The clinical history which is the basis of this report presents so many anomalies that it may well appear as if contrived to confuse the clinical mind. It proves that therapeutic courage grows out of the clinical emergency quite as much as out of general preparedness, and urges caution in any present day discussion of the kidney dyscrasias. It proves particularly that we should discard the blanket term "uremia," coined many years ago to describe a symptom complex supposedly due to a single cause, and rely definitely on the physiologic chemist to separate and distinguish the large group of entities that fall into the nephritic group of diseases.
With the particular patient described in this article, the results of renal functional tests seemed not to indicate surgery; yet operation was necessary. The metabolites in the blood were enormously high, but the systolic pressure was not unduly elevated, and the diastolic