To clarify the incidence of thin basement membrane disease (TMD) among the patients with idiopathic asymptomatic hematuria and/ or proteinuria, in 217 serious renal biopsies (children 85, adults 132) were studied with clinical and morphometric analysis. TMD used is defined as follows; 1) Glomerulus in minor abnormalities ; 2) GBM ≤ 200 nm in width, with more than 20% in total glomerular capillary surface; 3) Absence of significant immunoglobulins or complement components.Out of 217 patients 93% had either IgA nephropathy (55%), normal glomeruli (21%) or TMD (17%) .TMD consisted of 22% in children and 14% in adults.Remained 15 consisted of non-IgA mesangial proliferative glomerulonephritis (6 cases), incomplete foot process disease (5), membranous nephropathy (2), membranoproliferative glomerulone-phritis (1), and unclassified (1) .Patients with TMD were found mostly (71%) in younger age less than 20 years old.Out of the patients with TMD, 38% had renal abnormality in the family history, but remainders were sporadic. The common urinary abnormality in TMD was microscopic hematuria occasionally with mild proteinuria (95%), while proteinuria only was rare (5%) .Outcome of TMD was favorable prognosis with normal renal function. TMD was his tologically divided into 2 groups; diffuse type (GBM thinning was more than 50% in the capillary surface) (19 cases; 51%), and focal type (it was less than 50%) (18 cases; 49%) .The incidence of those family history was 64% and 15%, respectively (p < 0.05) .It was concluded that TMD was a popular disorder in patients with asymptomatic hematuria and/ or proteinuria and it may expect 17% in incidence.

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In order to clarify the mechanism for elevation of serum IgE level in minimal change nephrotic syndrome (MCNS), we investigated FcE receptor 2 (FC.A R2/CD23) expression, using fluorescein isothiocyanate (FITC) labeled anti-CD20 monoclonal antibody, phycoerythrin (PE) labeled anti-CD23 monoclonal antibody and two-color flow cytometry. More over, serum IgE level was examined by radio-immunosorbent test. The subjects included 25 cases of MCNS, 17 cases of focal glomerular sclerosis (FGS), and 25 healthy volunteers as controls. The patients in the nephrotic stage of MCNS demonstrated significantly elevated levels of serum IgE, while those in the remission stage of MCNS showed no change in their serum IgE levels. In patients with nephrotics of MCNS, CD23+ cells, CD20+ CD23+ cells and CD23/CD20 ratio were significantly increased compared to normal controls. Furthermore, CD23/CD20 ratio in MCNS was significantly correlated with serum IgE level. Concerning FGS, there were no differences in serum IgE level and Fcs R2 expression compared to those of normal controls. These results suggest that Fc.A R2 expression may be important in the mechanism of elevated serum IgE level in MCNS.

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Exercise-induced proteinuria is of the mixed glomerular-tubular type and has been thought to be due to increased glomerular permeability to macromolecular proteins in response to activation of the renin-angiotensin system and catecholamines and a reduction in renal hemodynamics, The excretion of the tubular type of proteins, however, can't be explained by the above mechanism. Two groups, consisting of subjects with the highest (H-alb, n=20) and the lowest (L-alb, n=20) excretion of albumin 30 min after exhaustive exercise were selected from a total of 69 normal male participants. No differences in VO₂ max, max HR, changes in plasma angiotensin II, catecholamines, urine volume, or Ccr following exercise were observed between the two groups. The increase in blood lactate concentration immediately after exercise, increases in urinary excretion of lactate, pyruvate, _α1M, _β2M, albumin and decrease in Cl^- excretion 30 min after exercise in the H-alb group were significantly greater than in the L-alb group. The greater the urinary excretion of lactate and pyruvate, the greater the excretion of albumin, _α1M and _β2M, and the less the urinary excretion of Cl^-. The coefficient of correlation between the urinary excretion of lactate and _β2M was 0.757, and between urinary excretion of albumin and .A2M, 0.756 (p<0.001).These results suggest that exercise-induced organic acids and/or decrease in renal circulatory pH caused by organic acids may alter renal glomerular permeability and inhibit renal tubular reabsorption of low molecular weight proteins (_α1M, _β2M). The permeability of the glomerular basement membrane (GBM) to macromolecular proteins may be altered by a reduction in the charge barrier of the GBM, which may be caused by the overproduction of organic acids and a lower pH.

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It is well known that urinary FDP is one of the parameters of intrarenal coagulation in renal disease. The measurement of urinary FDP, however, is not satisfactory enough, since it is not a quantitative and sensitive method. Latex photometric immunoassay has recently been developed as a quantitative and more sensitive method. Since fibrinogen reacts with FDP-E less than FDP, the measure ment of urinary FDP-E is much better than that of urinary FDP in order to determine the presence of intrarenal coagulation and fibrinolysis of patients with renal diseases. The aim of this study is to clarify the clinical significance of urinary FDP-E measured by LPIA in the renal disease. The results were as follows: (1) Urinary FDP-E correlate with urinary protein, FDP, FDP-D, fibrinopeptide A (FPA), but not serum FDP-E. (2) The diseases which showed higher amounts of urinary FDP-E were diabetic nephropathy, amyloidosis and chronic glomerulonephritis. On the other hand, the diseases which showed smaller amounts of urinary FDP-E were minimal change, toxemia of pregnancy and lupus nephritis. All patients with higher amounts of urinary FDP-E showed marked renal dysfunction. But all the patients with the marked renal dysfunction did not always show higher amounts of urinary FDP-E. The urinary FDP-E showed a positive correlation to 1/serum creatinine. These results suggested that the measurement of urinary FDP-E is a useful method in determining the presence and degree of intrarenal coagulation and fibrinolysis in renal diseases.

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In order to clarify the abnormalities of blood coagulation and fibrinolysis in patients with various renal diseases, some molecular markers for hemostasis and thrombosis were examined in comparison with those of the patients with disseminated intravascular coagulation. The results were as follows : 1) PIC was significantly higher in the patients with CGN, NS, SLE, HD and DIC than normal subjects. 2) TAT was significantly higher in the patients with CGN, NS, HD and DIC. 3) SFMC was significantly higher only in the patients of DIC. 4) FDP and FDP- E were significantly higher in the patients with HD and DIG. 5) D-dimer was significantly higher in the patients with CGN, CRF, HD and DICR These results suggested that the abnormalities of blood coagulation and fiblinolysis in patients with various renal diseases are relatively mild, and situated between the normal subjects and patients with DIC.

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We investigated the effect of partial nephrectomy on mercuric chloride (HgCl₂) -induced acute renal failure (ARF) in rats. HgCl₂(2 mg/kg) was subcutaneously injected to male Wistar rats 2 days or 2 weeks after either partial nephrectomy or sham surgery. Both deterioration of renal function (serum creatinine, creatinine clearance, and fractional excretion of sodium) and renal tubular damage due to HgCl₂-induced ARF were inhibited by 5/6 nephrectomy. A moderate inhibitory effect was also noted by uninephrectomy. The levels of renal tissue ATP and total nucleotide did not increase 12 and 48 hours after uninephrectomy. These results suggest that partial nephrectomy is effective in suppressing the development of HgCl₂-induced ARF. The mechanisms of the protection are not explained completely by a consequence of hypertrophy or an acceleration of intracellular energy metabolism. Intrarenal blood flow redistribution may be involved in one of the mechanisms.

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The urinary activities of N-acetyl-β-D-glucosaminidase (NAG), γ-glutamyl transpeptidase (γ-GTP) and alanine aminopeptidase (AAP) are known to elevate markedly in initial phase of clinical acute renal failure (ARF). This study was performed to clarify the pathophysiological mechanism of the activation of these enzymes using experimental postischemic reperfusion ARF in rats. The relation between the levels of the lysosomal enzymes and lipid peroxidation induced by oxidant stress in these animal models was the main focus of this study. Renal ischemia was made by clamping renal artery for 30 minutes to create a complete ischemia and reflow. Catheterizated urine was collected to measure changes of the activities of NAG, γ-GTP and AAP from 60 to 480 minutes after reper fusion of the kidney. The activities of renal tissue glutathione peroxidase (GSH-Px), NAG and γ-GTP, and the values of renal contents of glutathione (GSH) and malondialdehide (MDA) were measured in each sample. It is already known that GSH redox cycle plays an important role in removing various hydroperoxides induced by oxidant stress, generating oxidated GSH from GSH in scavenging process. In order to confirm if GSH plays an important role in intrinsic anti-oxidant system in this model, buthionine sulfoximine (BSO) which is r-glutamylcysteine synthetase inhibitor, was administered intraperitoneally to decrease renal GSH contents before the procedure renal ischemia. The following results were obtained; 1) urinary activities of NAG, γ-GTP and AAP were elevated markedly in GSH depleted rats compared with controls. 2) renal tissue activities of NAG were higher in BSO administered rats than controls. 3) renal contents of MDA increased in GSH depleted rats. 4) close correlation was observed in renal tissue contents of MDA and tissue activities of NAG. 5) kidney tissue obtained 360 minutes after reperfusion, renal contents of MDA were markedly elevated compared with controls. It was concluded that lysosomal membrane injury induced by lipid peroxidation might be one of the main mechanism of the lysosomal enzymuria in acute renal failure and the renal content of reduced GSH might be one of the determinants of susceptibility to postischemic renal injury. Also, these data suggested that tubular activity of γ-GTP plays an important role in preserving renal tissue content of GSH.

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In the dignosis of renal osteodystrophy (ROD) and the monitoring of its clinical course, several biochemical parameters have been appreciated as a useful indicators. The present investigations were designed to evaluate the clinical value of serum tartrate resistant acid phosphatase (TRACP) as an additional parameter of osteoclastic activity in ROD based upon the concept that TRACP was marker enzyme spesific for osteoclast. Serum TRACP was assayed in 72 patients on long term hemodialysis and compared with conventional parameters of ROD such as ALP, Osteocalcin, Hydroxyproline. Bone change was analyzed according to Jensen's method and categorized into 4 stages. Serum TRACP was exclusively elevated and revealed a evident correlations with each parameters as followes TRACP v. PTH-C, r=0.501 p<0.01., Hydroxyproline, r=0.429 p<0.05., ALP, r=0.001., Osteocalcin, r=0.540 p<0.01. In addition, TRACP value in the patients with high stage significantly higher than that in those low stage ROD. These results suggest that measure ment of TRACP would be of clinical importance and useful for diagnosis of ROD in chronic maintenance hemodialized patients.

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We studied the effects of recombinant human erythropoietin (rEPO) on angina pec toris in patients with chronic maintenance hemodialysis. We evaluated hemodynamic changes and exercise tolerance in 6 patients underwent symptom-limited treadmill exercise tests, before and 3-months after treatment with rEPO. Hemoglobin concentration and hematocrit increased significantly from 8.1±1.0 to 10.3±1.1 g/dl, from 25.7±2.7 to 31.5.±2.5%, respectively. Exercise duration increased significantly from 291.±68 to 396+77 sec. Maximal oxygen uptake (VO₂max) also increased significantly from 18.3+3.3 to 24.2.±3.4 ml/kg/min during correction of anemia. Systolic blood pressure (SBP) and pressure rate product (PRP) at rest, and at maximal exercise showed no significant changes, on the other hand ischemic ST change at maximal exercise decreased significantly from 1.2.±0.7 to 0 .2.±0.3 mm under 3-months treatment. Our results suggest that improvement of exercise capacity and ST depression in patients with chronic hemodialysis is the outcome of increased coronary oxygen supply with unchanged cardiac oxygen demand after correction of renal anemia treated with rEPO.

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Reports on renal cell carcimoma (RCC) as an incidental finding have been increasing in recent years as the imaging modalities including ultrasonography (US) and computerized tomography (CT) scan have gained popularity in clinical medicine. Because effective treatment in RCC is only surgical removal of the involved kidney even at present, it is imperative for urologists to find and to diagnose the RCC in early stage. Whether RCC found incidentally is in early stage cancer is not determined at present. To determine if the RCC found incidentally is in early stage cancer and if the survival rate is better than that of the RCC found with symptoms, we undertook the following study. Between December 1972 and March 1990, 65 patients with RCC were registered at the Department of Urology, Teikyo University Hospital. Of 65 patients 20 with RCC as an incidental finding were subjected to this study. 34 patients with RCC found with symptoms including hematuria were subjected to control group. Causes of the diagnosis in 20 patients included workup for non-urological diseases in 11 patients (55.0%), workup for urological disease other than RCC in 5 patients (25.0%) and routine medical checkup in 4 patients (20.0%). First-line imaging modalities for the diagnosis was US in 9 patients (45.0%), DIP in 6 patients (30.0%) and CT in 5 patients (25.0%). Size of the tumor, pathological stage (pT) and grade in these 20 patients were tended to be smaller and lower, respectively, but these results were not significant as compared to those of the control group. Incidence of the remote metastasis, at the time of diagnosis, however, was significantly lesser than that of the control group (p=0.04). Survival rates in 5-year and whole-year were tended to be better in the subjected group, respectively, but they were not significant statistically. It is concluded from this study that the RCC as an incidental finding is not always in early stage cancer and that the survival rate tended to be better if treated surgically. Further studies on this subject are expected from other institutions.

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We report a patient presenting rapid deterioration of renal function due to primary cholesterol atheroembolism. The patient was 75-year-old hypertensive male and was admitted to a hospital because of rt. hemiplegia which developed 2 weeks earlier. On admission, his blood pressure was 200/100 mmHg and serum creatinine level was 2.9mg/dl with urinalysis 1 + both for protein and hematuria.2 weeks later, an angiotensin converting enzyme inhibitor (ACE inhibitor, delapril 15mg/day) was given to control high blood pressure. Immediately after this medication, his renal failure rapidly progressed with a fall in blood pressure (110/60mmHg) and oliguria (100ml/day). Although he was transferred to our hospital and was treated withhemodialysis, he died of an attack of acute myocardial infarction in a week.At post-mortem examination, microscopic findings of the kidney disclosed numerous occlusions of medium-sized artery by cholesterol emboli. These emboli were also observed in other organs, but not so prominent as in the kidney. The coronary arteries exhibited severe sclerosis.In this presented case, acute deterioration of renal function was caused by ACE-inhibitor, although which was administered in a volume depleted condition. Therefore, further study would be necessary whether or not ACE-inhibitors predispose the patients with this disease to acute renal failure.

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Renovascular hypertension is most, frequent causes of secondary hypertension . Although angiography of renal artery is reliable procedure for the diagnosis of the renovas cular hypertension, it is expensive and invasive. We report two cases which become possible to make diagnosis of the renovascular hypertension by measurement of velocity of segmental or interlobar artery using 2-D color Doppler method. Case 1: 39 year-old male was hospitalized because of hypertension (200/130 mmHg). Ccr was 82 ml/min. 2-D Doppler test demonstrated that the Vmax, the Vmin and the Vmin/Vmax of the right segmental artery were 40cm/sec., 24cm/sec. and 0.60, respectively. The Vmax, the Vmin, and the Vmin/Vmax of the left segmental artery were 42 cm/sec., 22cm/sec. and 0.52, respectively . Renal angiography shows right renovascular stenosis. After percutaneus transluminal angioplasty, the blood pressure became normal and Vmin/Vmax ratio of the right segmental artery was down to 0.52. Case 2: 46 year-old male was hospitalized because of chronic renal failure (Ccr: 14.6ml/min) and uncontrollable hypertension . 2-D Doppler test demonstrated that the Vmax, the Vmin, the Vmin/Vmax ratio and the acceleration of the right segmental artery were 10cm/sec., 6cm/sec., 0.62 and 1.7 m/sec.², respectively. The Vmax, the Vmin, the Vmin/Vmax ratio and the accleration of the left interlobar artery were 8cm/sec., 5cm/sec., 0.63 and 0.8m/sec.², respectively, Renal angiography shows bilateral renovascularstenosis. Thus, the elevated value of Vmin/Vmax ratio (over 0.6) (mean value: 0.43±0.08, when Ccr is over 70 ml/min, whereas 0.32±0.11, when Ccr is under 30 ml/min) and decreased acceleration (under 2.0 m/sec.²) of the segmental or the interlobar artery seems to be helpful for the diagnosis of renovascular hypertension.

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We reported two cases of nephrotic syndrome associated with hydronephrosis. A forty four year old male patient who suddenly complained of nephrotic syndrome, showed left hydronephrosis caused by lower ureteral stenosis. Renal biopsy specimen obtained from the right kidney revealed minor glomerular abnormalities. A sixteen year old female patient had a long history of proteinuria before the onset of nephrotic syndrome. She suffered from bilateral hydronephrosis of which the etiology was unclear. Renal biopsy specimen obtained from the left kidney revealed membranous nephropathy. Because in both cases urine samples collected from each ureter showed the presence of a massive protein, the other kidney was thought to be involved with the same disease. The associa tion of nephrotic syndrome with hydronephrosis is extremely rare. The significance of this unusual combination was discussed with respect to the literature.

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A 32-yesr-old woman undergoing hemodialysis for 12 years was reff erect because of systemic bone pain and pathological fracture of ribs and right tibia. Her serum ferritin was 4800 ng/ml, liver CT level was extremely high and skeltal scintigram by 99 m-Tc-MDP revealed high activity of soft tissue. Her serum aluminum was elevated more than 20 .Eg/dl by deferoxamine infusion test. Osteomalacia and positive staining of both aluminum and iron was observed by bone biopsy examination. After treatment with deferoxamine as a chelating agent of iron and aluminum, bone pain was relieved and second bone biopsy specimen revealed improvement of osteomalacia. But serum aluminum was slightly reduced and serum ferritin level and liver CT level were unchanged.

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