Intrarenal hemodynamics were estimated in patients with primary aldosteronism (PA) using the Gomez's equations and by analyzing their renal function curve. The study was performed in 6 patients with PA for 2 weeks; they were given a regular sodium diet (12-15 g/day) in the 1st week and a sodium restricted diet (1-3 g/day) in the 2nd week. Blood pressure and urinary sodium excretion (UNaV) were measured on the last three days of each stage. Glomerular filtration rate (GFR) and renal plasma flow rate (RPF) were also measured on the regular sodium diet. Afferent (RA) and efferent (RE) arteriole resistances, and glomerular hydrostatic pressure (PG) were calculated using Gomez's equations. UNaV was plotted on the ordinate as a function of mean blood pressure (MAP) on the x-axis. Assuming that the difference between MAP and the x-intercept of this renal function curve represents the effective filtration pressure, RA, PG and gross filtration coefficient of capillaries (KFG) were also calculated. GFR and RPF were 102±6, 469±27 ml/min, respectively. Estimated RA (6600±700 dyns·sec·cm-5) was markedly elevated, while RE (2500±100 dyns⋅sec⋅cm-5), PG (57±2 mmHg) and KFG (0.195±0.041 [ml/sec]/mmHg) remained normal. The intrarenal hemodynamic parameters obtained by analyzing the renal function curve were consistent with those by Gomez's equations. Recently, in DOCA-salt hypertension, an animal model analogous to human PA, PG has been reported to be increased, leading to renal damage. However, the increase in RA was as marked as seen in essential hypertension, and further the increase in PG was not observed in the patients of this study. Thus, it is not clear whether there is a meaningful relationship between glorrerular hypertension and renal damage in PA as reported in DOCA-salt hypertension.

View full abstract

The present studies are an attempt to elucidate the vulnerability of focal glomerular sclerosis (FGS). The distribution and morphology of the arterial cushions were studied in rat renal arteries by light microscopy, transmission electron microscopy and scanning electron microscopy (SEM) using of the renal vascular casts.The arterial cushions were observed at a region of the branching arteries from the arcuate arteries and the interlobular arteries. They were extensively demonstrated mainly in the raid cortex and juxtamedullary cortex by the serial sections, but not in the subcapsular cortex.The arterial cushions showed valve-like protrusions and consisted of three components, such as the endothelial cells, the smooth muscular cells and the interstitial ground substances, electron microscopically. The cushions are covered by the endothlial cells which often showed various variation in thickness. Also these had deep processes which elongate into the interior of the cushions. The cells of interior portions of the cushions were modified smooth muscular cells. These cells contained numerous myofibrils and a large number of scattered glycogen glanules. No nerve fibers were seen within the cushions. The modified smooth muscular cells were embedded in a loose matrix (probably acid mucopolysaccharides) which contained strands of basement membrane like material. The cushions were observed on the wall of the arcuate and interlobular arteries in the cortex except for subcapsular cortex by SEM. They showed elongated indentation surrounding lumen of their arteries.These results of the observation, the cushion may be important factor for the regulation of blood flow in small arteries and arterioles. The disorder of autoregulation of interlobular artieries due to dysfunction of the cushions with anionic loss were assumed to be one of the important factor in progress to the glomerular sclerosis.

View full abstract

Three patients aged over 60 with endocapillary proliferative glomerulonephritis and nephrotic syndrome were reported. Immunof luorescence and electron microscopical findings were similar in all of them : granular deposits of IgG and C 3 along the capillary loops, electron dense deposits in the subendothelial area, and partial mesangial interposition. The levels of CH 50 were slightly suppressed in two of them, but neither preceding infection nor elevation in ASLO were noticed. None of then responded to steroid therapy. One patient fell in renal failure in spite of intensive steroid therapy, and died of bronchopneumonia. In another patient, proteinuria was remitted with systemic treatment against high blood pressure. The remaining patient took a favorable course during the admission without any special treatment, but proteinuria recurred after the discharge. These clinical manifestations and clinical courses were not compatible with the diagnoses of acute glomerulonephritis, mesangiocapillary glomerulonephritis, or vasculitis. We concluded that the endocapillary proliferative glomerulonephritis in adults over 60 years might be different form of glomerulonephritis from that of AGM, MPGN, and vasculitis, in which diffuse endocapillary proliferative changes in the glomeruli are seen in younger people.

View full abstract

A case of IgD lambda type multiple myeloma that developed acute renal failure was presented. Histopatholosic studies revealed apparent myeloma cast nephropathy with typical giant cells and light chain deposition isolatedly along tubular basement membrane and inter peritubular interstitium. Glomerular deposits of light chain were absent by electron and immunofluorescent microgram. The presented case showed a very uncommon histophasolosic findigs of unusual deposits of light chain, to tubulo-interstitium except for glomeruli, in addition to virtically rare IgD myeloma. A sixty-year old female who was suffered from acute renal failure and treted by hemo-dialysis for one month was admitted to our institute. Phisical examinations revealed illappearant and emasiated uremic patient on admission. Laboratory and radiolosical studies demonstrated IgD lambda type monoclonal protein and numerous punched out appearnce of skull bone. The diagnosis of IgD lambda myeloma was confirmed with aspiration bone marrow test. Anti-myeloma therapy of melpharan and prednisolone have started, however, fatal arrythmia suddenly suffered the patient and resuscitation attempts failed to get any success one week after admission. Renal necropsy was performed and specimens were studied by light, immunofluorescent and electron microscope. Tub lointerstitial lesions consisting myeloma cast nephropathy, interstitial fibrosis, infiltrating cells and thickning of tubular basement membrane were prominent on light microscopic findings. Silver staining (PAM) demonstrated numerous dark deposits along tubular basement membrane and inter-peritubular interstitium on the findings of light and electron microgram, corresponding with light chain deposits. No evident findings of renal amyloidosis and glomerular nodular lesions that were usual findings of renal light chain deposition disease were demonstrated. It is difficult to explain why the depositis of light chain located isolatedly along tubular basement membrane and interperitubular interstitium, however, a possible depositing pathway from peritubulary capillary to interstiti ummay be considerable, in addition to usual trans. tubular pathway from tubular lumia.

View full abstract

In order to examine the efficacy and safety of long-term and low-dose desferrioxamine (DFO) therapy against hyperaluminemia and the clinical symptoms associated with hyperaluminemia, 4 patients (3 men and 1 woman, 40-62 years old, period of hemodialysis : 69-189 months) undergoing maintenance hemodialysis were treated by DFO (0.5 g/week) and hemodiafiltration for 27 weeks. 1 patient had only hyperaluminemia, but other 3 patients had refractory ostalgia and arthralgia associated with hyperaluminemia. Clinically, ostalgia and arthralgia disappeared within 1 month after the initiation of treatment. The decrease of serum aluminium level was recognized in all patients (74±7μg/l to 52±7 μg/l). Also the decrease of Δ aluminium was recognized in 2 patients. Serum iron levels did not change, but unsaturable iron binding capacity levels increased slightly. Serum ferritin level decreased in 1 patient. Serum PTH-C levels increased slightly in 3 patients. Serum total protein and albumin levels did not change. Serum transferrin levels increased slightly Bone mineral contents were mesured by microdensitometry method. In 1 patient with only hyperaluminemia, MCI and S. GS/D ameliorated remakably. Side effects were not recognized in all patients during the course of treatment with DFO. In conclusion, it was thought that the treatment of long-term and low-dose DFO was effective and safe against hyperaluminemia and aluminium intoxication in patients undergoing maintenance hemodialysis.

View full abstract

In a retrospective analytical study involving 98 children with primary glomerulonephritis who were seen by us at our hospital during a 2-year period from 1984 through 1985 and who had renal biopsy performed previously, attempts were made to correlate pathological findings with both clinical findings and prognosis. The results are summarized as follows: 1) Of 87 patients with asymptomatic chronic glomerulonephritis, glomerular findings were those of minimal change lesion, mesangial proliferative nephritis, MPGN, membranous nep-hropathy and FGS or sclerosing nephritis in 29.9%, 51.7%, 13.8%, 1.1 % and 3.5%, respectively. Among the other 11 patients in whom the diagnosis was made after manifesting the nephritic symptoms, minimal change was noted less frequently and MPGN was detected more frequently than in the aformentioned asymptomatic group. IgA nephropathy was estimated to account for 44.2% of cases of asymptomatic chronic nephritis. 2) Mild mesangial proliferation was observed relatively frequently and severe mesangial proliferation or MPGN rather infrequently in hematuria cases without proteinuria while in those with severe proteinuria minimal change lesion was uncommon and severe mesangial proliferative changes, MPGN or FGS were relatively frequent. 3) In 22 patients with IgA nephropathy and 11 with non-IgA nephritis the severity of glomerular changes was related to the intensity of proteinuria at the time of renal biopsy. 4)A 3 to 5 years' follow-up study of patients with mesangial proliferative nephritis inclusive of IgA nephropathy disclosed that 26-28 % of patients became free from urinary abnormalities, 27-37 % had persistent hematuria without proteinuria and 24-32 % still had proteinuria of 2 plus or above, Patients with milder glomerular changes had a definitely batter prognosis than those with severe glome-rular lesions.

View full abstract

Endoscopic treatment of early gastric cancer (type lla in all patients) was performed in four patients undergoing chronic hemodialysis, Surgical treatment was considered contraindicated because of various risk factors in these patients. Endoscopic treatment was performed by concomitant use of YAG laser irradiation, local ethanol injection and mucosal resection. After endoscopic treatment, stomach biopsy revealed no cacer in four patients. In one patient who is alive now, no sign of cancer recurrence has been noted for about two years after endoscopic treatment. This patient has undergone hemodialysis on outpatient department. The remaining three patients died from diseases other than gastric cancer. When one of them was autopsied, no gastric cancer demonstrated. Taking the prognosis related to life in to consideration, endoscopic tratment should be used positively when surgical treatment of early gastric cancer cannot be performed in patients undergoing chronic hemodialysis.

View full abstract

Escherichia coli (E. coli) is still a major pathogen in urinary tract infections (UTI). It was found that 15 out of 20 cases (75%) of E. coli related UTI were caused by P-fim-briated E. coli, compared to the mere 15% of E. coli isolated from urine and 22% from the stool of healthy controls that were P-fimbriated. All patients studied were pregnant women and their delivered children. Antibody responses to P-fimbriae in the sera of these patients were detected with enzyme-linked immunosorbent assay (ELISA) using purified P-fimbriae. Positive antibody responses were observed at titers of 800-6400 in 8 out of 9 cases of UTI of pregnant women caused by P-fimbriated E. coli. The high level of antibody titers persisted for one month on average and then decreased. These antibodies to P-fimbriae were essentially IgG and transmitted to delivered children from UTI mothers. Therefore, the pretective role of these antibodies from P-fimbriated E. coli infections in new born children has been suggested.

View full abstract

We measured plasma α₁-proteinase inhibitor (α₁-PI) levels in patients with idiopathic nephrotic syndrome (INS), chance proteinuria and/or hematuria, and normal controls to examine the roles of proteinase inhibitors in the pathogenesis of renal diseases. Plasma α₁-PI concentrations were significantly decreased in patients with INS at relapses and remissions of INS. The α₁-PI activities, anti-trypsin and anti-elastase activities, were also decreased in relapses of INS. However, the values revealed no statistically signifiant difference in remissions of INS. Significant correlations between the PI activities and α₂-macroglobulin levels were revealed, which suggested a possible contribution of α₂-macroglobulin to the plasma PI activities in INS. From these results we conclude that the decrease in plasma α1-PI activities may be responsible for the reduction of glomerular negative charge, possiblly caused by some unknown proteinase(s), and the resultant development of proteinuria.

View full abstract

The present study was undertaken to clarify the low erythrocyte (RBC) α-tocopherol (TUC) concentrations in patients on maintenance hemodialysie (HD) using in vivo and in vitro experiments. 15 age-matched male controls and HD patients were evaluated. The experimental designs and the results were as follow: 1) Changes in fasting stage; TOC levels of plasma, high density lipoprotetins (HDL) and RBC, especially RBC, were lower in HDpatients than in controls. The ratio of RBC to plasma and HDL showed more significant changes between HD-patients and controls. In controls, RBC-TOC was noted to have a positive correlation with HDL-TOC and a negative correlation with non HDL-(plasma-HDL)-TOC, whereas a reverse correlation was observed in HD-patients. 2) In vivo experiments: Each 7 of HD-patients and controls were orally given TOC 600 mg after meal at early morning; the blood was sampled at 0, 3, 6, 10 and 24 hr. Poor increase of RBC-TOC in HD-patients was observed. In contrast, HDL-TOC was significantly highter at all measurement times than in controls. The change of plasma-TOC was similar to that of non HDL-TOC. 3) In vitro experiment : RBC from patients or controls showing various concentrations of RBC-TOC and plasma from controls were incubated at 37°C or 4°C. The inactivated plasma from controls was prepared by incubation at 56°C, 30 min or by supplement of 2 mM parachloromerucuric benzonic sulfonate. The ratio of RBC and plasma was at 2; 3 close to physiological conditions. No difference between patient and control RBCs as an acceptor of TOC and no apprecicable tranfer of TOC between RBC to plasma at 4°C were observed. When RBC-TOC was low, tranfer volume of TOC from plasma to RBC was increased and TOC was supplied from mainly non HDL fractions ; in contrast, when it was high, the main source of TOC was due to the transfer from HDL fractions which was reduced when lecithin: cholesterol acyltransferase (LCAT) reaction was inhibited. From above in vivo and in vitro studies. it was concluded that low levels of RBC-TOC in HD-patients may be due to an insufficiency of TOC transfer from HDL fractions affected by low LCAT activity.

View full abstract