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JAMA. 1947;134(5):425-429. doi:10.1001/jama.1947.02880220009002.
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Many writers1 have noted that the development of shock is accompanied by oliguria or anuria and by the retention of nitrogenous wastes, often leading to uremia if the subject survives a few days. This feature is not one of the debatable aspects of shock, yet its mechanism and significance are not adequately discussed in medical literature. It has been shown2 that shock is accompanied regularly by severe parenchymatous degeneration, especially pronounced in the kidneys; often this produces necrosis of the tubular epithelium. The possibility that these changes are related to the functional deficiency deserves thoughtful consideration.

In some instances a state of sublethal shock continues for several days; then renal deficiency often dominates the clinical picture. The urine is dark, smoky in color and has a high specific gravity. It contains albumin, hemoglobin, débris, epithelial cells, erythrocytes and casts, both granular and hyaline; frequently the casts are deeply


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