Schönlein-Henoch purpura (SHP) is recognized to be more common in children than in adults. Though the relationships between streptococcal infection, drugs and foods allergy have been inferred, its pathogenesis is not yet clear, Renal involvement of SHP is found more frequently in adults and it is more contributory to the prognosis of SHP than other factors. During the last 2 years, we have had the opportunity to examine five cases of adult SHP nephritis and to investigate their clinical courses and histological findings of renal biopsy. In this paper, we present the results on clinico-pathological study of these cases together with some review of the literature.

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Circulating immune complexes (CIC) were examined in sera from 50 patients with IgA nephropathy using JM cell method and platelet aggregation test (PLA). Analysis of correlation between CIC and glomerular immune deposits was investigated. In addition, relationship between serum IgA levels and IgA-CIC was surveyed. To determine whether CIC detected by JM cell method were Ag⋅b complexes or aggregated immunoglobulin, the author assayed by gel filtration the molecular weights of the CIC, and compared them before and after dissociation with NaI on selected sera which contained only one class of immunoglobulin in CIC. (5 cases of IgG-CIC and IgA-CIC respectively)The results werr as follows.1) 32 sera (64%) were positive by JM cell method and 13 sera (26%) by PLA.2) Immunoglobulin class of CIC detected by JM cell method revealed that IgG-CIC were positive in 18 sera (36%), IgA-CIC in 17 sera (34%) and IgM-CIC in 12 sera (24%).3) There was no significant correlationship between titer of CIC and intensity of glomerular immune deposits in IgG, IgM and IgA-CIC respectively, nor between serum IgA levels and titer of IgA-CIC.4) Median values of the molecular weight ranged from 7.7×105 to 12×105 in IgG-CIC, from 5.85×105 to 12×105 in IgA-CIC and the mean of the IgG-CIC was 8.1×105 and that of IgA-CIC 8.58×105. 4 cases were completely dissociated and 1 case incompletely by NaI in IgG-CIC. With regards to IgA-CIC, 3 cases were completely dissociated and 1 case incompletely by NaI but 1 case was not dissociated at all. That is to say, CIC detected by JM cell method were proved to be Ag⋅ Ab complexes in high probability. It was suggested that IgA nephropathy was induced by CIC.

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The intraglomerular disposal mechanism for foreign bodies as well as for normal blood components with particular regard to the phagocytic function of the mesangial cell was studied. Saccharated ferric oxide, Fesin (FS), and ferritin (FR) as tracers were intravenously administered into mice, which were sacrificed at variuos intervals. The ferritin immune complex was made in vivo by the second shot of FR and the mice were also sacrificed at definite intervals. The renal specimens were investigated by light, electron and immunofluorescence microscopy. The iron-stain positiveness in the glomerulus by light microscopy was most intense on the 3rd day after the FS injection, whereas in the FR group, it was most remarkable at 24 hours after the administration. The positiveness was transposed to the medullary tubules and interstitium as it decreased in the glomerulus. The iron particles either of FS or FR in electron microscopy entered the mesangial cell readily and rapidly through the mesangial matrix. The particles in the mesangial cell accumulated in large and small clusters forming siderosomes, most of which had the limiting membrane but some were devoid of it. They later changed into lysosomes and disappeared, although in the FS group they remained much longer than in the FR. In all the mice recieved the second injection of FR, dense deposits containing the iron particles were found in the mesangial matrix, particularly near the mesangial cell membrane. They were neither observed in the mesangial cells nor in the peripheral capillary wall in each experi mental period. The immunofluorescence microscopy showed a positive granular mesangial pattern for IgG as well as slightly for C3. The dense deposits in the mesangial matrix decreased in number and quantity progressively and completely disappeared in 5 weeks, leaving only slight lucent halos or varied densities of the matrix, claer or dark, at the site of the dense deposits. Despite of the unaware disappearance of the dense deposits from the mesangial matrix there was no structural abnormality in the glomerulus such as positive phagocytosis by the mesangial cell or an infiltration of scavenger cells, neutrophils or monocytes, in the mesangium. The above results suggest that the phagocytic function of the mesangial cell may be much lower than hitherto mentioned, and may act rather passively than positively depending on the molecular size and nature of the substances deposited in the mesangium; and that deposits of large molecular substances may be removed with an unknown mechanism other than phagocytosis such as a disintegration by humoral lytic factors released from leucocytes, mesangial cells or others. Further discussions were made on the routes of removal of disintegrated foreign substances or normal blood components from the glomerulus.

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Clinical significance of crescent formation especilly in less than 50% of glomeruli have been unsatisfactorily studied. Thus, we attempted to clarify this paint, and investigated the clinical features and the prognoses of 53 patients with mesangial proliferative glomerulonephritis with cellular or fibrocellular crescents in more than 10% of glomeruli. Fourteen patients having more than 50% of glomeruli involved by crescent formation (group I) were analyzed separately from 39 patients with less than 50% involvement (group II). In group I, 85% (12/14) of patients presented acute onset and reduced renal function (GFR<80ml/min). Renal function was subsequently declined rapidly and 12 of 14 patients progressed to terminal renal failure. In group II, 77% (30/39) of patients presented insidious onset and 54% (21/39) of patients presented normal renal function. Even in this group, however, renal function was declined slowly but steadily, and 10 of 39 patients progressed to renal failure. The survival rates of group I were 31% at a 5 years and 15% at 10 years. Those of group II were 75% and 63%, respectively. The extent of interstitium involved by cellular infiltration revealed good relation to the prognosis and the percentage of glomeruli involved by crescent. From this study, it is suggested that the clinical feature and prognosis are influenced by the percentage of glomeruli involved by crescent. And it is proven that glomerulonephritis with crescent formation even in less than 50% of glomeruli was progressive, as well as it in more than 50%.

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1. A histopathological study on twenty five patients with idiopathic membranous nephropathy was carried out with special reference to progressive process of glomerular changes. In addition to the thickening of glomerular capillary wall (membranous change), adhesion, segmental sclerosis, global sclerosis, hyalinosis, mesangial enlargement and crescent were observed by light microscopy. These glomerular changes were observed more frequently in the group with decreased renal function (GFR<70mlmin) including two cases of chronic renal failure than in the group with normall renal function. 2. The progression of segmental sclerosis to global sclerosis arising from the peripheral capillary with adhesion to Bowman's capsule seemed to concern most to the deterioration of renal function. These glomerular changes remain as irreversible lesions, whose accumulation decreases renal function, howw ever slow progress this process may make, 3. Although the membranous change itself is generally hard to decrease renal function, it seems to be possible that the narrowing of glomerular capillary lumen due to mesangial enlargement and notable thickening of the glomerular basement membrane, may take part in decreasing glomerular function.

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The author examined urine γ-GTP activity and renal tissue γ-GTP activity in patients with renal diseases and in nephrosis rats induced by aminonucleoside (AN) to evaluate the significance of the urine γ-GTP in renal diseases. Urine γ-GTP activity was determined among 187 subjects which consisted of 89 cases with the nephrotic syndrome (33 in acute stage, 56 in non acute stage), 22 cases of healthy control, 53 cases with chronic glomerulonephritis, and 23 cases with chronic renal failure. The exacted amount of γ-GTP increased as following order, chronic renal failure, control, chronic glomerulonephritis, non acute stege of nephrotic syndrome, acute stage of nephrotic syndrome. Histochemical study for biopsy specimens of human kidney revealed that γ-GTP activity was found most commonly in proximal renal tubule and its intensity of γ-GTP activity was almost parallel to the exacted amount of urine γ-GTP. The result of histochemical study of γ-GTP activity in the AN nephrosis rat was almost similar to human case, namely, acute stage of nephrotic syndrome>non acute stage of nephrotic syndrome>chronic renal failure. Tissue r-GTP activity also was found most commonly in proximal renal tubule, same as human kidney. γ-GTP purified from the kidney, from the liver, from serum and from urine was electrophoresed by "Cellogel" respectively. Serum γ-GTP moved to approximately the same line as liver and urine γ- GTP moved to the same line as kidney γ-GTP, so urine γ-GTP is different from serum γ-GTP derived from liver. Consequently it is considered that urine γ-GTP is derived from kidney. Urine γ-GTP reflects some of pathologic conditions of renal diseases especially proximal tubule and so determination of urine γ-GTP activity is useful for clinical study of the nephrotic syndrome.

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Nephrectomy was performed for two cases with acute renovascular hypertension due to clamp injury (Case 1) and blunt lumbar trauma (Case 2), and it was followed by normal plasma renin activity (PRA) and normotension. Changes of blood pressure, pulserate, PRA, plasma aldosterone concentration (PAC) were observed by oral administration of Captopril (12.5mg) before and after nephrectomy. In pre-nephrectomy stage, blood pressure lowered remarkably, PRA increased, and PAC temporarily increased during observation in two cases, Pulse rate was ucchanged. In postnephrectomy stage, blood pressure lowered slightly, PRA increased, and PAC decreased in both cases. Pulse rate was unchanged. Accordingly, it is possible that temporary increase of PAC by oral administration of Captopril before nephrectomy depends on production of bradykinin and prostaglandins.

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Aminoglycoside antibiotics have become very useful in the treatment of severe Gram-negative bacterial infections, but their potential nephrotoxicity sometimes poses clinical problems. We recently encountered several patients who had developed renal proximal tubular lesions following gentamicin administation. Early detection of renal damage caused by aminoglycosides is thus clinically important. The purpose of this study is to evaluate the usefulness of measuring urinary N-acetyl-β-D-glucosaminidase (NAG) activity as indicator in early detection of renal damage. The urinary NAG activity was determined by the method of Borooah, et al. Most patients given a daily dose of 120-240mg of gentamicin showed a remarkable increase in NAG activity within ten days of administration. In some cases, polyuria, proteinuria, a reduction in PSP excretion, and an increase in urinary electrolytes along with reduced serum electrolytes were also observed. But these abnormalites returned to normal within a week after interruption of the drug administration. Kidney sections from 2 autopsied patients, who had received gentamicin 120-240mg/day continuously until death, showed distinct necrosis and exfoliation of the proximal tubular epithelial cells. No increase in NAG activity was found in patients given a daily dose of 80mg of gentamicin. Administration of aminoglycoside drugs other than gentamicin did not produce a marked increase in urinary NAG activity as seen with gentamicin. In addition, there was almost no occurrence of polyuria, abnormalities in electrolytes or reduced renal function. From the results above described, it is concluded that measurement of urinary NAG activity is useful for the early diagnosis and monitoring of nephrotoxic reactions to aminoglycosides.

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Twenty-one patients with lupus nephritis were treated by high dosis intravenous administration of methylprednisolone "pulse" therapy. Ten out of 21 patients were regarded as effective by the criteria 6 months after pulse therapy. The criteria for classification of patients treated by pulse therapy into "effective" or "ineffective" group was as follows. In 11 patients with impaired renal function, if 25% or more increase of creatinine clearance, or, 25% or more decrease of serum creatinine was observed, patients were classified into effective group and the other patients were classified into ineffective group. In ten patients with normal renal function, if 50% or mare decrease of proteinuria or hematuria was observed, they were classified into ef-fective group and the other patients were classified into ineffective group. Ten patients classified into effective group had following features at start of pulse therapy and these were considered as the indicative factor of pulse therapy on lupus nephritis.1. They had relatively short interval from onset of disease to pulse therapy and its mean value was 31.5 months.2. All 10 patients had marked hypocomplementemia, and 5 out of these patients had high ds-DNA binding activity.3. Seven out of 8 patients had marked glomerular subendothelial immune deposits and glomerular cellular proliferation in spite of minimal glomerular and interstitial sclerosis. Pulse therapy itself has an effect of quick normalization of serum complement or ds-DNA antibody compared with oral administration of corticosteroid, so, it is indicative for patients with lupus nephritis those hay above features and require quick therapeautic effects of adrenal corticosteroid.

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A 51 year-old hypertensive man with a unilateral hydronephrosis and erythrocytosis is described. The preoperative peripheral plasma renin activity was normal and the renal vein renin ratio was 1.6. Erythropoietin level in plasma was slightly elevated. After nephrectomy, his blood pressure returned to normal and his erythrocytosis had complete remission for more than two years. In the preoperative period, the angiotensin II analogue infusion indused a rise in blood pressure on normal sodium diet, while the administration of SQ 14225, 12.5mg, p. o. did a reduction in blood pressure under the same diet. After operation, the plasma renin activity changed from normal to a lower value with the concomitant fall in blood pressure. These findings suggest that a normal value of peripheral plasma renin activity in our case may still be inappropriately high in his blood pressure regulation.

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