Membranous glomerulonephritis reneals pashologically characteristic friedings of immune deposits in renal glomeruli by elecron and immuno fluorescent microscopy. The immune deposits are initially homogenous and electron high dense meteorials in subopithelial layer of the basement membrane and changed gradually into fine granular substances within the electron lucent matrix in the lamina densa. The deposits are assumed to contain mainly IgG and β₁C by immuno-fluorescent microscopy. We observed electron microscopically deposits with variable densities in subepithelial space of the basement membrane and those enclosed by the lamina densa by immuno peroxidase method using anti-human IgG rabbit serum labelled with horse radish peroxidase. Peroxidase positive aggregates were obserned as electron dense materials. Deposits with high density in subepithlial space contained IgG, and substance containing IgG were also observed in the cytoplasm of epithelial cells which were continuous to the former deposits. The fine granular deposits within the lamina densa also contained IgG. In these cases IgG deposits were showed as continuous electron dense products within the fused epithelial cytoplasm just adjacent to the basement membrane. The epithelial cytoplasm along the Basement membrane seems to play a role in deposition of the immune complexes.

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Several kinds of matabolic abnormalities in chronic uremic patients have already been noted. Recently, dialytic therapy has been proven to be an epochal treatment to relieve many patients with severely deteriorated renal functions from uremia. These abnormal metabolisms are also ameliorated in some degree by intensive hemodialysis, but it does not thoroughly cure them. In these disturbances, the long-standing disorader of fat metabolism is one of the most important problems in relation to the pathogenesis of arteriosclerosis. On the other hand, clofibrate (CPIB), an antihyperlipidemic agent, has been used all over the world for more than ten years to treat hyperlipidemic patients. Although the effectiveness of CPIB in primary and secondary hyperlipidemia of other diseases has been noticed, there are contrary discussions on the treatments of hiperlipidemia secondary to chronic renal failure, and what is more, some investigators have reported the untoward effects of CPIB. Here, we describe our experiences of the adverse actions of the drug, which was prescribe to seventeen hemodialyzed cases to treat their hypertriglyceridemia. Twelve (70.6%) complained of the decrease of appetite. General malaise developed in eight (47.1%). Ten (58.8%) had gastrointestinal synptoms. Eleven (64.8%) noticed dryness of the mouth. In this study, it should be noted that all complained of sweet tastes and muscle pains. Sweet tastes, which has not been described as a side-effect of CPIB, were noticed when patients smoked, rinsed out their mouths, and took meals. Its etiolgy could not be clarified. Various degrees of muscle pains, which Langer and Levy named clofibrate-induced "acute muscular syndrome", occurred mainly in proximal muscles of both legs. Severe myalgia led to disturbance of gait in eleven (64.8%). In association with these symptoms S-GOT went up to 100-fold level, CPK to 90-fold level, aldolase to 35-fold level, and LDH to 14-fold level with the inceases of LDH₁ and LDH₂. The other blood studies and the electrocardiograms, however, revealed almost within normal ranges. Microscopic examinations of muscle biopsy specimens showed atrophy, degeneration and vacuolation of muscle fibers without infiltration of the inflammatory cells. These findings indicate the occurrance of a clofibrate-induced acute myopathy. The drug was discontinued in all patients because of onsets of muscle pains by the seventh day. The activities of serum enzymes returned to basal levels one month after stopping medication. Three patients who were suffering from severe myalgias strikingly improved after corticosteroid therapy. Prednisolone, 20mg daily, was administrated for three days and was tapered off. We should emphasize that regular checks of serum enzyme activities may be of values in predicting "acute muscular syndome" induced by GPIB. As the prolonged half-life of the drug is confirmed, the dose of 1500mg may be an over-dose for these patients. Much smaller dose should be given to safely achieve the decrease of serum lipid levels.

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Nineteen out-patients on regular hemodialysis, showing low serum calcium and high alkaline phoshatase, were treated with 1α-OH-D₃ for six months.
1α-OH-D₃ administration was initiated with a daily oral dose of 0.5μg. The dosage was gradually increased at a rate of 0.25μg every two weeks to maintain serum total calcium around lower limit of normal level. The mean maintenance dose was 1.28μg per day.
They showed significant increase in serum total calcium and ionized calcium (whole blood) in parallel with marked reduction in serum alkaline phosphatase. There wese also marked reduction in raised serum immunoreactive parathyroid hormone, and in eight cases it returned to normal. Increase in serum phosphorus was observed, but not significant. The intestinal calcium absorption, which was low initially, rose in five of six patients. Both bone mineral content measured by photon absorptiometry and metacarpal index did not change. Bone survey by X-ray showed disappearance of pre-existed subperiosteal bone resorption, but no change in metastatic calcification, pathological fractures and osteoporosis.
Although we administered relatively low dose to prevent hypercalcemia and its associated symptoms, totaling twelve episodes of hypercalcemia occurred in seven patients, by which time their serum alkaline phosphatase had returned to normal.
We found no significant correlation between ionized calcium and serum immunoreactive parathyroid hormone.
It is concluded that 1α-OH-D₃ seems a useful drug for the treatment of secondary hyperparathyroidism in hemodialysis patients.

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The aim of this study is to study the mechanism in which the uremic toxins affect the renal tubular functions. The experiments were conducted in order to examine the effects of the uremic toxins upon the ATP-ase activity of rabbit kidney cortex microsomal fraction.
1) In Vitro; The deproteinized uremic serum inhibited the total ATP-ase activity of rabbit microsomal fraction. The inhibition, however, was not observed when the deproteinised uremic serum was either absorbed by activated charcoal or dialysed. Furthermore, it was found that the inhibition was specific to the Ouabain sensitive ATP-ase activity.
2) In Vivo: The experimental conditions in which the kidney was exposed to the uremic toxins in vivo were created. Under these conditions the total ATP-ase activity of renal cortex microsomal fractions decreased distinctively, although the decrease was not specific to the Ouabain sensitive ATP-ase activity.
The above mentioned facts suggest two possibilities concerning the mechanism in which the uremic toxins affect the renal functions.
1. The uremic toxins inhibit directly the transport mechanism of renal tubulus by directly affecting the tubular cell membrane and inhibiting its ATP-ase activity.
2. The uremic toxins inhibit indirectly the transport mechanism of renal tubulus by disturbing the circulation in renal cortex.

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The influence of aging on renin provocation test by the intravenous administration of furosemide (1 mg/kg) and 2 hours of upright posture was studied in 54 patients with essential hypertension, ranging from 14 to 68 years. Resting plasma renin activity (PRA) was not affected with aging under 59 years, but markedly reduced over 60 years. PRA after the provocation test was clearly related to aging. There was a significant negative correlation between the two (r=-0.81. p<0.05). Urinary Na excretion and GFR after the provoc tion test were also related to aging. There were also a significant negative correlation between U_NaV and aging (r=-0.81. p<0.01), and between GFR and aging (r=-0.82. p<0.01). The ratio of mean blood pressure (MBP) after the provocation test to resting MBP showed a significantly positive correlation with PRA after the provocation test (r=0.91. p<0.05). Heart rate and urine volume after the provocation test were not affected with aging. The present results suggest that the reserve of renin in the iuxtaglomerlar cells. may be decreased with aging in essential hypertension.

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Proteinruria and albuminuria were generally identified, but strictly speaking it was necessary to distinguish between each other, as tubular proteinuria consisted with partially sulfosalicylic acid negative urinary proteins. In gel-filtration study, albumin was precipitated by sulfosalicylic acid and total urinary proteins were almost precipitated by phosphotungstic acid. For this above stated results, sulfosalicylic acid negative urinary proteins were seemed to be able to estimate by our new simple modificated method of Lippman, that sulfosalicylic acid shepositive proteins subtruct from phosphotungstic acid positive proteins (total urinary proteins), by vky-Stafford tube (PTA method). Sulfosalicylic acid negative urinary proteins estimated by PTA method have no significant correlation with sulfosalicylic acid positive urinary proteins (albuminuria), but have significant correlation with urinary mucoproteins estimated by Anderson-Maclagan method, which are regard as tubular urinary proteins, and with urinary osmolality in normal subjects. There fore PTA method is thought to be a very simple and useful diagnostic tool for detection of glomerular and tubular proteinuria, as screening test or semiguantitative estimation.

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The following conclusions concern about the chronological changes of cardiovascular abnormalities in seventy-two patients on long-term hemodialysis (H.D.). The clinical observations included here were on blood pressure, ECG abnormalities, cardiothoracic ratio (CTR) and aortic calcification seen on chest film, vascular calcification of the peripheral blood vessels and pulse wave velocity of the aorta.
1. Blood pressure was well controlled by H.D. and was stabilized in longer dialysis period, resulted in decreased incidence of hypertensive patients.
2. CTR was decreased and stabilized in longer dialysis period, with no tendency of its increase except age group over 60 years old. The incidence of patients with CTR above 50% on H.D. lasting more than six years was 17 % of the patients, although these patients showed large CTR before the institution of H.D.
3. Sv₁+Rv₅ on electrocardiogram (ECG) showed 34.8±12.7mm at the onset of dialysis treatment, and temporary increase in the length of one or two years and then the same value as in the onset of H.D.. Incidence of patients with Sv₁+Rv₅ on ECG above 35mm was 47.5% at the institution of H.D. followed by no increase after the above period. These results suggest left ventricular hypertrophy (LVH) may not progress in the course of H.D.. ECG abnormalities with LVH were seen in half of the patients at the onset of dialysis treatment, which suggest that blood pressure control is of great importance before the institution of H.D..
4. ECG abnormalities with ST and T changes were seen in 41.7% of patients at the onset of dialysis treatment, which showes subsequent decrease in one year, and increase again thereafter. The appearance of patients with myocardial infarction, anginal episode and arrhythmia in the course of dialysis treatment suggest coronary atherosclerosis may progress insidiously.
5. Pulse wave velocity of the orta showed no significant changes suggestive of the advancing atherosclerosis, and the radiographic findings of the aortic calcification and vascular calcification of the peripheral vessels showed gradual increase of the incidence in the course of dialysis treatment, which may reflect the rapid progress of the vascular lesions.
6. The characteric features of the above items by age groups and chronological changes were that the aged patients manifest the high incidence in all of them with its increase in the course of dialysis treatment. It should be stressed the aged patients may develope and deteriorate the cardiovascular abnormalities.

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