The Japanese Journal of Nephrology
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
Volume 21, Issue 11
Displaying 1-9 of 9 articles from this issue
  • Multiclinic Double Blind Test
    Yasushi UEDA, Shizuo TOJO, Michinobu HATANO, Toshiyuki FURUKAWA, Kaoru ...
    1979 Volume 21 Issue 11 Pages 1171-1183
    Published: 1979
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Dipyridamole (Persantin) 300 mg/day, or its placebo were administered for 4 weeks to the nephrotic syndrome who had been treated by corticosteroids and their effects were compared by double blind method. 1) General improvement rate of Persantin (88.2%) was significantly (p<0.05) higher than that of placebo (46.7%) in steroid unresponsive nephrotic syndrome group. 2) As to urinary protein decreasing effect indicated by average decreasing rates of urinary protein in a week, the effect was better in Persantin group than in placebo group in the 1st and 2nd week. The same results were confirmed more evidently in the steroid unresponsive nephrotic syndrome group and also in those patient except minimal changes in histological classification. 3) As to the endogenous creatinine clearance, Persantin group showed a significantly large increase, compared with placebo group. 4) As to serum cholesterol level and triglycerid level, Persantin group showed a bigger tende-ncy to decrease, compared with placebo group. 5) As for side effects, headache, palpitation, nausea, retching, and others were observed in Persantin group. However, these were not serious and disappeared after discontinuation of administra-tion of the drug.
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  • Toshio Ogihara, Anna Maruyama, Hiroshi Mikami, Toru Naka, Jitsuo Higak ...
    1979 Volume 21 Issue 11 Pages 1185-1192
    Published: 1979
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Effect of a single dose of captopril on blood pressure and the renin-angiotensin-aldosterone (R-A-A) system was evaluated in 0 normal subjects and 11 hypertensive patients with various etiologies. Captopril was administered orally to normal healthy subjects and hypertensive patients on unrestricted diet. Blood pressure was monitored for 4 hours. Blood was drawn at 0, 30 min., 1, 2, 3 and 4 hours for analysis of plasma renin activity (PRA), angiotensin I concentration (AI) and aldosterone concentration (PAC). Angiotensin II analogue (AIIA) test was done in each sub-jects after sodium depletion (40 mg f urosemide administration daily and mild sodium restricted diet for 3 days) Captopril in a dose of 100 mg caused no blood pressure change, increased PRA, AI and decreased PAC in normal subjects. When captopril was administered to patients with renovascular or malig-nant hypertension, blood pressure fell significantly for 4 hours, PRA and Al increased and PAC decreased for 4 hours. In low reninemic patients these paramenters showed little change. In all the subjects studied, change in mean blood pressure was inversely correlated with pre-treatment PRA value (y=-1.4×-2.8, r=0.85, p>0.001). Magnitude of blood pressure reduction by captopril was significantly correlated with that induced by angiotensin II antagonist (y=0.8×-5.0, r=0.93, p>0.001). From the results obtained, it is concluded that the acute blood pressure lowering effect of captopril in hyperreninemic hypertensive patients closely related to its effect on the suppression of R-A-A system. It may be useful to monitor the acute phase response of captopril to provide a prediction for the effectiveness of long term treatment of hypertension.
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  • Katsunori Sawada
    1979 Volume 21 Issue 11 Pages 1193-1205
    Published: 1979
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    The metabolic disorders in the erythrocyte of the patients with chronic renal failure were investigated in the aspect of adenine nucleotides metabolism, and the following results were ob-tained. 1) ATP content of uremic erythrocyte was increased. 2) Biosynthesis of ATP from adenine was activated in uremic erythrocyte, and this was con-sidered to be caused by a high ATP level in uremic erythrocyte. 3) Both intra- and extra-cellular accelerating factors which activated biosynthesis of ATP in uremic erythrocyte were demonstrated. 4) These factors could not be dializable by the procedure of regular hemodialysis. 5) Extra-cellular factor was mainly detected in the low molecular weight fraction (less than M.W.10, 000) in uremia serum, and this factor was impossible to identify with so-called uremia toxins, 6) Intra-cellular factor was also detected in the low molecular weight fraction (less than M.W. 10, 000) in uremia erythrocyte, and this factor was heat stable and was not soluble in the Folch's solution. These obtained results indicate the limit of the present hemodialysis, and receuire the develo-pment of new treatment based on the view point of biochemical disorder for chronic renal failure.
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  • -Histological and clinical study in 13 Cases-
    Takao Saito, Takashi Furuyama, Yasuhiko Sasaki, Yoshio Kyogoku, Yoshio ...
    1979 Volume 21 Issue 11 Pages 1207-1218
    Published: 1979
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Out of 1500 cases examined by biopsy in our clinic, 13 cases were diagnosed as focal glomerulo-sclerosis (FGS) because of more than three (>10%) sclerotic glomeruli with hyaline deposits in their biopsy specimens. Clinically, 11 patients had nephrotic syndrome and the other 2 patients had hypertension. All patients were resistant to the therapy, and 4 patients took downhill courses to renal insufficiency. The glomerular sclerosis index (G. S. I.) and the tubular atrophy index (T/S) respectively devised by us were mesured in every biopsy specimen. There was a statistically significant cor-relation between them (r=-0.78, p<0.001).T/S indicated lower values in most of the FGS cases than in the control cases (chronic glomerulonephritis and idiopathic nephrotic syndrome except FGS) whereas the creatinine clearance were nearly equal in the two groups. It is likely that this finding is due to hemodynamic abnormalities frequently occurring FGS patients with nephrotic syndrome or with hypertension.
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  • Xoshihide Uraoka
    1979 Volume 21 Issue 11 Pages 1219-1230
    Published: 1979
    Released on J-STAGE: March 01, 2011
    JOURNAL FREE ACCESS
    UItrastructural studies of membranous nephropathy and proliferative glomerulonephritis were performed by an electron-immunoperoxidase method. PLP (periodate-lysin-paraformaldehyde) fixa-tive solution preserved the antigenicity of IgG and IgA, and the ultrastructure of the renal glo-merulus well. The peroxidase-labelled Fab' fraction of IgG penetrated well into the mesangium matrix and the basement membrane of the renal glomerulus of the frozen section specimen (6μm), but the peroxidase-labelled IgG did not penetrate into either tissues. In membranous nephropathy, IgG deposits were recognized mainly in the subepithelial space and were also present in the subendothelial space of the glomerulur basement membrane and other points (lamina densa, endothelial cell membrane and polynuclear leucocyte cellular surface). The combination method using PLP fixative solution, peroxidase-labelled Fab' fraction of IgG and frozen section method (6μm) can be used with reliability to identify the localization of im-munoglobulins in the renal glomerulus.
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  • Kazuo Nigawara, Yuji Yagihashi, Toshiari Kogawa, Asao Kawamata, Kanemi ...
    1979 Volume 21 Issue 11 Pages 1231-1242
    Published: 1979
    Released on J-STAGE: July 04, 2011
    JOURNAL FREE ACCESS
    Angiotensin II antagonist (AIIA, 1-Sar-8-Ala-Angiotensin II) in the range from 0.5 to 5.0 tcg/ kg/min was infused to 27 patients with chronic renal failue (CRF) who received hemodialysis to investigate the role of plasma renin activity (PRA) in manintaining blood pressure. 1. In six out of seven cases of high renin group with PRA value above 3.0 ng/ml/hr in the control period, a remarkable hypotensive effect was observed, lowering the systolic pressure by 18-30 mmHg. This hypotensive effect had no relation to the blood pressure of the control period. At the end of infusion, PRA increased about 1.7 times while plasma aldosterone concentration (FAG) decreased to half of the control value. 2. In nine out of 16 cases of normorenin group with PRA value 1.0-2.9 ng/ml/hr, a distinct hypotensive effect was observed lowering the pressure by 15 mmHg and over. PRA value was 2.0+0.6 (Mean+S. D.) ng/ml/hr in the control period. After AIIA infusion PRA increased and FAG decreased, and this result was similar to high reamn group. In other seven cases, which showed little change in blood pressure, PRA value was 1.4±0.4 ng/ml/hr in the control period and exhibited no notable change during AIIA infusion. However, PAC values were varied and did not indicate a specific trend. 3. In two out of four cases of low renin group with PRA value less than 1.0 ng/ml/hr, blood pressure slightly elevated by AIIA infusion. In other two cases, blood pressure showed no change. On the other hand, as in normorenin group PAC values varied and did not show any trend. 4. A negative correlationship was observed between PRA in the control period and maximum rate of the systolic pressure during the AIIA infusion. 5. A positive correlationship existed between PRA in the control and recovery period. The relationship, however, diminished as the amount of AIIA infusion was increased. From the above results, we conclude that in CRF patients PRA levels exceeding 2.0 ng/ml blood pressure is maintained by the renin-angiotensin system whether high or low. At the same time, the FAG level also depends mainly on the renin-angiotensin system.
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  • Shoichi Ueda, Kazutaka Matsushita, Keiichi Ikegami, Matao Sakanashi, K ...
    1979 Volume 21 Issue 11 Pages 1243-1249
    Published: 1979
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
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  • Sho Yamasaki, Hiroshi Nakatani, Kenji Kusunoki, Takeyoshi Kawashima, H ...
    1979 Volume 21 Issue 11 Pages 1251-1263
    Published: 1979
    Released on J-STAGE: July 04, 2011
    JOURNAL FREE ACCESS
    The effects of 1-Sar-8-lle-angiotensin II (analogue) on rabbits with acute (11 days after clipping) and chronic (50 days after clipping) two-kidney hypertension were studied, 50 pg or 100 pg bolus of analogue was hand-injected into an ear vein and changes of blood pressure (BP) were observed as a rule for 10 minutes. The rabbits with acute phase hypertension had significantly high peripheral plasma renin activity (PRA) compared to preconstriction values. But PRA returned to preconstriction levels in chronic phase. Seven of 23 rabbits with acute phase hypertension responded to first administration of analogues Only 1 of 23 rabbits with chronic phase hypertension had a high PRA value with marked elevated BP and hematocrit (Ht), and responded to analogue injection. This rabbit showed no elevation of blood pressure in acute phase, so, in this time analogue injection was not performed. In acute phase hypertension, at first administration of analogue, BP, PRA and Ht of the res-ponders, were, significantly higher than those of the non-responders. Five of 7 responders at first administration of analogue in acute phase hypertension had a sustained high blood pressure in chronic phase, but all 5 responders in acute phase became to non-responders at first administration of analogue in chronic phase. BP and PRA of this chronic phase were significantly lowerer than those of the acute phase. All non-responders in acute phase hypertension had also no response at first administration of analogue in chronic phase. There were no marked changes of BP, PRA and Ht in these two phases. Each of responders and non-responders in acute phase hypertension became same non-responders at first administration of analogue in chronic phase. There were almost same levels of BP, PRA and Ht in these two groups. After volume depletion, about 30 percent of nonresponders at first administration of analogue responded to analogue. However, it is possible that sodium depletion stimulates renin release which, in turn, participates in maintaining the BP at the same level that existed prior to depletion. In this experiment, even control rabbits showed a depressor effect by the administration of analogue after volume depletion. This suggests that there are many difficult problems in differentiating the normal homeostatic response from pathologic response after volume depletion. In conclusion, as the hypertension became chronic, purely renin dependent hypertension had been involved in non-renin mechanisms. Moreover, this involvement decreased the degree of BP levels from severe to mild, These results suggest that angiotensin plays an important role in the pathogenesis of acute and severe two-kidney hypertension. However, angiotensin appears not to be the solely main pathogenesic factor in the maintenance of elevated BP in chronic hypertension or in mild hyper-tension. In clinical use, the analogue administration does not seem to provide a greater degree of sensitivity in the detection of unilateral renovascular hypertension.
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  • Nobuo Usui
    1979 Volume 21 Issue 11 Pages 1265-1274
    Published: 1979
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Many reports are available concerning to the effects of hypercapnea on acid-base disorder complicated with neonatal respiratory distress syndrome, severe bronchial asthma, cardiac failure and so on. But little was known as to the effects of hypoxia on these states, especially in respect to the renal buffer action. According to the study reports of AkashP of our labolatory, urinary hydrogen ion excretionn was delayed as a result of the decreased renal and cellular buffer action which probablly causedd by the intracellular accumulation of lactate in hypoxiad This study was undertaken to investigate the mechanism of the impaired renal buffer action in hypoxia. In the present study, the urinary acidification in response to oral ammonium chloride (NH4C1) load was examined in the patients with cyanotic or non-cyanotic heart disease The increment of urinary net acid excretion was decreased in cyanotic patients, The total urinary ammonia excretion in 42 hours after acid load was decreased by 28e 9 mmoles in cyanotic patients compared with 39.0 mmoles in non-cyanotic patients, although titratable acid. (TA), total CO2 content and pH were not significantly different between the two groups. Following these studies, the urinary acidification was examined in rats with control, hypoxia (10% 02+90% N2 gas inhalation), metabolic acidosis (HC1 administration iv.) and metabolic acidosis+hypoxia. In metabolic acidosis, ammonia and TA excretion increased and total CO2 content decreased soon after HCl administration, while ammonia excretion was not sufficiently increased in metabolic acidosis 1- hypoxia Changes of pH and electrolytes of these 4 groups showed decreased pH, potassium con-centration (K) and increased sodium concentration (Na) in tissue level, while pH, Na decreasedd and K increased in blood level, and urinary Na reabsorption, K excretion decreased in hypoxiaa and metabolic acidosis+ hypoxia, as most likely in decreased activity of aldosterone. We concluded that impaired urinary acidification in hypoxia was due to the inability of the kidney to excrete sufficient amount of ammonia into the urine.
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