The controversy that exists as to the identity of distinct types of chronic Bright's disease, such as chronic parenchymatous nephritis and chronic interstitial nephritis, continues, and by some it still is considered a debatable point whether the arteriovascular changes are primary or secondary to the renal changes.
McCrae1 says that neither chronic parenchymatous nor chronic interstitial nephritis ever exists alone inasmuch as "interstitial change never exists without an accompanying parenchymatous change, and parenchymatous change cannot exist long without interstitial alteration following or accompanying it." He doubts the development of a primary contracted kidney.
Strumpell2 considers chronic interstitial nephritis as an atrophy of the renal parenchyma which begins in a previously healthy kidney and is not necessarily the ultimate termination of a chronic diffuse nephritis, though he describes a secondary contracted kidney which he considers simply a more advanced form of chronic diffuse nephritis. His distinction is further explained
BULSON AE. SOME EARLY DIAGNOSTIC RETINAL SIGNS OF ARTERIOSCLEROSIS AND CHRONIC BRIGHT'S DISEASE. JAMA. 1912;LIX(12):1032–1038. doi:10.1001/jama.1912.04270090276049
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