In an attempt to elucidate the role of renal extraglomerular vssels for maintaining the medullary blood flow in diseased kidneys, changes in intrarenal vascular patterns were studied in 37 autopsid kidneys with various renal diseases, using either micro-angiographic & histologic, plastic corrosion or india ink-plastic double injection technique. Ninty-one preparations without primary renal diseases were also studied as controls. The donors of these kidneys ranged from 9 month to 92 year old. The extent of destruction of cortical arteriole-glomerular nuits (A-G units) was increased with the severity of the glomerular impairment resulted from renal diseases or aging process. On the other hand, in juxtamedullary A-G units, direct continuity Between afferent and efferent arterioles developed and thus direct medullary pathway could be well maintained. In normal kidneys, increase in direct medullary vessels were proportionate to the age. In diseased kidneys, however, the extent of formation of direct medullary vessels was far greater than that simply due to ageing process; the extent of these vessels formation correlated well with the histological changes in the intrarenal vasculature especially with changes in glomeruli. Changes in intrarenal vascular patterns were variable depending on primary renal diseases. However, when the kidneys became contracted intrarenal vascular patterns revealed a common tendency in their changes regardless of the primary renal disease. The vascularization of the cortex was markedly destructod, whereas extraglomeruar medullary vessels (spiral vessels, afferent giant arterioles and an usual type of juxtamedullary A-G units) were preserved well. From the standpoint of homeostasis, these phenomena would be advantageous for maintai-ning the medullary blood flow in diseased kidney.

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The experiments described here have been carried out in an attempt to elucidate the possible role of regenerating adrenocortical tissue in the genesis of hypertension. In immature female rats treated with. 1 % sodium chloride, uninephrectomy besides bilateral adrenal enucleation was performed in one group, and bilateral adrenal enucleations without renal removals were undergone in another group. After experi-mental procedures, the severity of hypertension increased in the former group, however the latter remainedd normotensive. Histological and histochemical findings revealed the hyperfunction of the regenerated adrenals. But no evidence was found to indicate a change which would be expected to initate a blood pressure rise in the regenerated adrenals of hypertensioe group. In she rats bearing regenerated adrenals, the body weight ratios of the adrenals indicated significantly high values as compared with those of controll ones. But the experiments led to the conclusion that the body weight ratios of the regenerated adrenals never indicated the adrenocortical function of the regenerated adrenals. The pathogenesis of this form of experimental hypertention described by Skelton (1965) was diacusseda.

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Needle biopsy of the kidney was carried out in prone position by means of Vim-Silverman's needle in 80 patients with movable kidney which was diagnosed by pneumoretroperoperitoneum. Renal tissue block sufficient for light and electron microscopic examinations, namely, containing more than 5 glomeruli, was gotten in 60 of these 80 patients who had no past history of renal diseases. This renal tissue block was cut into two parts. One part for light microscopic examination was fixed by 10% formalin solution, embedded in paraffin, cut in serial sections with 3 to 4μ thickness and stained by such methods as hematoxylin-eosin, van Gieson and PAS, furthermore, if necessary, Azan and PAM. Another part of renal tissue for electron microcopic examination was fixed soon after the needle biopsy for 60 minutes at 0-4°C in 2% osmic acid solution added with veronal-acetate buffer solution, dehydrated by ethanol and embedded in epoxy resin. After confirming the presence of glomeruli in embedded material, ultrathin sections were prepared and stained electronically by uranium acetate and lead tartarete, and set for an electron microscope of 11-A Type of Hitachi Co. Direct magnification of 5, 000-10, 000 was used for the examination. The sixty examinees were classified into the following 4 groups : Group A : Proteinuria (+), hypertension (+) Group B : Proteinuria (+), hypertension (-) Group C : Proteinuria (-), hypertension (+) Group D : Proteinuria (-), hypertension (-) The resuts obtained are as follows : 1) Light microscopic findings. Histological changes were found in all the 60 cases examined. a) As to glomerulus there were found irregular thickening of basement membrane, proliferation of mesangial cell, adhesion with Bowman's capsule, dilatation of capillary, dilatation of urinary space and congestion in many cases. b) As to Bowman's capsule there was found thickening in some cases. c) As to tubule there were dilation of caliber and atrophy of epithelial cell in some cases. d) All the above mentioned findings were the severest in group A, severer in Group B, faint in Group C, and fainter in Group D. e) The incidence of these findings were the highest in Group A, higher in Group B and C, and slight in Group D. f) These findings suggested slight hydronephrosis, glomerulonephritis or congestion, though not evident enough to dessignate the diseases. 2) Electron microscopic findings. Electron mieroscopic changes were found in all the 22 cases examined. Electron micropic examination revealed so slight findings to be encountered that they could not be found by light microscopic examina-tion. There were found abnormal findings in basement membrane, urinary space, capillary, mesangial cell and Bowman's capsule. These abnormal findings were the severst in Group A, severer in Group B, and faint in Group C and D.Their incidence wes higher in Group A than in Group B, C and D.Conclusions 1) Some abnormal findings can be found by light as well as electron microscopic examinations in all the cases with movable kidney though slight in general. 2) The grade as well as the incidence of these abnormal findings have something to do with protei-nuria and hypertension.

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Using a renographic unit of RDP 102 Type of Toshiba Co., renography was carried out in 10 controls, 48 patients with movable kidney, 15 hypertensives and 11 patients with glomerulonephritis. Movable kidney was diagnosed by pneumoretroperitoneum. Renal postural or respiratory displacement over 3 cm was regarded to be of movable kidney. And if patients with movable kidney had complications of hypertension or glomerulonephritis, they were excluded from the study objects. Before performing renography, a single dose of 300 ml of coarse tea or water was given orally to an examinee at hunger, and 30 minutes thereafter, 1 ml of ¹³¹I-Hippuran solution containing 0.5 μCi/kg was injected intravenously. Starting just before the injection, a renogram was recorded for 20 minutes in prone position. Two to five days thereafter, another renogram was recorded on the same examinee in the same way in standing position. Patterns of renograms were classified according to Machida's method, and semi-quantitative analysis of renograms was performed by measuriug total concentration (TC), minute concentration (MC), minute excretion (ME), 15-minute excretion (E₁₅), t_b, t_c and t_e according to Krueger et al, and Otake et al. Just after the recording renogram, voluntary urination was done to calculate urinary radioactivity. In all the examinees, renal biospy was undergone to get accurate diagnosis, and such examinations as routine urine tests, blood pressure, Fishberg's concentration test, PSP excretion test, GFR, RPF, FF and urea-clearance were carried out to understand the pathology of each examinee. The results obtained are as follows : 1) When the patient takes a standing position, the kidney may be displaced in sagittal direction, and so, the distance from the detector to the kidney may be different between prone position and standing position. Thus, a false renographic difference may be demonstrated between the prone position and the standing position. But, it was found that such a false difference could be neglected in practice. 2) The renographic difference between right and left kidneys is not found in controls either in prone position or in standing position, and so, all the right and left kidney can be united as a whole in this study. 3) In movable kidney and hypertension, Machida's pattern becomes worse in standing position than in prone position. In glomerulonephritis, the pattern does not always worsen in standing position, though it is already bad in prone position in many cases. 4) In movable kidney, TC, MC, and ME are not different from that in controls in prone position, but they become smaller by taking a standing position to show some disturbance of renal function. E₁₅ in movable kibney is smaller than that in controls even in prone position, and becomes smaller by taking a standing position. The postural changes of TC, MC, ME and E₁₅ are evident in postural movable kidney, though not found in respiratory movable kidney. Either in hypertension or in glomerulonephritis, ME and E₁₅ are smaller than in controls in prone position, and furthermore, MC is smaller than in controls in standing position. In hypertension, MC, ME and E₁₅ are smaller in standing position than in prone position. In glomerulonephritis, TC and MC are smaller in standing position than in prone position. 5) There is no correlation between the maximal renal displacement and the postural renographic change. 6) In hypertension, t_c and t_e are distinctly prolonged in standing position compared with prone position. 7) There is no relation between the postural change of urinary radioactivity count and that of reno-graphic excretion values. It is concluded that renographic patterns and values show more severe disturbances of renal function in standing position than in prone position in movable kidney. The same is the case with

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Achilles tendon reflex (ATR) was recorded in 30 patients with chronic renal failure by a modified Zawson's electromagnetic method described in the previous paper. The recorded curves were studied in relation to the changes in serum electrolytes and other biochemical components. The following conclusions were obtained. 1) Areflexia was found in 3 patients. One of them was diagnosed clinically as uremic neuropathy, whose sensory disturbances and areflexia were not improved after 6 months of maintenance dialysis. 2) Mean S-D (the interval from tapping point to the end of muscular contraction), S-C (reflex latency) and C-D (contraction phase) for 27 patients were 273±25, 78±15 and 193±24 msec, respectively. These intervals are significantly prolonged than those in the normal subjects (p<0.001 for each interval). 3) The prolongation of ATR-intervals was not correlated to the severity of the disease. 4) S-C was not improved by a single dialysis, what is suggestive of organic changes in nervous system. On the contrary, C-D was improved by a single dialysis, suggestive of functional nature of muscle disorders. 5) In the patients on maintenance dialysis, S-C was positively correlated to serum sodium and chloride content, and C-D to BUN and serum potassium content. In hyperkalemic patients administered with sodium cycle resin, improvement of C-D was associated After dialysis, improvement of C-D was seen with reduction of blood pH to the normal. No definite relationships were found between thyroid function and ATR-intervals in uremic patients. From these observations it is assumed that the neuromuscular function is under the direct influence of blood urea and serum electrolytes. 6) From the fact that the amplitude ratio (M-value as the ratio of contraction height to tapping height) is increased in uremia while it is diminished in diabetes, it seems likely that the causes of the neuropathy in the two diseases are not identical. 7) ATR estimation can be used as an aid to detect subclinical neuromuscular disorders in chronic renal failure and to know the metabolic changes in patients on dialysis.

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