By measuring the antibody avidity to native DNA (n-DNA), was investigated the relationship between the histological activity of lupus nephritis and the antibody avidity and were discussed. the factors determining the localization of immune complexes in the kidney tissues. Amounts of anti-n-DNA antibody and the antibody avidity to n-DNA were measured in systemic lupus erythematosus (SLE) sera by the method of Minden and Farr, using tritiated actinomycin D-DNA as antigen. The histological activity of lupus nephritis was divided into 3 groups; active, inactive group and the group without urinary abnormalities, followed by the criteria of Pollak et al.1. The antibody avidity to n-DNA was almost less than 40%.2. The relationship between the histological activity of lupus nephritis and the avidity of antibodies showed a good correlation. The avidity of active group was relatively higher than that of inactive group and the group without urinary abnormalities.3. No paralletism was demonstrated in the relationship between the amounts of anti-n-DNA antibodies and the histological activity of lupus nephritis.4. The relationship between the localization of complexes and the antibody avidity was studied. In the group with high avidity of anfibodies, the deposits both in the subendothelium and mesangium were the main changes. In the group with low avidity antibodies, the deposits tended to be localized in the subepithelial side of glomerular basement membrane (GBM).5. The complexes composed of high avidity antibodies were larger than those of low avidity and the former was greater than 19 S, which was more prone to deposit in the glomeruli. If the n-DNA-anti-n-DNA system were the mechanism basic to lupus nephritis, the differe-nces in immune response of the host, namely the degree of antibody avidity may affect greatly complexes formation and influence upon the histological activity and nephritogenecity of lupus nephritis.

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Forty-seven cases with chronic glomerulopathies were treated with indomethacin for the periods ranging from 7 to 330 days (58 days in average). The dosage was 75 to 250mg/day, 75 to 150 mg/day in most cases. The antiproteinuric effect was evaluated as follows: Complete remission (disappearance of proteinuria), incomplete remission of srade I (reduction of proteinuria below lg/ 24 hr in the cases of nephrotic syndrome and below 25% of the initial proteinuria in non-nephrotic cases), incomplete remission of grade II (reduction of proteinuria, but over 1g/24 hr in nephrotic cases and reduction to 26%-70% of the initial proteinuria in non-nephrotic cases), and no effect. 1) In the cases in which the drug was effective, proteinuria began to decrease on the second day and reached to the lowest level on about 7th day. The effect did not diminish throughout the period ranging from 17 to 47 weeks, except in the cases with decreased renal function. The increase of the drug dosis brought an increase of the effect in some cases of lobular GN and chronic diffuse proliferative GN. 2) There was no correlation between the effect and the PSP-excretion rate. The drug had the tendency to be more effective in the cases with lesser proteinuria. 3) Complete remission or incomplete remission of grade I was obtained in 84% of non-nephrotic cases of post-acute chronic GN, in 61% of non-nephrotic cases of primary chronic GN, in 40% of nephrotic cases of post-acute chronic GN, in 30% of nephrotic cases of primary chronic GN. No effect was observed in 3 treated cases of pure nephrosis. 4) Histologically said, complete remission or incomplete remission of grade I was obtained in all cases of lobular GN, in 53% of chronic diffuse proliferative GN, in 17% of idiopathic membranous nephropathy. Little favorable effect was obtained in membranoprolif erative GN and minimal change nephrosis. 5) In 18 cases slope Θ was measured before the regimen. Favorable effect was observed in 15 cases of 16 cases with slope Θ of 16° to 66°, namely of low, average and intermediate selectivity. These results differ from those obtained by corticosteroid regimen. There was no significant correlation between the degrees of Θ and the effect of the drug. In 8 of 10 cases in which the drug was effective, slope Θ was increased during the drug administration. 6) Glomerular immune deposits were observed both in the cases with benefitical effect and in those witout it. Patterns of deposition of IgG, A, M, β1C/1A and fibrinogen had no correlation to the effect of the drug. 7) The resullts described above suggest that the drug is indicated to nephrotic and nonnephrotic cases of post-acute chronic GN and non-nephrotic primary chronic GN. Light-microscopically, the indication is to lobular GN and chronic diffuse proliferative GN. The favorable effect may be expected in the cases with glomerular immune deposits and with slope Θ of less than 67°. For idiopathic membranous nephropathy and membrano-proliferative GN, the effect is of low grade and low frequency.

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Percutaneous renal biopsy was performed on two patients of chronic hepatitis with persistent HB antigen. In both cores symptoms of oedema, proteinuria and hematuria were predominant. Renal biopsy revealed diffuse thickening of the glomerular basement membrane. By immunof luorescent staining of glomeruli IgG, BIC and HB antigens were observed as coarse granular deposits along basement membrane and within the mesangium. Electron microscopic study showd epimebranous and intramembranous electrondense deposits along the capillary loop and within the mesangial matrix. By high magnificated micrographs of the basement membrane spherical particles measuring 200-400 Å were clearly demonstrated. These findings suggest that the HB antigen is related to the pathogenetic mechanism for development of membranous glomeulonephritis in patient of chronic hepatitis.

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While steroid-responsive nephrotic syndrome of childhood readily remits, it is likely to relapse and, accordingly, its long-term prognosis is usually unpredictable and in many remains to be clarified. In view of this, a long-term follw-up study was made of 68 children with steroid-responsive nephrotic syndrome in terms of renal function and histopathology. The results are summarized as follows :-1. The study population was 68 children in whom steroid therapy brought about complete remission. The male: female ratio in this series was 54 : 14 and the distribution of age at onset was similar to hithertofore reported series, the peak frequency being found at 4 years.2. Detailed study of the series showed that relapse tended to occur frequently during 3 years after onset of the disease, while in 10 years after onset there was an increasing proportion of cases showing complete remission and many cases became free of relapse. Four children died during the study period, the presumed cause of death being fulminant hepatitis in one and concurrent infection in the other 3 (hence unquestioned renal failure in none).3. In all the subjects but one, there was no evidence of gross depression of kidney funtion noted on several function tests (P. S. P. test, Fischerg's concentration test and endogenous creati.nine clearance) inclusive of serum creatinine and urea nitrogen levels, None of the subjects were found to have any progressively diminished funtion of the kidney during a prolonged follow-up period. It was felt, therefore, that steroid-reponsive nephrotic syndrome of childhood, except in some small proportion of cases, is almost unlikely to progress to renal failure even after repearing relapse, in contrast to the nephrotic type of chronic nephritis in which case a state of renal failure usually is reached by 23 years of age.4. Microscopic study of renal biopsies of 13 subjects revealed 5 to have minimal changes and the remaining 8 to have slight to moderately sever proliferative dhages mainly in the mesangium. In 2 cases, the findings were those of a globar focal glomerular sclerosis brought about complete associated with hyalinosis of entire glomerular tufts. In all of these cases, steroid therapy remission of symptoms, proving to be of therapeutic benefit. A comparison of the distribution of histo pathological changes showed that the frequency of proliferative changes was somewhat higher in our present series those reported hithertofore. A study was furtherr made of the clinical course in relation to the histopathological findings. The results indicate there were instances in which histological changes continued to be minimal for more than 10 years during which time relapse occurred in repeated episodes while in others, considerable changes with hyalinosis in some glomerulus, were noted relatively early after onset of the diseases. This finding suggets that the histopathological changes observed in steroid responsive nephrotic syndrome are less likely to progress in severety, 5. However, in one case following up for 24 years where histological changes in kidney have remaind minimal for 10 years after diseases onset, the patient has several bouts of proteinuria with presumptive evidence of slight decrease of kidney funtion. The possibility that the patient with minimal changes in the kidney, if persistent in for long time, might be resulted in progressive impairment of renal function later in life cannot therefore be ruled out. The results of the present study strongly indicate the necessity of conducting further long-term follow-up studies of a larger group of cases involving careful clinical observation and detailed laboratory evaluation.

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