Hypercoagulability is considered as one of the exacerbating factors in glomerular diseases. It is important to investigate the effect of glncocorticoids on blood coagulation which may accelerate the coagulation system. To study this problem, we performed several coagulation tests before and after the treatment of prednisolone in 16 patients with primary glomerular diseases (Membranous Nephropathy 7 cases, Mesangial Proliferative Glomerulonephritis 5, Membranoproliferative Glomerulonephritis 2 and Focal Glomerular Sclerosis 2). The results were as follows-The procoagulant activities of blood coagulation factor VIII, IX and XII were significantly elevated, and activated partial thromboplastin time was shortened. This shortening was dependent on the daily dose of prednisolone. The level of von Willebrand factor activity was elevated. The platelet aggregation rate induced by collagen and ristocetin and the release of ATP induced by ADP and collagen were also elevated. On the other hand, antithrombin III was increased, and fibrinogen was decreased. In addition, total cholesterol was elevated, and urinary protein and creatinine clearance remained to be unchanged. The results showed that a hypercoagulable state was induced by the administration of prednisolone in primary glomerular diseases. Therefore, it is suggested that prednisolone may accelerate the intraglomerular coagulation and other thromboembolic processes. It might be necessary to use the anticoagulants and/or antiplatelet agents against these side effects of glucocorticoids.

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In an attempt to clarify the participation of hepatitis B virus (HBV) antigens in glomerular lesions associated with liver diseases, 20 adult patients positive for HBV surface antigen (HBsAg) in the blood were studied. They were composed of healthy carriers (3), and those with acute hepatitis (2), chronic active hepatitis (8) and liver cirrhosis (7). The light microscopy revealed the double contour of the glomerular capillary walls in 5 patients, one of which was accompanied with the bubble-like appearance and spike for mation as well as mesangial proliferation. Another patient was diagnosed as membranous nephropathy because of the diffuse spike formation. The immunofluorescence technique was carried out using monoclonal antibodies disclosing mesangium-dominant HBsAg deposition in 7 patients and capillary wall-dominant HBeAg together with IgG depositions in 8 patients. However, HBV antigens were not detected in patients with liver cirrhosis, and furthermore no HBsAg was detected in any patients. These results indicate that HBV nephropathy in adults may be characterized by capillary wall lesions such as the double contour, bubble-like appearance and spike for mation attributed to the capillary wall deposition of immune complexes composed of HBeAg and IgG class antibodies, and should be discriminated from so-called hepatic glomerulosclerosis characterized by both mesangial IgA deposits and proliferation.

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Two types of terminal complement complex are formed when complement activation occurs. One is a membrane bound complex, the so-called membrane attack complex (MAC), and the other is a complex of S protein and terminal complement components (SC5b-9, etc.) in the fluid phase. S protein is known to be regulator of MAC. In the present study, the localization of S protein in renal tissues, the serum S protein levels and the presence of SC5b-9 complex in various renal diseases were examined. S protein was found to be localized in the glomeruli of patients with various renal diseases such as acute glomerulonephritis (AGN), membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN), IgA nephropathy and lupus nephritis, using an immunofluorescence technique. The deposits of S protein had similar distributions to the immunoglobulin and complement components (especially C5 and C9) inn the glomeruli. The serum S protein levels in patients with AGN and patients undergoing hemodialysis were significantly lower than those in healthy individuals, but MPGN and SLE revealed no significant changes. SC5b-9 complex was not present in detectable amounts by the ELISA technique in the sera of patients with renal disease having hypocomplementemia and complement activator the same as in normal human serum. However, SC5b-9 com plex was present in the serum treated with zymosan or in the serum after incubation of normal human serum and patient's serum which contained complement activator. These data suggest that, when complement activation has occutred, terminal complement complex is formed and S protein activates regulation of MAC in the kidney or the blood of patients with renal diseases, and the terminal complement complex may be involved in the initiation and progression of glomerulonephritis.

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This study was performed to clarify the renal interstitial involvements in Sjogren's syndrome. A total of 120 patients was studied, including 15 males and 105 females. Their age ranged from 23 to 79 (average 52) years, Renal specimens were obtained from 101 biopsied cases and one autopsied case. In the majority of cases varying degree of interstitial mononuclear cell infiltration, interstitial fibrosis, and tubular atrophy were observed, and moreover interstitial calcification in 5 cases. The degree of mononuclear cell infiltration were divided into 5 groups to compare the results of renal function tests with eachother. Renal function tests were undertaken, including endogeneous creatinine clearance (Ccr), urinary concentrating capacity and ammonium chloride loading test. Further, the concentration of serum and urinary .A2-microglobulin (.A2MG) was measured by RIA. These results revealed that there is a significant correlation of the degree of interstitial lesion to the frequency of abnormality in Ccr, urinary acidification capacity and the value of serum .A2MG. The cases with severe tubulo-interstitial change had a disability in urinary concentrating capacity and remarkably higher values of urinary β2MG . Thus these data may be concluded that Sjogren's syndrome has more frequent and variable renal interstitial involvements than previously reported. In addition, the degree of interstitial lesion may be interpreted in terms of several renal function tests.

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It has been shown that head-out water immersion induces a natriuresis and diuresis in normal man. To examine the water immersed effect of swimming, eight children with renal disease (Ccr>100 ml/min/1 .73 m2) were studied during swimming at school and under control conditions.(1) There was a tendency for creatinine clearance to increase during the period of swimming, but it was not statistically significant.(2) Urine volume rose during the period of swimming and after the post-swimming period, but this was not statistically significant.(3) Fractional excretion of sodium increased significantly during the period of swimming and the post-swimming period. (p<0.005) These results indicate that swimming at school induces natriuresis, and it may be due to water immersed effect. Natriuresis induced by swimming at school may be considered beneficial effect for children with renal disease.

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We determined urine output for consecutive 24 hours subjecting healthy volunteers and required its circadian rhythm of urine output. We comparatively studied the rhythm under water free, water retractive and water loading conditions, respectively. The circadian rhythm of urine output which subjects have individually was observed at water free condition. A tendency that rhythm at water free condition makes a flatness was noted in water retractive condition. A tendency that rhythm at water free condition is enhanced, was noted at water loading condition. From the above, it was clarified that circadian rhythm of urine output in normal renal functions reveals fundamentally the same rhythm at water free condition even though water ingestion. Moreover, cases recognizing the irregularity of rhythm comparing with that of water free condition were noted in water loading condition, and this phenomenon was considered to suggest the decrease of renal function concerning to the potential excretion of free water.

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Uremic peak 2a has previously been detected by high performance liquid chromatography (HPLC) of uremic fluids such as plasma and hemofiltrates (HF). In this paper, the peak fraction from HF was further analyzed by anion exchange HPLC to examine acidic components. At least eight main peaks were detected commonly among patients with chronic renal failure as acidic sub-fractions of 2a. Each peak was again fractionated and the main components were analyzed by UV spectra, NMR, and GC MS. resulting in detection of organic acids such as neuraminic acid derivative, N-phenylacetylglutamine, quinolinic acid, p-carboxyphenyl glucuronide, oxypurinol uronide, traps-acotinic acid, and 2, 5-furan dicarboxylic acid, Since the components were rather low molecular weight, membrane permeability of the peaks was examined by using ultra filtration membranes of different cut-off molecular weight, 500, 1000 and 5000a Permeability of peak 2a and the sub-peaks was very low in membrane -500 and -1000, then became high in membrane 5000, besides coexisting uric acid and creatinine peaks showed high permeability in membrane-500. Eventually the peaks behaved as if their molecular weight were between 1000 and 5000 in spite of their components of rather low molecular weight. One of reasons was attributed to binding with medium size molecules (MW: 1000^3000) which were presumed to co-exist in 2a fraction. Such phenomena may explain a part of an elusive nature of " Middle Molecular Toxins".

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Aluminum (Al) removal by continuous ambulatory peritoneal dialysis (CAPD) was studied in twenty-four patients. The patients were divided into two groups, group A (n=13) was consisted of patients who had received Al containing phosphate binder (ACPB), group B (n=11) was patients who had never received ACPB. Serum Al levels of the first measurement were 59.2±50.8μg/1 in group A, 15.3 ±8.6μg/1 in group B (p<0.05). Al concentration of dialysate after 6 hours dwelling were 4.6±2.5μg/1 in group A, 1.5±1.7μg/1 in group B (p<0.01), respectively. Serum levels of Al decreased gradually following the withdrawal of ACPB in group A and stabilized below 30 .Eg/1 in group B. We conclude that CAPD is effective tool to reduce serum Al as far as patients ceased to receive ACPB.

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Chronic renal failure is often accompanied with anemia by which the pathological mechanism is complicated and remains not fully elucidated. It is thought that erythrocyte absolutely needs SOD for its function of oxygen transport. In patients under periodic hemodialysis, erythrocyte SOD activity was determined by the biological assay according to the cytochrome c inhibition method and by the immunological assay using anti SOD antibody. Then the role of erythrocyte SOD was analysed. The biological activity of erythrocyte SOD in patients under hemodialysis showed increasing but not significant tendency compared with healthy subjects. The biological activity of erythrocyte SOD had negative correlation with peripheral red blood cell counts and with hemodialysis duration. On the other hand, the immunological activity showed no difference compared with healthy subjects. There was no particular correlation with red blood cell counts and with hemodialysis duration. So, in the hemodialysis patients, the biological activity of erythrocyte SOD showed no particular correlation with the immunological activity. Comparison with the values of erythroctye SOD before and after hemodialysis revealed no significant difference for both biological and immunological activity. The values of the biological SOD activity rose in uremic anemia and were more enhanced as anemia became worse. So, it appears that the biological values vary according to circumstances of uremia. The immunological activity which represents the amount of enzyme proteins, was scarcely influenced by either the grade of anemia or varying hemodialysis duration.

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The incidence of antibodies to adult T cell leukemia virus-associated antigens (ATLA) was analysed in 949 chronic hemodialysis patients in Kumamoto prefecture, a heavily epidemic area. The positive rate in patients was 19.7%, which was significantly higher (P<0.01) than 3.6% in 13, 329 healthy residents in the same area. The posive rate in 681 patients with the history of blood transfusion was 22.5%, which was higher than that in 268 patients without any blood transfusion, but even the latter showed the positive rate of 12.7%, which was significantly higher (p<0. 01) than that in healthy residents. The results suggest that not only the blood transfusion is a factor increasing the seroconversion but there may be another close relations between chronic renal failure and HTLV-1 infection.

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The importance of calcium, especially, cellular calcium in hormone release was reported by many investigators. The present study was undertaken to investigate the role of cellular calcium uptake in plasma AVP, aldosterone level and PRA (plasma renin activity) in normal subjects. In present study, we used diltiazem inhibiting cellular calcium influx and the effect of diltiazem on plasma AVP, aldosterone level and PRA in hypertonic saline test (osmolar stimulus) and upright posture test (hypovolemic stimulus) was studied in 12 normal men. Diltiazem (1 mg/ml/min, iv) alone did not cause significant changes in plasma AVP, aldosterone, PRA, blood pressure and other parameters. Diltiazem combined with hypovolemia induced by upright posture test (standing for 10 min) significantly inhibited AVP release. On the other hand, diltiazem combined with hyperosmolality induced by hypertonic saline test (10% NaCI 40 ml iv) did not alter AVP release. The interrelations between AVP and renin-angiotensin-aldosterone system (RAA system) were not clear in present study. These results indicate that cellular Ca uptake is an important factor in AVP release to hypovolemic stimulus in normal men. Diltiazem combined with hypertonic saline test or with upright posture test did not alter PRA and plasma aldosterone level. So, the influence of diltiazem on RAA system can not be concluded.

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A 31 year old man experienced generalized muscle swelling, pain and wine red urine 24 hours after heavily drinking. This was accompanied by severe rises in the muscle enzymes (CPK, 741200IU/L, aldolase, 2655IU/L) and the myoglobin concentration of serum and urine (>3 mg/ml, respectively). A muscle biopsy specimen showed acute rhabdomyolysis, He developed acute renal failure, severe hypocalcemia (Ca, 2.8 mg/dl) and hyperphosphatemia (P, 19.7 mg/dl). General muscles showed severe atrophy. Hemodialysis was performed during oliguric period for 30 days. 2-3 days after the secession of hemodialysis therapy, he developed gradually hypercalcemia (max. 15.7 mg/dl) and bilateral nephrolithiasis, and then Type I renal tubular acidosis. The most likely source of this patient's hypercalcemia was resorption of calcium from metastatic deposits in soft tissue. Failure to incorporate calcium into bone during the period of immobilization may explain the prolonged hypercalcemia. His renal tubular acidosis suggested to be caused by nephrocalcinosis and/or nephrolithiasis.

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SLE nephritis was studied on clinicopathological findings and therapeutic courses, in two male and two female cases, with onset at the ages of 9-15 years and clinical and histological remissions, after flare-ups occurring altogether 15 times during the course of observation (range 48 months to 97 months). With each repeated flare-up a decrease in the frequency of appearance of clinical symptoms, such as fever, eruption, aphtha in the oral cavity, etc., was noted.Elevations of GOT and GPT in the serum were noted at the time of onset in three out of four cases, further at the time of flare-up an elevation of GOT was noted in 9/15(60%), that of GPT in 13/15 (87%), and they were considered to be an index showing the activity of SLE, as well as the change of CH50. When renal biopsy was performed 2-3 times in each case (9 times in all), the urinary findings and renal histological findings were not always in agreement. Therefore, it seemed necessary to confirm the presence of immune complex deposition by a second or third biopsy, in case that abnormal urinary findings are absent at the time of onset, or after abnormal urinary findings have been alleviated by treatment. Owing to the combined treatment with steroids (including pulse therapy) and cyclophosphamide, remissions could be obtained for longer terms than with the single steroid administration.

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This case report describes a maintenance hemodialysis patient with tuberous sclerosis presenting as severe hypocalcemia. A 50.year-old woman was admitted to our institution because of chronic renal failure which had developed over a period of 5 years. At the age of 12 years she suffered seizures, but these were controlled with anticonvulsant drugs. Physical examination on admission revealed angiofibromas on the face, subungual fibromas and slight mental retarm dation. Abnormal laboratory findings were obtained as follows ; BUN 94.6 mg/ dl, Cr 7.6mg/dl, Ccr 3.8 ml/min, Ca 3.5 mg/dl, Pi 7.4 mg/dl, ALP 305 mIU, C-PTH 2.5 ng/dl, Hb 6.5g/dl and Ht 20% A diagnosis of tuberous sclerosis was reached based on the typicalskin lesions, mental deficiency, periventricular calcifications and phakomas in the retina, Angiomyolipomas and cystic lesions were found in both kidneys by ultrasound examination, computerized tomography scan and angiographyo The severe hypocalcemia may have been due to disturbance of 25-hydroxyvitamin D3-1..-hydroxylation and the influence of anticonvulsant drugs. The patient was treated by hemodialysis and followed an unemventful course for one year.

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