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Even when no specific action of the causal factor of this disease is exerted upon the kidneys, the urine of malarial subjects varies somewhat with the type of infection, whether regularly intermittent or estivo-autumnal, as well as remaining to a certain degree subservient to physiologic influences, as amount of fluid ingested, season, climate, time of day, and the other usual considerations. In not a few cases, however, and it must be confessed that these are almost universally of the estivo-autumnal variety, the kidneys suffer severely, either in the production of an acute nephritis, or in the hemoglobinuria of pernicious ague, or both. Again, a former attack or attacks of ague may have gradually produced a chronic nephritis, upon which an attack of pernicious estivo-autumnal fever has engrafted an hemoglobinuria, as in the case reported by Brown ("Malaria;" report of twenty-eight cases), in which granular and epithelial casts were found in
THE URINE OF THE MALARIAL FEVERS. JAMA. 1898;XXXI(8):418–420. doi:10.1001/jama.1898.02450080044006
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