The elimination of urine from the body is not the function of the kidney alone: the blood and the tissues are profoundly concerned. The blood may be considered the connecting link between the other two. The concentration in the blood of those substances which eventually appear in the urine must fluctuate with variations in the chemical state of either the tissues or the kidney or both. It is conceivable, therefore, that an absolutely, or apparently, identical chemical disturbance of the blood might result from either chemical changes in the tissues or disturbance of the excretory function of the kidneys. The general problem of the site of initiation of disease characterized by retention of urinary elements is thus complicated by the possibility that fundamentally different diseases may present the same superficial appearance.
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Keith et al. (1926) studied this question.
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