Bright's Disease

BRIGHT'S DISEASE, morbus Brighti, a designation formerly used to denote kidney diseases accompanied by the excretion of protein in the urine and the phenomena of dropsy. The term Bright's disease is associated with the name of the English physician R. Bright, who in 1827 first established the dependence of the above-mentioned symptoms upon renal lesions. At the end of the 19th century, when it was elucidated that Bright's disease could be based upon three different forms of kidney disease, termed acute parenchymatous, chronic parenchymatous, and chronic interstitial nephritis, clinicians began to speak of the "Brightian symptom complex," and to designate the disease by another term, specifically, one of those given above in accordance with the clarified type of disease. At the present time, following the works of Volhard and Fahr, in connection with the significant refinement of our concepts regarding kidney diseases and the establishment that the excretion of protein in the urine and edema can be observed in degenerative, inflammatory, and vascular-sclerotic changes in the kidneys, the term "Bright's disease" has not only ceased to be used entirely, but the designations acute parenchymatous, chronic parenchymatous, and chronic interstitial nephritis have also been dropped. According to modern views, what was formerly called Bright's disease is based either on nephrosis, or glomerulonephritis, or arteriulosclerosis of the kidneys (arteriolosclerotic nephrosclerosis), or one or another combination of these forms. In each individual case of diffuse kidney disease, the character of this disease must be ascertained in the sense of the presence of one of these forms of lesion or one or another combination thereof. It is necessary, however, to pay attention 1) to the frequency of these combined forms of disease (thus, for example, in acute diffuse kidney diseases, as a rule, there is a combination of glomerulonephritis and nephrosis) and 2) to the fact that transitional forms exist between some of these main types. Thus, chronic glomerulonephritis and arteriolosclerosis of the kidneys can be combined (already Volhard and Fahr introduced the so-called combination form into their classification). By these combinations and transitional types, all these forms of kidney disease are united to a certain extent into a single whole, and from this point of view, the union of all these forms of disease under the general name of Bright's disease may be justified in a certain sense.