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THE DIAGNOSIS OF KIDNEY INSUFFICIENCY AND THE TREATMENT OF UREMIA.

OLIVER T. OSBORNE, M.D.
JAMA. 1907;XLIX(8):651-654. doi:10.1001/jama.1907.25320080019001f.
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I do not believe that uremia is caused by diseased kidneys alone, but that it is largely due to disturbances of the liver. The liver makes bile and glycogen, and stores the latter and iron. It also makes urea out of ammonium salts, which probably reach the liver in combination with sarcolactic acid or as lactate of ammonium. Extirpation of the liver in animals almost entirely prevents the formation of urea, which excretion is replaced by the ammonium salts and perhaps by leucin and tyrosin, and death soon occurs, generally preceded by convulsions. The liver has a controlling action on toxins, alkaloids and strong drugs, and it is this organ that allows a larger dose of a drug to be tolerated by the stomach than when given hypodermatically. In other words, the liver is our Pasteur filter, and the blood leaves it standardized. If any disease or condition interferes with

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