Albuminuria, though not a definite disease, deserves special consideration from the dietetic standpoint. Unlike glycosuria, to which it bears but a superficial analogy, and unlike various other manifestations in the urine, it is, for the most part, due strictly to local conditions, although, in many instances, as for example in renal congestion, the local condition is due in turn to general conditions.

Albuminuria, analogous to glycosuria, occurs only after the entrance into the blood of foreign albumin. It is nearly limited in practice to the passage of egg albumin, after the ingestion of raw eggs, five or six eggs being necessary to produce this phenomenon. It is not a sign of disease but it may be important to estimate approximately the amount of nutriment wasted. Apparently no harm follows this elimination of albumin.

Adventitious albuminuria due to the entrance of lochia, vaginal discharge, semen etc., must be excluded. So, too, must be excluded reactions with nitric acid clue to balsamic preparations, etc.

There must also be differentiated essential albuminuria due to leakage through the kidneys, from albumin in the urine eman-atingfrom inflammatory,suppurative and haemorrhagic discharges along the urinary passages. While the loss by such processes may be considerable, no dietetic problems are presented except as for similar processes elsewhere and to avoid irritation by oxalates, purins, volatile poison, sotc.

The bulk of precipitated, moist albumin, greatly exaggerates the impression of loss of protein. Coagulating by heat and cen-trifugalizing thoroughly, the volume percentage of albumin is 6 - 10 times that of dry albumin by weight. Purdy's method, in which precipitation is secured by adding to each 10 c.c. of urine, 3 c.c. of 10% potassium ferrocyanid and 2 c.c. of 50% acetic acid, exaggerates the true proportion of albumin about 50 times.

Barring gross haemorrhage, the urinary albumin varies from a normal trace to 4% (in terms of dry albumin). 1% is rarely exceeded, in inflammatory conditions with copious discharge of leucocytes. In chronic interstitial nephritis, 1/3% is rarely exceeded - 5 grams for 1500 c.c. of urine. More than 2%, not due to haemorrhage, indicates extreme degeneration of the renal epithelium. In such instances, the urine is usually scanty, not exceeding 500 c.c. in 24 hours, so that the loss of albumin rarely exceeds 10 grams. It is probably a conservative statement that, barring haemorrhage or copious discharge of pus and confining our attention to filtration from the blood, the maximum loss of albumin in the urine is 20 grams a day.

Hence, it can almost never happen that the mere loss of nutriment by albuminuria assumes serious importance. Neither does the actual or relative quantity of albumin correspond closely with the functional or organic condition of the kidneys. Still, barring fluctuations, the relative amount of albumin does indicate to some degree the severity of the lesion and if the percentage is greater than 2 and the urine considerable in amount, the actual loss is worth considering, especially as the centrifugal method is easy and fairly accurate.

In acute nephritis, the diet should be bland, easily digested, free from purins, and should approximate the physiologic minimum in all respects. While about 60 grams of protein are required, it is well to avoid meats, using eggs - which should be cooked to avoid the passage of undigested, foreign albumin through the system - milk, and cereals. Salt should be given to the amount of about 10 grams daily. The total quantity of water should be adjusted to the amount eliminated by the skin and bowels. Even if diaphoresis is not secured, about 2500 c.c. are required daily, though not entirely as a beverage.

It should be remembered that, although there is a general indication for adequate nutrition and for elimination, the indication to spare the kidneys outweighs both the indication to nourish and to wash out waste material by excessive diuresis. On the other hand, the general opinion is that less strain is imposed on the kidneys by the passage of fairly dilute than of concentrated urine. Dropsy is not usually excessive and it does less harm than the immediate attempt to force the kidneys to eliminate resorbed transudate. Excessive urinary acidity - more than 50% by phenolphthalein and decinormal alkali - should be relieved by the use of fruit beverages, such as orange and lemonade or, if necessary, by the use of alkalies.

Anuria is best relieved by high enemas of physiologic salt solution at a temperature of 120 F. If there is no considerable dropsy, water and fruit juices should be given freely. Milk is the best form of food.