Microvascular sleeve anastomosis, whereby one vessel is inserted into another using 2 extraluminal sutures, was applied to rat-renal autografts. In an experimental study of 10 rat-renal autografts, 20 anastomoses of renal vessels were performed and subsequently examined 100 days after surgery. No failures were documented in 10 arterial and 10 venous anastomoses as examined 100 days after surgery by means of light microscopy and scanning electron microscopy. It was concluded that the sleeve anastomosis is as reliable as the conventional end-to-end anastomosis and also guicker and easier to perform.

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Guanidinosuccinic acid (GSA) synthesis was studied in isolated hepatocytes prepared from normal rats in order to elucidate the metabolic pathway of GSA synthesis, and the mechanism of its increased synthesis in renal failure. It the presence of 10mM sodium lactate and 10 mM NH₄C1, the urea synthesis rate of 7.6 μmol/10⁸ cells/h continued unchanged for 4 hours and GSA synthesis was not detected However, in the presence of 100mg N/dl of urea, with or without 10 mM NH₄C1, GSA was formed at a rate of 10.2 nmol/10⁸ cells/h. The rate of GSA synthesis increased almost proportionally to the urea concentration reached 200mg N/dl. Acetohydroxamic acid which inhibits urease did not affect the rate of GSA synthesis in the presence of 100mg N/dl urea with or without 10 mM NH₄Cl. These results indicate that GSA synthesis varies depending on the urea concentration, and that the addition of ammoniun chloride, a nitrogen donor for urea synthesis has no effect on the GSA synthesis.

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We investigated the opsonic capability and requirements of C-reactive protein (CRP) for clearance of autologous erythrocytes sensitized with pneumococcal C-polysaccharide (CPS) in mouse "in vivo" model. Mouse erythrocytes (E) were coated with CPS to provide a binding site for CRP. When E-CPS or E-CPS-CRP were injected into mice, E-CPS-CRP were preferentially sequested by spleen as compared to E-CPS. The increased splenic sequestration caused by CRP was abolished by pre-treating the mice with cobra venom factor. The removal of CRP from E-CPS-Complement with EDTA showed no increase in splenic sequestration It was also shown that E-CPS-CRP did consume significant amounts of both C4 and C3 in mouse serum. These results demonstrate that CRP mediates opsonic clearance of cells in vivo as well as anti-bodies, indicating that this opsonic effect requires both the complement activation and the continued presence of CRP.

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Cardiovascular function of patients with acute and chronic renal failure (ARF and CRF) was examined by means of Swan-Ganz thermodilution catheter and a comparison of the results was made with that of cardiac patients. As a result, left ventricular function curve, indicating the relationship of left ventricular stroke work index and diastolic pressure of pulmonary artery (PA_D), was obtained. Because of the fall in cardiac index (CI) and the rise in PA_D, right-and-downwards shift of the left ventricular function curve was observed in congestive heart failure. On the contrary, the results in ARF and CRF were not significantly different from that of coronary-sclerosis without angina attack (Control). These results indicated that most of patients with ARF and CRF show no marked reduction in left ventricular function as compared to cardiac patients. Since PA_D and mean right atrial pressure (RA), related to preload, and CI increased slightly in patients with renal failure, it may be considered that development of symptoms like left-side heart failure are pulmonary congestion mainly due to fluid overload. In clinical evaluation of hemodynamic changes during hemodialysis (HD), patients were divided into three groups on the basis of blood pressure (BP) response to ultrafiltration of HD ; "BP up", "BP stable" and "BP down" groups during HD. In fact, PA_D and RA were decreased in all three groups. Although CI was also decreased in three groups, BP was elevated due to compensatory increase in total systemic peripheral resistance (TSPR) in "BP up" group whereas BP was depressed without sufficient elevation of TSPR in "BP down" group. Changes in cardiac output and TSPR are presumed to be balanced during D in "BP stable" group. In conclusion, change in TSPR appears to be a critical factor of the BP response during HD.

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With the view of studying participation of Na retention on blood pressure elevation in low renin hypertension, furosemide was intravenously injected to 10 low renin hypertension, 10 normotensive control, 9 primary aldosteronism, 7 post-operative primary aldosteronism and a bilateral adrenalectomlzed patient (post-operative pheochromocytoma) under normal Na diet. Urinary Na, K, creatinine and plasma 11-deoxycorticosterone, corticosterone, aldosterone were measured every 2 hours before and after administration of furosemide. The results were as follow. Na excretion during 2 hours after furosemide administration was less in low renin hypertension, primary aldosteronism and post-operative primary aldosteronism than normotensive control Negative correlationship was seen between blood pressure(both mean value for 1 week and the day of this test) and 2 hours Na excretion after furosemide administration in all the subjects There was a positive correlationship between Na and creatinine excretion in a group of normotensive control and post-operative primary aldosteronism in addition to primary aldosteronism. However, regression coefficients were different in these 2 groups. Seven cases out of 10 low renin hypertension showed values in the range of normotentive control and other 3 cases represented in the renge of primary aldosteronism. Furtherrmore, Na/K ratio of the 2 hours urine after furosemide administration was high in bilateral adrenalectomized patient, low in primary aldosteronism, and normal in post-operative primary aldosteronisme In low renin hypertension, the Na/K ratio was normal in 6 cases and low in other 4 cases. Plasma 11-deoxycorticosterone, corticosterone and aldosterone were almost in normal range in low renin hypertemlion, and that there are 2 different types, mineralocorticoid dependent type and non-dependent type.

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To investigate the role of the renin-angiotensin system in the regulation of blood pressure in "juvenile" essential hypertensin (below the age of 35 years), single dose of oral converting enzyme inhibitor, captopril, 100mg, was administered in 9 patients with "juvenile" essential hypertension and in 9 hypertensioe patients above 35 years. All 18 patients have a significant fall in blood pressure (P< 0.001), during the administration of the inhibitor. The fall in mean blood pressure caused by the inhibitor was correlated with the basal (pretreatment) plasma renin activity (y=-2.91x-1.43, r=-0.67, P<0.01, n=18 measurements). In petients with "juvenile" essential hypertensin, basal plasma renin activity was more elevated than in patients above 35 years (2.78±0.30vs. 126±0.09ng/ml/hr, P<0.001), while the hypotensive effect of captopril was more pronounced in "juvenile" hypertensives a The average percentile of decrease in mean blood pressure was 10.0±1.4 per cent in patients below 35 years and 4.6±0.9 per cent in patients above 35 years (P<0.005), respectively. The results presented suggest that the renin-angiotensin system may play an important role in the regulation of blood pressure in "juvenile" essential hypertension.

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Hyotensive mechanism of Angiotensin I Converting Enzyme Inhibitor (SQ 14225) was investigated in 10 patients with essential hypertension (EH) and in 4 patients with renovascular hypertension (RVH). After the administration of SQ 14225 (50mg) in two groups, both systolic and diastolic blood presetsure decreased significantly, and the Plasma Aldosterone Concentration (PAC) also showed significant decrease Negative correlation was observed between the pre-administration Plasma Renin Activity (PRA) levels and the degree of hypotensive effect. The decrease in total peripheral resistance (TPR) was observed in seven out of 11 cases in which their blood pressure were lowered. The chronic administration of SQ 14225, 75mg/day, for seven days showed significant hypotensive effect, and negative correlation was observed between the pre-administration PRA and the degree of hypotensive effect. Negative correlation was observed between the increase of serum K* and the degree of the hypotensive effect, and between the urinary Na excretion and the degree of the hypotensive effect in normal renin group of EH and RVH group in which gignif icant hypotensive effect was observed. In the study of ACTH infusion test, the increase in the PAC levels were suppressed after the study of ACTH infusion test, the increase in the PAC levels were suppressed after the administration of SQ 14225. The present study suggest that the main mechanism of SQ 14225 were due to the decrease in endogenous Angiotensin II in the acute phase, and due to the decrease of PAC as well as endogenous Angiotensin II in the chronic phase.

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Blood concentration and urinary excretion of captopril (SQ 14, 225) following oral administration were dstermined by highperformance liquid chromatography in 7 patients with essential hypertension (EH) with normal renal function dosing 50mg and 7 patients with chronic renal failure (CRF) dosing 25mg. Plasma renln activity (PRA), plasma aldosterone concentration (PAC), angiotensin converting enzyme (ACE) activity and blood pressure were also measured simultaneously. The patients had a daily salt intake of 7 g for ten days or more before this study. The maximum blood concentration of the free form of Captopril was obtained within 1 hour after administration in both groups (EH group ; 179.3±57.1ng/ml, CRF group; 80.7±25.5 ng/ml, mean ± S.E.), and it decreased markedly after 6 hours in EH group (9.3±4.3 ng/ml) but it showed a delay in the disappearance of Captopril from the blood in CRF group and remained relatively high concentration after 6 hours (22.1±5.3ng/ml). A 46% of administered capropril was excreted into the urine as free form and metabolites within 24 hours in EH group and 13% in CRF group. Mean blood pressure fell significantly (P<0.01) within 30 minutes in EH group as well as in CRF group (P<0.05), and serum ACE activity was suppressed significantly (P<0.05) within 1 hour in both groups. PRA increased sign nificantly (P<0.05) in both groups and PAC decreased significantly (P<0.05) in EH group whereas decreases in PAC showed no signifiicance in CRF group. It is suggested that low urinary excretion ratio of captopril in EH with normal renal function and CRF compared with normal subjects may be affected by the fall in blood pressure or altered renal funcmtion caused by captopril administration besides the grade of impaired renal function.

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Sixty two patients with nephritis or nephrotic syndrome were treated with either 3×10⁴ IU or 6×10⁴ IU of intravenous urokinase daily for 14 days. The diagnosis on clinical grounds and biopsy findings was nephrotic syndrome in 29, chronic glomerulonephritis in 26 and was rapidly progressive glomerulonephritis in 7. A decrease in urine protein and an increase in creatinine clearance (Ccr), both statistically significant, were observed at the middle and at the end of the two-week treatments When analyzed according to clinical strata, the decrease in urine protein with the treatment was significant in; 1) those with nephrotic syndrome, and 2) those with pretreatment plasma fibrinogen level above 400mg/dl. Furthermore, a significant decrease in proteinuria was associated with a decrease in plasma α₂-plasmin inhibitor (α₂-PI) level by more than 25% with urokinase administration. A significant increase in Ccr was observed in; 1) those with nephrotic syndrome, 2) those with pretreatment serum FDP level above 5μg/ml, and 3) those with pretreatment urine FDP level above 0.5μg/ml. Comparison of the two dose schedules revealed that a significant decrease in proteinuria occurred only in those treated with 6×10⁴ IU/day. A significant decrease in plasma α₂-PI level was observed only in those treated with 6×10⁴ IU/day. Urokinase therapy, thus, was shown to have an effect to improve proteinuria and renal function in patients with glomerulopathy. However, since the average extent of the improvement was not quite large in the present study, selection of the cases particularly amenable to the treatment is considered important. And the present study indicated that a response is particularly expected in those with nephrotic syndrome and in those with high urine or serum FDP level. The present study also indicated that 6×10⁴ IU/day for 14 days is a more reasonable dose as compared to 3×10⁴ IU/day for the same number of days.

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