had gonorrhea nor syphilis. No previous urinary trouble. Present Illness.\p=m-\In July, 1905, while working on a farm, the rack of a hay wagon fell over on the patient, and a large iron bolt struck him on the right side of the back "between the ribs and hip bone." He was stunned for a few minutes, but soon was able to return to his work, although there was considerable pain present in the region of the trauma. During the next week he had a good deal of pain in the right lumbar region, but he continued at his work. Ten days after the injury he noticed for the first time that the urine waá quite bloody. He feels sure that there was no hematuria before this, and says that micturition was normal in every way before and after the onset of the bleeding. There was no swelling present in either side, and he felt well but for the dull pain in the right lumbar region which had persisted since the accident. There had been practically no let-up in the hematuria since its beginning, although the amount of blood present had varied somewhat. During this time his general health had been excellent and his only symptom had been a slight, dull pain located in the right lumbar region, almost constantly present but never severe. The blood had alwat'S been well mixed with the urine-never any clots. Never any pain nor discomfort on the left side, nor any disturbance to micturition. The urine was continually bloody and had been so for the previous 16 months. The patient had lost weight and was much weaker than normal. He had a dull pain "in the region of the right kidney" which he said felt beneath the ribs in front and in the small of the back on the right side. Occasionally the pain radiated toward the right hip bone, but never into the bladder, groin nor testicle. There was a slight increased frequency of urination and occasionally burning pain in the urethra. His sexual powers were normal, and he had no pain during ejaculation, during defecation or during urination with the exception of the occasional burning pain in the end of the penis previously spoken of. Examination.-The patient was somewhat emaciated and rather pale. There was a slight arteriosclerosis present. The heart and lungs were negative. Neither kidney was palpable nor tender, and there was no tenderness along the course of either ureter. The patient did not complain when deep pressure was made on the region of the kidney on either side. The genitalia and rectum were negative. The urine voided in three glasses was uniformly reddish-brown in color. Under the microscope only blood cells were to be seen. There were no bacteria present. Cystoscopic Examination.-A catheter was passed with ease and there was no stricture present. The bladder was large and difficult to wash clean of blood. The cystoscope showed.a slight median prostatic bar with a shallow cleft on each side. The lateral lobes of the prostate were not enlarged. The bladder was normal. The trigone was a little irregular and hyperemic. The ureteral ridges and interureteral ligament were slightly hypertrophied. The right ureteral orifice was small, secreted at normal intervals and the urine emitted was apparently clear. The left ureteral orifice was larger, located in a prominent papilla and surrounded by congested blood vessels, but no distinct ulcération or inflammation was seen. It was secreting intermittently at normal intervals and the fluid coming from it was smoky in color. The patient was given urotropin (hexamethylenamin) and was requested to return for ureter catheterization. He was also sent to Dr. F. J._ Baetjer for skiagraphs to be made. On Dec. 4, 1906, Dr. Baetjer reported that skiagraphic examination of the kidneys was negative. Within the bony pelvis and along the supposed course of ths right ureter were two small shadows about 5 mm. in diameter, lying close together and apparently about 1 cm. above the point of juncture of the ureter and bladder. They might have been phleboliths, but Dr. Baetjer was inclined to think that they were small ureteral calculi. Nothing was seen on the left side of the pelvis or along the other portions of either of the ureters. Cystoscopic examination was again performed and bloody urine was seen coining from the left kidney and clear urine from the right.
doi:10.1001/jama.1907.25220460010002 fatcat:ctby7bj3p5flpdr272u7gpokfi