To find the correlations between renal functions, blood pressure, and histologic changes of the kidney, needle biopsies were performed in 24 patients with essential hypertension and 49 patients with glomerulonephritis. The histologic changes of the kidney were represented by the grade of the sclerotic changes of the renal arterioles and the percentage of the hyalinized glomeruli in hypertension and by the grade of glomerular impairment in glomerulonephritis.Followings were the results obtained.(1) In hypertension, the grade of the sclerotic change of the renal arterioles was closely correlated to the rise of the systolic, diastolic and mean blood pressures and was negatively correlated to RPF, but it showed no significant correlation to GFR. With progress of the arteriolar sclerosis, concentration power, NPN, albuminuria, and ocular findings were in general aggravated. Especially in the case of decompensated heart failure NPN was elevated evidently.(2) In glomerulonephritis, the mean blood pressure seemed to be elevated with the grade of the glomerular damage in acute and subacute stages, while in chronic stage marked hypertension was observed only in the cases with most markedly impaired glomeruli. Between renal clearance and the grade of glomerular damage no direct relation was to be seen in acute and subacute stages, but in chronic stage all of the cases with far advancedly damaged glomeruli showed markedly diminished clearance values. In chronic stage, NPN was elevated and concentration power was declined with advancing of the glomerular damage. Marked ocular findings were found in the chronic cases with advanced glomerular change. Albuminuria was, in each stage, more intensive in the cases with advanced glomerular change(3) Minute analyse of the relations among blood pressure, renal clearance, and histologic changes of the kidney revealed that in some cases GFR is said to be maintained in normal range by elevated blood pressure despite of the arteriolar and/or glomerular changes. It led to a presumption that there may exist, in some respect, a purposive rise of blood pressure to maintain the glomerular function and the possible existence of this regulation in hypertension and glomerulonephritis was discussed.

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The fine structure of normal mammalian and human glomeruli and the glomerular lesions of biopsy specimens taken from 115 patients with various renal diseases were studied with the electron microscope using ultrathin sections. In normal glomeruli, four distinct components are recognized; which are epithelium, basement membrane, endothelium and mesangial cell. Fundamentally, there is no difference between mammalian species and human subjects. Epithelium is characterized by numerous foot processes. Basement membrane consists of three layers. A central relatively homogeneous part of basement membrane is Lamina densa, which is about 2, 000 to 3, 500 A in thickness in human adults, and normally never recognized fibrillary structure or fine pore. Adjoing less dense layers of L. densa are outer and inner translucent layer. Endothelium is extremely attenuated and interrupted except nuclear region, and these interruptions or pores are covered with endothelial cell menbrane. Mesangial cell lies in glomerular capillary stalk. Epithelium of Bowman's capsule is a sheet of flattened epithelial cell, and basement membrane of Bowman's capsule has a lamellated structure and is about 6, 500 to 10, 000A thick in human adults. Epithelium and basement membranes of Bowman's capsule are continuous at one end with epithelium and basement membrane of glomerular capillary, and at other end continuous with epithelium and basement membrane of proximal convoluted tubule. The percutaneous needle biopsy specimens of kidney were taken from 94 patients with glomerulonephritis, 12 patients with diabetic nephropathy, 4 patients with systemic lupus erythematosus, and 5 patients with essential hypertension. The author already described the electron microscopic characteristics of glomeruli of these renal diseases, refering to the clinical and laboratory and light microscopic findings. In this paper, glomerulonephritis were classified as acute, elapsed acute, subacute, subchronic, chronic, chronic sclerosing and nephrotic glomerulonephritis In acute glomerulonephritis, most striking changes were marked proliferation and swelling of mesangial cells, and many leucocytes were seen in narrow capillary lumina. In elapsed acute, glomerulonephritis, slight inflammatory changes were still observed and basement membrane-like materials were accumulated. In subacute glomerulonephritis, the marked proliferation of glomerular capillary cells, epithelial crescent, and deposits of osmiophilic substances were seen. The author found that subchronic glomerulonephritis were classified to epithelial type and intramembranous type. In chronic and chronic sclerosing glomerulonephritis, the ranges in changes of L. densa and mesangial area were considerable, being quite severe in chronic sclerosing glomerulonephritis. The final state of scarred or hyalinized gl.omerulus was mostly composed of remains of L. densa and a few atropnic cells. In nephrotic glomerulonephritis, it is demonstrated that nephrotic syndrome could coexist with all type of glomerulonephritis except acute type, and that the common characteristics of glomerular changes are the structural changes of L. densa, loss and fusion of epithelial foot processes, accumulations of basement membran-like materials, and occasional deposits of osmiophilic substances. Moreover, loss and fusion of epithelial foot processes organization and appearance of microvilli are found to be, to some extent, reversible. The author classified diabetic nephropathy into three groups according to the degree of proteinuria, and found that the presence and severity of proteinuria appeared to be relatively related to the glomerular changes as well as severity of diabetes mellitus. In diabetic nephropathy, specific glomerular lesion consisted of the thickening and folding of L. densa and basement membrane of Bowman's capsule, and accompanied by marked accumulations of basement membrane-like materials. In systemic lupus erythematosus, striking changes

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The technical problems of renal microdissection method that were included procedure of maceration-and staining properties of macerated nephrons, and findings of both of normal and diseased tubules isolated by microdissection in human, dogs, and rats were investigated. The changes in tubules with various renal diseases were observed and following results were obtained. 1) In nephrotoxic nephritis in dogs, a slight dilatation of the lumen was observed in theproximal tubules, but loops of Henle and distal tubules were remained to be normal. 2) In cases of subacute glamerulonephritis in human, atrophy and disarragement of the epithelial pattern, dilatation of lumen and cast formation were marked over the entire length of tubules. Proliferation of interstitial tissue was marked. 3) In chronic glomerulonephritis, changes, rich in variety, of the proximal and distal tubules were -marked; disarrangement and obscurity of the epithelial pattern, atrophy mixed withh compensatory hypertrophy and luminal dilatation. Interstitial proliferation and fragmentation of the tubules were also observed. 4) In secondary contracted kidney following to chronic glomerulonephritis, all kinds of changes that were observed in chronic glomerulonephritis were noted in much advanced and extensive degree. 5) In primary contracted kidney, moderate atrophy of both of the proximal and distal tubules -were observed, but epithelial pattern was remained to be normal. 6) In the contracted kidney secondary to hydronephrosis, atrophic changes of tubules were conspicuous and an irregular luminal dilatation with striking cast formation was characteristic 7) In amyloid kidney, characteristic elongation and narrowing of the proximal portion of the proximal tubules, i. e. so called "Swan neck lesions" were observed. Tubular atrophy was also noted. 8) In experimental renal failure in rats produced by transient ligation of the renal artery and by the administration of uranium nitrate, tubular atrophy, granular and necrotizing changes with tubular wall disruption of the proximal tubules were observed 9) In kidney of rats injured by aminonucleoside, granular changes in the proximal tubules without tubular wall disruption were principal, but necrotizing tubular damages were rare.

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I. The Clinical Study on Acute Glomerulonephritis in Children 69 Children with acute glomerulonephritis which were diagnosed both by clinical courses and by histological findings of renal specimens obtained by percutaneous biopsy were studied. The results of scrutinizing change of renal function attached with acute glomerulonephritis by means of renal clearance tests were as follows : Within a week after the onset of the disease, GFR and FF were fairly low. Until four weeks after then, GFR and FF were still low in majority cases. As to RPF and RBF, marked changes were not observed. The renal histological findings after a week or so following the attack indicated that almost glomeruli were evenly suffered, and intensive changes were found at this period. Then, though the acute glomerulonephritis became gradually convalescent, even after three to five months following acute attack, acute inflammatory changes were observed in a few cases. In some cases of the disease, the epithelial crescent were occasionally found too It was understood that hematuria indicated high degree and continued for a considerably long term in such cases. Above mentioned findings revealed a certain guide about bed rest and diet therapy of acute glomerulonephritis. In cases of acute exacerbation in glomerulonephritis, hypercellularity and enlargement of glomeruli were slight in early stage following acute attack, ischemia was rarely seen, and many cell infiltration and fibrosis of interstitium were observed. Histological changes in the older children with acute exacerbation in glomerulonephritis were markedly observed. The tonsillectomy is indicated in such a case, As the acute inflammatory changes in the renal biopsy specimens at short duration of the clinical healing of the disease still remained in some glomeruli, severe exercise must be avoided. Even after clinical healing, the glomerular changes such as fibrosis and hyalinization were prominently found in some cases. In such cases which severe damaged glomeruli and slight ones were distinctly separated, the prognosis is presumed good. II. The Study on Masugi-Nephritis in Various Ages Mature rabbits, weighing 1.8-2.5 kg. (I-group), young rabbits, weighing 600-800 gr. (II-group) and young rabbits, weighing 200-300 gr. (III-group, weaning period) were used for the studies of development of the Masugi-Nephritis, and the clinical and pathological changes were studied in each age. In III-group, the clinical and histological findings were slight, and the individual differences in renal histological changes were -great. Generally, in the young rabbits (II, III-Group), the loss and flatting of foot processes of characteristic organization of epithelial cytoplasm were seen with the electron microscope, and the fusion of the foot processes were found at the site of severe damaged basement membrane, and also it was seen that broad masses of epithelial cytoplasm covered partially or completely the surface of the basement membrane.

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The glomerular permeability has been investigated using Polyvinylpyrrolidone (PVP), a synthetic polymer. PVP is cleared from the plasma by restricted filtration and without tubular reabsorption or addition, Therefore, the relative PVP-clearance (PVP-clearance/GFR) is identical with the sieving coefficient through the glomerular basement membrane. The PVP-clearance, the molecular distribution of PVP, the GFR and the albumin excretion have been estimated in normal adults and nephrotic patients. The results were as follows: 1) The clearance value of PVP was roughly proportional to the GFR, but it diminished gradually after the administration of PVP. 2) In the cases of renal insufficiency the relative PVP-clearance increased, though the PVP-clearance and the GFR decreased. 3) There was no difference between nephrotic patients and normal adults respecting the relative PVP-clearance. 4) In normal adults and nephrotic patients, the relative clearance of each PVP-molecular fractions showed nearly the same value and the effective porous radii of the glomerular basement membrane calculated by the Pappenheimer's theory were equal. In the nephrotic patients the permeability of the glomerular basement membrane was not increased in the middle molecular PVP. From these results we presumed that the glomerular basement membrane had the following properties to the permeability of the macromolecular substances. Both in normal adults and nephrotic patients, the porous radii of the basement membrane show Gaussian distribution and the mean porous radii in the two groups are equal, but the standard deviation in the former is smaller than in the latter. Therefore, we could not prove the increase of the glomerular permeability concerning the middle molecular sudstance such as PVP in nephrotic patients, whereas the permeability of large molecular substances, such as albumin, increased.

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