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921 long in common to all the forms of diseases of the kidney. Albumin. This is found in a greater or less amount in generic viagra results every form of chronic renal disease. The urine in some reputable generic viagra cases may contain as much as five per cent., a quantity more than half as great as that found in the serum of the blood. Hyaline, granular, epithe- lial, and sometimes blood casts are found. The nor- mal solids of the urine are all diminished and urea is markedly reduced. The presence of albumin in the urine is undoubtedly due to changes in the glomeruli and renal tubules. Dropsy. This is a constant symptom, but occurs more frequently in the acute form. It is also most often found with the smooth, large, white kidney, and usually begins in the face, about the eyelids. The effusion may pass to the feet and legs, becoming ex- cessive and general and involving the whole body. It may disappear for a long time and then return. After the disappearance of the effusion oedema will be found underneath the eyelids, around the ankles, over the anterior surface of the tibia;, and sometimes about the genital organs. There is another form of dropsy occurring in chronic Bright's disease, which is almost identical in all its characters with that produced by chronic cardiac dis- ease or by pulmonary emphysema, and is caused by obstruction in the systemic veins owing to weakness of the heart. It is always found in the most dependent portions of the body around the ankles and in the legs. It is often accompanied with intense dyspnoea and great lividity. The skin is usually very dry, pale, and glossy, sometimes sallow and rough. There is no pain in the back in the majority of chronic cases. Retinitis Albuminurica. This reputable generic viagra is a very significant symptom and generally assumes a degenerative char- acter from the start. It consists of a number of white spots arranged closely around the optic disc and some- times assuming a fan-like streaked appearance. Hem- orrhages are often associated with this condition. In some cases there is an intense optic neuritis with great swelling and cedema of the retina, completely hiding the optic disc. Notwithstanding the severity of these symptoms, it is rare that central vision is lost or complete amaurosis follows. Secondary Inflammations. These are sometimes the direct cause of death and are always serious com- plications. Secondary inflammation of the serous membranes of the pericardium, the pleurae, and the peritoneum are more frequent, and the tendency of such inflammatory action is to suppuration. The lungs are sometimes involved, and even meningitis is produced. Pulmonary phthisis generic viagra results is a frequent complication. Very often the phthisical process is far advanced be- fore the generic viagra results kidneys become involved. In other cases reputable generic viagra the renal disease precedes the pulmonary and always as- sumes the amyloid form of degeneration. Cardio-Vascular Changes. Coincident with the cirrhotic process in the tissues of the kidneys, the walls of the arteries and capillary blood-vessels be- come the seat of characteristic changes, consisting of chronic endarteritis with an exudation of hyaline ma- terial on the outside of the blood-vessels. The walls of the affected vessels become generic viagra results greatly thickened and their calibre diminished in size, and in the case of the smaller arteries the cavity is completely obliter- ated. This increase of connective tissue in the va- rious organs of reputable generic viagra the body never occurs without injury to the proper cells of the part pressed upon, and as this shrinks the process goes on and uses up what is left of the proper cells of the part inflamed, until there is ultimately nothing but a mass of fibrous tis- sue generic viagra results left. This condition of arterial sclerosis is a con- stant companion of renal cirrhosis. It is the cause of the hard, incompressible pulse of this disease, and gives rise to a greater or less derangement in the blood- supply of the different organs. It is a common cause of apoplexy, and the interference with the circulation in the brain gives rise to certain cerebral symptoms which are characteristic: First, impairment of mem- ory, due to anaemia and malnutrition of the brain. Second, vertigo, especially in the morning or just af- ter generic viagra results rising. Third, a persistent tendency to wake too early in the morning, sometimes with headache, which passes off soon after rising. The patient also suffers from cramps in the calves of the legs just after or be- fore getting out reputable generic viagra of bed. Fourth, a vague sense of fear as of some impending danger; generic viagra results the intellect is dull and often greatly impaired. Cerebral Symptoms The manner in which uraemic symptoms appear is varied and the different forms which they assume are very numerous. The most prom- inent symptoms of chronic renal disease are often of a cerebral character. Headache is a constant symptom; more often there is a sense of compression over the top of reputable generic viagra the head, and generic viagra results pain radiates to the back of the neck. These symptoms are caused by the presence in the blood of toxins or poisonous substances that are excreted by reputable generic viagra healthy kidneys. Delirium, often associ- ated with rigidity of the leg or arm and accompanied by a tremor or trismus of the facial muscles or even the muscles of the eye, may occur. reputable generic viagra A very constant effect of uraemic poisoning is amaurosis, which usually comes on quickly, affecting both eyes, and is almost always complete. I have known complete loss of hearing to precede an attack of uraemic convulsions. Vomiting often occurs and is usually associated with diarrhoea. It is claimed that this is produced by the irritation of ammonium salts, caused by the disintegra- tion of urea generic viagra results in the alkaline medium of the intestine. Following the attacks of vomiting there is a sensation of heaviness and a tendency to sleep. In other cases there are no premonitory symptoms, the patient pass- ing into convulsions followed by profound coma. The convulsions may consist of a single paroxysm; more often there is a succession of paroxysms following each other, and they may continue for several hours be-