Histological examination was performed on the cases of glomerulonephritis, using 108 biopsied and 40 autopsied subjects. Acute glomerulonephritis in children may be considered to be caused by some bacteria and/or its allergic mechanism, having a tendency of healing without any “Schub” in the course of the disease, Chronic glomerulonephritis in children, on the other hand, revealed the changes of chronic type even in the initial stage and ran its worse course than in adults. Nephritis in anaphylactoid purpura was characterized by the focal proliferative lesions in glomerulii and, furthermore, some of them might have developed into the typical lesion of chronic glomerulonephritis. Subchronic glomerulonephritis (KINOSHITA) may be a representative caused by a certain focal infection, and in chronic glomerulonephritis the focal infection, as well as the probable decay of lymphoidd tissues, may play an essential role in the development of this type of the disease. On this occasion renall deterioration may be exacerbated by occasional “Schub”, resulting the contracted kidneys. A possible classification of the glomerulonephritis is presented from a viwpoint that chronic glomerular lesions may be sequel to the phenomenon of “Schub”.

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The single injection-external counting method was used for measurement of renal clearances of ¹³¹I- hippuran (C¹³¹I-hip) and ¹³¹I-sodium iothalamate (C¹³¹I-ioth) in patients with various kidney lesions and/ or urinary tract abnormalities. To the disappearance curve analysis, a one-and tow-compartment models were applied, and the results obtained by each model were analysed statistically, comparing to bladder clearance of each radioisotope measured simultaneously, clearance of p-aminohippuric acid and thiosulfate (CPAH and CThio) determined by a single injection method, and a 24-hour endogenous creatinine clearance (Ccr). The following results were obtained : 1) Correlation between C (one) ¹³¹I-hip and C (two) ¹³¹I-hip was as follows : C(one) =1.32x C(two)-13.24 (r=0.993, p<0.0001, n=31), and therefor the difference between the clearances obtained by each model were large in practice when renal function was normal. 2) C(two)¹³¹I-hip coincided more closely with bladder clearance than C(one)¹³¹I-hip did. 3) C(one)¹³¹I-hip closely correlated with CPAH. Consequently, a two-compartment model proposed for the kinetics of ¹³¹I-hippuran would give reasonable value of the clearance, and the close correlation between C (one)¹³¹I-hip and C^PAH is probably due to the higher value given by application of a one-compartment analysis than true renal clearance of ¹³¹I-hippuran. 4) Correlation between C (one)¹³¹I-ioth and C (two) ¹³¹I-ioth was as follows : C (one) =1.15 X C (two) -5.77 (r=0.991, p<0.0001, n=12), and therefore the difference between the clearances obtained by each model were negligible. 5) C (one)¹³¹I-ioth closely correlated with bladder clearance and Ccr, and agreed well with C_Thio. Consequently, application of a one-compartment analysis is possible to the determination of renal clearance of ¹³¹I-sodium iothalamate that measures GFR. 6) As compared with the clearance measured by external counting technique, potential sources of Merror in bladder clearance was confirmed in patients with urinary tract abnormalities. Unnecessity of urine collection could be of great advantage to this method.

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The Kinetics of broad-spectrum penicillins and cephalosporins in subjects with normal and renal dysfunction was studied to determine the proper dose of these antibiotics in renal impairment. A single intravenous dose of 500 mg of hetacillin, AB-PC, CB-PC, CER, CET or CEZ or 1g oral dose of CEX was load in each subject. Its serum level and urinary excretion were assayed serially. Assay of antibiotic concentrations in serum and urine was carried out by the cup plate method with Bacilus Subtilis PCI 219 as test organism. Human serum was used in standards for determining the concentration in serum, and M/1.5 phosphate buffer pH 6.6 in standards for urine.1) In normal subjects loaded with penicillins, the highest serum level was obtained with hetacillin, andd the lowest and concomitant rapid disapperance from the serum with CB-PC. Within cephalosporins, CEZ showed the highest serum level and CET the lowest. In general, the serum levels of cephalos porins except CET were higher than those of penicillins. Both penicillins and cephalosporins weree cleared out from the serum with 6-9 hours after load.2) In normal sujects, the serum half-life of each of AB-PC, CB-PC, CET and CEX 0.6-0.8 hours andd that of hetacillin about 1 hour. In those with highly impaired renal function, the serum half-life of all these antibiotics was much elongated to 7-22 hours, being 10-20 times of those with normal or slightly impaired renal function. The serum half-life was roughly paralleled to the degree of BUN and GFR.3) The urinary excretion in normal reached rapidly to 1000-3000 mcg/ml and continued the level up to 4-6 hours. In those with severely impaired renal function, the urinaly excretion was low as 50-200 mcg/ml, and lasted much longer.4) The rovers concentration was seen between the degree of renal impairmet and the urinary recovery rate. In normal subjects, the urinaly recovery rate of cephalosporins was larger than that of penicillins.5) The renal impairment was divided in to 5 groups : normal, slightly, moderate, severe impairment and oliguric, and the proper doses of penicillins and cephalosporins in them were mentioned.

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The kinetics of broad-spectirum penieillis and cephalosporins were studied in patients treated with peritoneal and haemodialysis after intravenous, oral or peritoneal load to determine the proper dose of these antibiotics in dialysis treatment. The method used in assays in serum and dialysate was the same as described in previous report.1) The half-life in serum of patients with peritoneal dialysis was almost comparable to that of patients without dialysis. The half-life in haemodialysis, however, was somewhat shorter and comparable to that of moderately impaired renal function. No difference was seen in Kolff and Kiil kidney.2) The recovery in peritoneal fluid after 9-10 hours dialysis was 30% of oral CEX dose and 10-20% of doses loaded intravenously. The recovery of AB-PC and CE was more than that in severly impaired without dialysis in 24 hours urine.3) When an antibiotic was added to dialysate in amount of 62.5 mcg/ml, its peritonal absorption rate was calculated as 30-60% and its serum concentration exceeded 10 mcg/ ml at the end of dialysis. The concentration obtained in peritoneal fluid exceeded the MIC against E. coli, Staphylococcus aureus, Staphylococcus albus and Enterococcus, was considered to be sufficient to prevent the peritoneal infection. However, the serum concentration obtained insufficient for prevention or treatment of infection: other tissues and organs.4) The recovery rate of CET in dialysate of haemodialysis with kolff kidney was 8 %, and the rate of CER and penillins 40%.5) The peritoeal clearance rate of these antibiotics was 1/3-1/4 of that of haemodialysis and the results seemed to well explain the difference of the half-life in serum in dialysis.6) It is concluded that 500 mg dose of hetacillin, AB-PC, CER, CEZ, or CEX was required at the end of haemodialysis in addition to the dose used in severely impaired patients, while no additional antibiotics, was needed in patients with peritoneal dialysis.

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The blood sugar levels and serum IRI (immunoreactive insulin) levels during the 50 g oral glucose tolerance test, were measured to investigate clinically the glucose metabolism in renal failure. Also, the effects on these levels during ordinary hemodialysis and with xylitol dialysate or glucose-free dialysate, were observed. The results were as follows.1) The 50 g oral glucose tolerance test of the patients treated without dialysis revealed higher blood sugar levels than the ones of the patients treated by hemodialysis.2) The serum IRI and FBS levels or the patients treated without dialysis were higher than the levels of those treated by dialysis.3) The blood sugar levels and serum IRI levels increased when the concentration of glucose in the dialysate was increased.4) The serum blood sugar level and IRI level did not fluctuate during dialysis with glucose-free or xylitol dialysate.5) The effects of dialysis on BUN, serum creatinine, uric acid, and the effects on the concentration of electrolytes and on the acid base balance were similar with three dialysates. The clinical data suggest that it would be better to use glucose-free dialysate or xylitol dialysate, when patients with a carbohydrate abnormality due to severe renal failure or with diabetes mellitus, are Treated by hemodialysis.

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Recently, hemodialysis therapy has been popularized in Japan, but little work has been done concerning the study of hemodialysis in the home. We have endeavored to develop a safe, economical and practical.l system of home dialysis. The purpose of this communication is to describe the improvement of the equipment for home dialysis to explain the reduction of the initial and operating costs, and to consider some of the social problems involved. The summary of the paper is as follows :1. In the last three years, we trained five male and two female patients for hemodialysis treatment at home. Each patient spent three to four months in the hospital for the training. Unfortunately, the second patient trained, a medical doctor, died of cerebral hemorrhage. The youngest patient is 17, and the oldest is 53. They have various occupations, and most of themm live a considerable distance from the hospital. In the time since the program started, we have had no fatal or serious accidents, and there have been no severe complications directly related to hemodialysis.2. Our new machine for hemodialysis in the home consists of 300 liter bathtub, an effluent pump box, a head vessel, a main box, and a cart. One big improvement in this machine is that each one of the main parts can be exchanged or replaced separately. In order to stabilize negative pressure, a screw pump is used as an effluent pump. The cost of the machine is about one-third of the ordinary Kiil type machine. The dialysing effect of the new machine is the same as that of the usual type of machine.3. In order to keep expenses down, blood tubes and blood ports are used nine times, and dry chemicals are used.4. The paper emphasises that the cooperation of the patient's personal physician, and the understanding and cooperation of local administrative authorities are absolutely essential to solve the social problems thatt are an obstacle to home dialysis.5. Finally, the merits and demerits of home dialysis are summarized, and once again it is stressed thatt definite policies must be established and enacted to wive the problems of home dialysis.

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Some investigators said that the ACTH stimulated the renin secretion and the juxtaglomerular index by its direct action to the kidney. We sullied the effect of the ACTH on the renin-angiotensin system, especially on the rat plasma renin activity, the rat renal renin content and the rat juxtaglomerular index. And it was investigated the changes of the rabbit plasma renin activity after the streptokinase injected into some rabbits, for the plasmin-activating substance streptokinase was reported to destroy the ACTH. It was resulted that the subcutaneous injection of the ACTH (2 units, Organon) into the rats increased the plasma renin activity (Skinner's method), the renal renin contents (Haas' method) and the juxtaglo-merular index (Hartroft's method). And the slow infusion of the synthetic angiotensin II (Hypertensin, CIBA) decreased all the three measurements maintained the rat carotid mean blood pressure above 130 mmHg. And the streptokinase injection (10, 000 units, Varidase, Lederle) into some rabbits lowered the plasma renin activity compared with the ACTH injection intravenously. Otherwise the injection of the ACTH into the rabbits elevated the plasma renin activity. It was thought that the ACTH could increase the plasma renin activity, the renal renin content and the kidney juxtaglomerular index, and its action was inhibited by angiotensin II through the vasoconstrictive effect of angiotensin II. And so on, we thought that the low plasma renin activity might result in the destruction of the endogenous ACTH, when the plasmin-activating substance streptokinase injected intravenously into the rabbits. So the endogenous ACTH, we thought, had an important role in the renin release from the animal's kidney.

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