A thirty-one year old female with typical primary aldoseronism caused by bilateral adrenal adenomas is presented. She was admitted because of benign hypertension and hypokalemia after her second delivery. Plasma renin activity was suppressed, even after sodium deprivation and making her maintain an upright posture after furosemide' administration. Plasma aldosterone and the excretion rate of urinary aldosterone were elevated. Plasma cortisol Concentration and urinary excretion of 17-OHCS and 17-KS were persistently normal. The presence of bilateral aldosteronomas was demonstrated by the following methods before surgery. The right-side adrenal tumor was showed by retroperitoneal pneumography. The bilateral aldosteronomas were revealed by adrenal phlebogram, measurement of the aldosterone concentration in adrenal venous plasma and calculation of the ratio of aldosterone to cortisol inadrenal venous plasma, respectively. Following bilateral adrenalectomy, histologic examination revealed bilateral adenomas, and No hyperplasia was found. Her blood pressure, serum potassium and general condition improved after surgery, and the adrenocortical function of the remainding two thirds of her left adrenal gland was normal.

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Abnormal lactation was observed in uremia female patients on regular dialysis treatment (RDT). Endocrinological studies were performed in these patients especially on serum Prolactin levels in comparison with uremic patients without abnormal lactation (N=120) and with normal controls (N=27) In 51 uremic females, 5 patients exhibited abnormal lactation not attributable to pregnancy, delivery and breast feeding (inappropriate lactation syndrome, ILS). Mean age of ILS patients was 37. The lactation appeared 5-18 years after her delivery as the progression of renal failure. Amenorrhea was observed in most of ILS patients during lactation period. Lactation showed progressive decrease in the course of RDT. High basal serum LH level in uremics (60.6±13.9mIU, N=15) was observed. LH response to LH-RH infusion was remarkaby disturbed in ILS patients and this response recovered in accordance with dinnunition of lactation and reappearance of regular menstruation cycle. Basal FSH levels were almost within normal range, while FSH response to LH-RH infusion was suppressed. Estradiol in amenorrheal and lactating patients was 28.5±7.9pg/ml and was significantly lower compared to uremic patients with normal cycle (143.3±32.3pg/ml, luteal phase). From these data, it can be suggested that there is a primary dysfunction of ovary in uremics, especially with ILS. Basal TSH levels were within normal range. TSH response to TRH infusion was remarkably disturbed in lactating period. Hypothalamo-pituitary dysfunction was also suspected. Serum prolactin levels (male : 36.0±3.2, female : 62.8±6.5ng/ml) of uremics were significantly higher than normal controls. Amenorrheal and ILS patients showed both significantly higher values than normal cycle uremic females. Long-term RDT and single hemodialysis showed no effects on serum prolactin levels, but slight reduction by single performance was observed in a few cases. The single dose administration TRH, L-dopa and CB-154 to ILS patients caused no changes on serum prolactin levels. Long-term medication with of CB-154 was only successful in diminishing lactation. In conclusion, hyperprolactinemia, and overian and hypothalamopituitary dysfunction can be regarded as common disorders in end stage renal failure, and as one of its manifestations, ILS appeared in uremic females.

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This study was undertaken to confirm the clinical effects of the supplement of eight essential amino acids and histidine on patients with chronic renal failure. In patients with a moderate chronic renal failure (Ccr 5-15ml/min), the preparation of essential amino acids (defined by Rose) and histidine was administered intravenously or orally under a low protein (0.5-0.6g/kg/day) with high calories (2, 000 Cal.) diet.1) In twenty patients, the supplement of essential amino acids and histidine resulted in improvement of nitrogen balance, decrease of blood urea nitrogen and elevation of serum albumin level.2) By administration of essential amino acids and histidine, productions of methylguanidine and guanidinosuccinic acid significantly decreased in twelve patients.3) In order to estimate prognoses both the supplement of essential amino acids and histidine (30 cases) and the low protein diet alone (56 cases), the statistical calculation was done with the Markov process. The expected average months from each state of serum creatinine level (5, 6, ..., 11mg/100ml) to the end state (serum creatinine ≥ 12mg/100ml, absorbing state of Markov process) was prolonged by the supplement of essential amino acids and histidine than a low protein diet alone, for example, when the initial state was 5.0-5.9mg/100ml of serum creatinine concentration, the difference between both groups was about 8.3 months. Thus, a low protein diet with eight essential amino acids and histidine supply for patients with chronic renal failure accelerates protein synthesis, probably by facilitating a utilization of endogenous nitrogen, and corrects abnormal nitrogen metabolism which are suggested by the decreases of blood urea nitrogen and production of methylguanidine and guanidinosuccinic acid. Also this therapy could markedly prolong the duration of a conservative management by the estimation of the Markov process.

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Seventy cases which had no evidence of renal disease or had no effect on the kidney were selected out of 6224 autopsy cases ranging from birth to ninety years of age were examined histologically to clarify renal changes with age. Glomerular size increased rapidly until the 2nd decade and was the largest in the 3rd decade. Glomerular size in each zone of renal cortex demonstrated the largest in the inner zone and smallest in the outer. A few hyalinized glomeruli, Bowman's capsular thickening and collapsed glomeruli appeared already in the first of the 2nd decade in the inner zone. Those glomerular changes were rarely found in the middle and outer zones, but occasionally from the 3rd decade. After the age of 45 years, two groups were divided, in one those changes increased gradually, in the other these rapidly. Crescent formation and tuft adhesion to Bowman's capsule were very rarely observed in few cases. Localized tubular atoropy with interstitial increase in cortex and diffuse interstitial increase in medulla were parallel to the glomerular changes. Granules of lipofuscin like pigment in distal tubules were found in young people, but those were more extensive in adult. It is possible that the renal changes may contain inapparent pathological in addition to physiological processes. It is suggested that the glomerular, tubular and interstitial changes may be concerned with sclerotic changes of renal arteries acoording to age.

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The urinary excretion of fibrin/fibrinogen aegradation products (FDP) were examined by the method of the tanned red cell hemagglutination inhibition immunoassay (TRCHII) in 140 patients with the primary glomerulonephritis without nephrotic syndrome.The results obtained are as follows:(1) More than 4 μg/ml of urinary FDP was regarded as positive (Table 1). Five of ten patients with acute glomerulonephritis, seven of 75 patients with smoldering form of chronic glomerulonephritis (smoldering form) and, 13 of 33 patients with progressive form of chronic glomerulonephritis (progressive form) showed positive results.(2) In comparison to the smoldering form the blood urea nitrogen levels, serum cholesterol and fibrinogen levels were higher in progressive form.(3) In acute glomerulonephritis and smoldering form IV Type the excretion of urinary FDP did not always correlated with the activity of glomerulonephritis, judged by the histological findings, hematuria with proteinuria in excess of 1g per 24 hours, or serum complement levels.(4) The urinary FDP excretion did not correlated with fibrin on immunofluorescent and electron microscopy(5) In comparison to the urinary FDP-negative cases of the progressive form, the positive cases showed more decreased renal function.(6) The values of serum FDP mesured by TRCHII in 102 patients were all within normal limits and did not correlated with the amount of urinary FDP.

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This report gives the following clinical evaluation on the hemodynamic study in regular dialysis treatment (RDT).1. Cardiac output was increased in chronic dialysis patients, due to anemia, increased venous return from subcutaneous A-V fistula and excess of body fluids. It was normalized by improved anemia, occlusion of A-V fistula and removal of fluid excess by hemodialysis (HD).2. There was no significant difference of cardiac output between the normotensive patients ana the hyper-and hypotensive patients. Peripheral vascular resistance (RVR) was increased in hypertensive patients than in normotensive patients, and was decreased in hypotensive patients than in normotensive patients. This suggested that the increase in PVR produced the high blood pressure and the decreased PVR did the reverse.3. The cardiac reserve in pulmonary congestion could be impaired, due to hypertensive cardiac changes (hypertrophy and/or dilatation) and myocardial injury, based on the following observations. The hemodynamic changes were studied before and after HD. Cardiac output in patients without pulmonary congestion was reduced significantly after HD, while in patients with pulmonary congestion cardiac output was usually increased after the correction of fluid excess by HD, showing no significant differences between them. Mean blood pressure of patients with pulmonary congestion in both pre-and post-dialytic readings was above that of patients without pulmonary congestion in pre-dialytic reading. Although the cardiothoracic ratio (CTR) was decreased significantly in the two groups, CTR of patients with pulmonary congestion remained above 50% even after HD, which was greater than the pre-dialytic value of patients without pulmonary congestion. This suggested the cardiac impairment including hypertrophy and dilatation might be the cause in patients with congestion.4. Cardiac function was studied analyzing the left ventricular conduction time, which disclosed the prolongation of Q-IIai and ICT in the two groups (with and without pulmonary congestion) compared with the controlled group. These abnormalities were not significant between the two groups, suggestive of the impaired myocardial function of them. Normalization of prolonged Q-IIai, shortening of ETi and increased PEP/ET ratio were noted after HD, suggesting that the myocardial function was suppressed in RDT.

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The efficative method and technique of dialysis using Hollow Fiber Artificial Kidney (HFAK) was investigated. Various properties of HFAK dialysis was gained by applying to the patient with chronic renal failure and by using the self-made apparatus of single fiber taken out from HFAK. Clearances of various electrolytes (Na, K, P) and non-electrolytes (urea, creatinine, uric acid, amino acids) were higher than those with another available dialyser. Unbiaced distribution of blood inside the dialyser was confirmed by both total clearance of HFAK and single fiber clearance, suggesting that total surface area worked effectively. Ultrafiltration rate was correlated to transmembrane pressure with the correlation of 0.97 (CDAK 0.9) . Fiber handle obstruction (%) of HFAK was calculated by measuring both the blood flow and the pressure drop during dialysis. Discontunuation of dialysis was decided, if ever, by fiber bandle obstruction (%) calculated from the blood flow and the pressure drop. Solute clearance was negatively and lineally correlated to the molecular weight, therefor, the larger the molecular weight the smaller the clearance. The respective solute clearance was decreaced as the dialysate flow was lowered. % decrease in solute clearance was negatively correlated to molecular weight of the respective solute. Net-flux of Na and K in HFAK were increased by raising blood flow and/or the concentration gradients of Na and K between the blood and dialysate. The sieving coefficients obtained from the so called Ultrafiltration method were apporoximately 100% in the various solutes such as amino acids, urea and creatinine, however, 13% in even inulin (MW 5200) Permeability ratio of CA membrane to CU membrane (CA/CU) was correlated to the molecular weight, Provided that middle molecular substances worked as the uremic toxins, the dialysis with CA membrane might be more efficative than CU membrane to restore the condition of uremia.

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