Twenty one paired samples of the sera and the plasma from the hemodialyzed 9 patients with chronic renal failure were collected. Titration of total complement activity was performed on these samples and the following results were obtained. 1) Total hemolytic complement activity was reduced by hemodialysis and the percentage of the reduction was 4.7% on an average. 2) Upon frequent hemodialysis, the percentage of the reduction ran into 15%. From these findings, it seems that influence of hemodialysis given to the complement system should not have to be disregarded.

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The present study was undertaken in an effort to elucidate the complex relationship between hyperension, renin, sodium and water balance in patients with chronic renal failure treated by hemodralysis. Thirty-nine patients were studied. They were divided into 3 groups according to the duration of dialysis: group I, 18 patients dialysed for 1-9 months; group II, 12 patients for 10-19 months; and group III, 9 patients for more than 20 months. Plasma renin activity (PRA) in peripheral vein blood was estimated radioimmunologically. The dialysis was carried out in a closed system against 50 L dialysate fluid, so the amounts of water, sodium, and other solutes dialysed-out from the body were easily measured. There proved a significant correlation between PRA before dialysis (pre-dialysis PRA) and the removed sodium/water ratio (removed sodium/removed water) obtained by the preceding dialysis in patient with long-term hemadialysis (group III). There was no correlation between PRA after dialysis (post-dialysis PRA) and removed sodium, or removed water; or the removed sodium/water ratio in all 3 groups. PRA ratio (pre-dialysis PRA/post-dialysis PRA) was correlated to the removed sodium/water retio in all cases, but the correlation was closer in the long-term dialysis patients (group III). The increase in PRA in relation to the removed sodium/water ratio tended to be high in the initial stage (group I), and become stabilized at a low value as the duration of treatment was prolonged (group III). From these results, it seems that the most important f acor regulating renin release is the removed sodium/water ratio.

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Twenty percent of essential hypertension have low resting plasma renin acitivty (PRA) and fail to increase it normally in response to sodium restriction and standing. It is, therefore, very difficult to differentiate them from primary aldosteronism. In the present study, PRA after load of low sodium diet, spironolactone (400mg per day) and hydrochlorothiazide (75mg per day) for 3 days was measured in 18 patients with primary aldosteronism who were cured later by the removal of adrenocortical adenoma and in 28 patients with low PRA essential hypertension. The estimated mean PRA values and SE in primary aldosteronism were 8.4±1.9ngjml at sest and 18.2±3.8ng/ml after upright posture. On the other hand, 5 timer greater response of renin secretion was obrerved in essential hypertension. The mean PRA values and SE were 58.8±5.3ng/rril at rest and 94.1±7.5ng/ml after upright posture. In this provocation test, 90% of low PRA essential hypertension were diescriminated from the patients with primary aldosteronism.

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We studied catecholamine levels in the urine or in the ultrafiltrate extracted from the blood of the patients with chronic renal failure in order to elucidate hypertension in renal failure.1. Urinary excretion of catecholamines in these patients was found to markedly reduce. Twenty four-hour excretion of catecholamines in 7 patients without dialysis were as follows; norepinephrine (NE) : 3.5±2.1 ig/day; epinephrine (E) : 3.0±1.4 and NE +E : 6.5±1.4. Daily excretion of NE and E in 17 healthy subjects aged from 19 to 40 years were 17.8±2.8, ug/day and 7.3±1.4, respectively.2. Reduced excretion of catecholamines in these seven patients well correlated with elevated systolic blood pressure as well as increased levels of BUN. The corelation coefficients were-0.45 in systolic blood pressure and -0.74 in BUN levels using distinct reciprocal plot analysis.3. Patients treated with regular dialysis were divided into two groups : one was normotensive and the other hypertensive (above 180nmHg of systolic blood pressure). The occurrences of hypertension and elevated NE levels in the ultrafiltrate extracted from the blood of "hypertensive group" were observed to appear 48 hours after the treatment of dialysis and were not observed immediately after 4 hours dialysis. NE and E contents in the ultrafiltrate extracted from the blood of normotensive patients were 0.5±0.lpg/L and 1.1±0.2, ug/L, respectively. However NE contents in the ultrafiltrate extracted from the blood of hypertensive patients were significantly higher (NE: 3.6±1.1μ/L, E:1.4pg/L) than that of normotensive patients. There is also a significant correlation (0.84) between this NE content and systolic blood pressure. In conclusion, our results indicate that catecholamines, especially NE appear to play important role on the occurrence of hypertension in chronic renal failure.

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The effects of fibrinolytic therapy of urokinase have been studied in 14 patients with chronic renal disease (8 patients with glomerulonephritis and 6 patients with nephrotic syndrome). Each patient was given by intravenous injection in a dose of 18, 000 I. U. of urokinase twice daily for 5 days, and 6, 000 I. U. of urokinase twice daily for following 5 days. After this therapy each patient was given 2, 700 mg of dextransulphal e per day. The effects of urokinase therapy were evaluated by the extent of decrease in proteinuria four weeks after beginning of the therapy. Four cases were improved, 3 were slightly improved, 3 were slightly improved and the other were not improved. In the improved patients, pretreatment findings were manifested by excessive proteinuria, hypoalbuminemia, high serum cholesterol and j3-lipoprotein values, raised plasma fibrinogen and lower normal serum FDP level. Their histological findings revealed mild or moderate prolif erative glomerulonephritis. The deterioration of clinical appearance and side effects were rot found with this therapy.

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