Plasma renin activity (PRA) of three different veins (d: affected side renal, i : contralateral renal, p : peripheral vein) were determined in hypertensive patients with 12 renovascular stenosis, 7 renoparen-chymal lesions and 4 control patients. All of 19 hypertensive patients underwent cerrective surgery for hypertension. Those with renal arterial stenosis in whom PRA was significantly higher in the attected side renal vein (>14 ng/ml plasma) than in the contralateral renal and peripheral vein, showing a pattern of d> i≅p, were found surgically curable. Patients with unilateral parenchymal lesions and control patients showed either d, i>p or d≅i≅p, but no d>i≅p pattern of PRA. In such patients operation did not improve hypertension. From these observations it was concluded that the pattern of PRA in the three different venous trees is a good indicator for detecting operative curability in hypertensive patients associated with unilateral renal disorders.

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Divided renal and peripheral vein plasma renin activity (PRA) and it's relation to the onset or course of renovascular hypertension induced experimentally were investigated. Constriction of the unilateral renal artery in the rabbits was produced with the silver clip, the opposite kidney being left intact. Five of the 15 rabbits thus operated showed sustained hypertension, mean arterial blood pressure being more than 150 mmHg 2 months after the clipping. Five showed a transient rise followed by gradual fall in blood pressure, and the rest of 5 no changes. In these all 15 rabbits, PRA was determined in three different venous bloods, d) : clipped side renal, , i) : contralateral renal and p) : peripheral vein. In those with sustained hypertension PRA was significantly higher in the clipped side renal vein than contralateral side or peripheral vein, A(d>i≅p) pattern. On the contrary, rabbits with transient hypertension and no change in blood pressure showed either B(d, i>p) or C(i>d≅p) but no A(d>i≅p) pattern of PRA. The significance of PRA pattern in three different veins in pathogenesis of renal hypertension was discussed. This observation is in accord with the finding obtained in our clinical experience that patients with d>i≅p PRA pattern are surgically curable in renovascular hypertension.

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Fibromuscular dysplasia accompanied with contralateral hypoplastic kidney is relatively rare. The report described here is dealt with the hypertensive woman of 21 years-old. Physically she was found with high blood pressure of 216/134 mmHg, bruit heard on the left upper quadrant of the abdomen, hypertensive retinopathy KW-2 and harelip. Laboratory examination showed proteinuria and slightly impaired GFR. Serum electrolytes were within normal limits. Plasma renin activity in peripheral venous blood was elevated as well as plasma angiotensin-III level in arterial blood, as determined radioimmunologically. Aldosterone secretion rate was not augumented. High renin level was also detected in renal venous blood ; the value of 8.40 ng of angiotension generation/ml/hr in the left was not differed significantly from that of 7.76 ng/ml/hr in the right. On the aortogram, the left renal artery was narrowed with the feature of “string-of-beads” suggesting the fibromuscular dysplasia of the artery and the arteriovenous fibromuscular dysplasia of the artery and the arteriovenous fistula was concomitantly demonstrated in the left kidney. The right kidney was contracted and its main artery was seeming small, which possibly showed the hypoplastic kidney. The descending aorta was also suggested hypoplastic. These findings of the harelip and abnormalities in the aorta and kidneys may be of the genetic origin, Fibromuscular dysplasia and renal hypoplasia are equally responsible to release of renin in excess. It is wellknown that high renin activity in peripheral blood is causatively related to hypertension in renovascular disease. However, the patient was not treated surgically because the both kidneys were involved. Conservative therapy with antihypertensive drugs caused a fall in arterial pressure and the patient is now kept in good control.

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An autopsy case of renal cortical necrosis following total cystectomy and Brickers' operation in a 61 year-old male with recurrent left ureteral tumor, is reported. Following the operation, the patient developed hematuria and his urinary output diminished gradually. In spite of repeated hemodyalysis for 13 times during the period of 24 days of anuria, he died on the 26 th postoperative day. Autopsy revealed complete destruction of all renal cortical tissue, excluding the subcapsular and juxtamedullary zone. Review of the Japanese medical literature revealed that 15 cases were reported up to date, including two survival cases. Some discussionsas to clinical differentiation between renal cortical necrosis and acute tubular necrosis were done. Renal cortical necrosis shoud be suspected if thrombocytopenia, fibrinogenomia and elongation of prothrombin time were present at the onset of acute renal failure and fibrinolytic therapy should be performed before almost fatal intravascular coagulation take place.

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Since Masugi first produced experimental nephritis in 1933, the procedure has undergone various revisions and modifications. In recent experiments, the antigens used are not only the kidney emulsion obtained from animals of other species but also the cortex emulsion obtained from its own kidney or the kidney of the same species, and the glomerular basement membrane of the same and different species. On the other hand, it has been demonstrated that the renal tubular epithelial components also have a severe nephrotoxicity. It has been also confirmed that, apart from the kidney, the administration of heterogenous substances to the host, such as egg-white albumin, and sera and thyroglobulin of animals of other species, can induce experimental nephritis and that appearance of an antibody reacting to one's own thyroglobulin results in experimental thyroglubulinic nephirtis. When these antigens invade the body in some form or other, there must occur a variety of immunological reactions in view of the diversity of the antigens. But these are understood enbloc as autoimmune diseases.

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