The Biopsy material taken from 18 cases which were diagnosed to be nephrotic symdrome of un-known origin on the clinical viewpoint. These were examined histologically as well as electronmicro-scopically, On the basis of electronoptic findings of mitochondria of the glomerular epithelial cell three types were postulated : A ; demonstrating severe enlargement of michondria including so-called myelin body. The latter being merely vacuolic rather peculiar is seen in concetric structure the shell of which is electron dense. Histologically sedan and PAS stainings failed to reveal neutral fat and mucopoly-saccharide, There were five cases assumed to be in this group which revealed mild nephrotic syndrome; lower proteinuria, almost normal cholesterinemia occasional edema and normal TP except for arbitural PSP excretion. B ; characterised by moderate enlargement of mitochondria, advancing disarrangement of crista, occasional electron dense granules in the glomerular epithelial cells. The basement membrane showed mederate thickning on lightmicroscopy and occasional fusion of foot processes. There were five cases being in this kathegory with occasional severe proteinuria and higher cholesterinemia. C ; show-ing almost normal mitochondria of the epithelial cell but rather severe thickning and flattening of epithelial foot processes. Eight cases were observed to be in the group exhibiting typical syndrome of nephrotisis and effective steroid and ACTH therapies. On the morphological and functional findings is drawn conclusion that the mitochondria of the glomerular epithelial cell would contribute to contaoll albuminuria with deformation of it. It would there-fore be mentioned that the protein leaking through the basement membrane could be taken in the cytoplasma the mitochondria of which play a role to manufacture it to from proteinuria of the ultafiltrate.

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1) The correlation of structure and function of human kidney in acute, subacute and chronic renal failure was studied, morphologically by microdissectional and histological methods. 2) In acute renal failure due to mismatched transfusion, changes of tubular epithelium were noted mainly in the distal tubules, while in the case due to toxic agents were found in the proximal as well as the distal ones. According to these findings, it is suggested that as a result of striking back duff u-sion of tubular fluid through the damaged epithelium, marked oliguria may occure. 3) In the case of subacute nephritis, membranous and exsudative changes in glomerulus and local 'hypertrophy with dilatation of lumens in the terminal portion of the proximal tubules were observed. According to these observations, the tubular dominant, as physiollogically suggested at a point of view in glomerular tubular balance, was also morphollogically supposed. This may result marked edema which affects unfavorably. 4) In human chronic renal failure, small mumbers of hypertrophied nephrons were observed in the contracted tissue. Formerly, it was assumed in my 1 st Report, that the renal function after partial resection of the Kidney in dogs were so similar to that of human chronic renal diseases. On account of these bases, it is suggested that the renal function of the human chronic renal failure may be done mainly by these small numbers of hypertrophied nephrons and not by the large numbers of atrophic nephrons. 5) In chronic renal failure, the tubular segmentation, so I called, one of the state of atrophic changes, were observed and the mechanism of the tubular segmentation were discussed by microdissectional method.

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An observation was made on the influence of high energy phosphorus bound substance-ATP-and the activated form of Vit. B₁ by phosphorilation - Co-Carboxylase - on the renal function, and wass studied the glucose metabolism in the kidney having renal disease or the rats kidney experimentally introduced renal disorder. ATP made a rise of renal clearance in the normal kidney of rabbits. After ATP and Co-Carb. administration PSP-test showed a rise or an improvement in cases lightly disturbed renal function, but not definite change in serious cases. ATP made a marked improvment of Δ10 P in the lightly disturbed rats kidney by potassium chromate but the minimum increase and slow return to the begining rate in serious cases. These improved also pyruvic acid and α-ketoglutalic acid in the renal disease. Thus it may be assumed that ATP and Co-Carb. improved the renal function on activating the the phosphorus metabolism and leading the smooth TCA cycle, and that PSP-test may indicate the reactivity of the renal function.

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　昭和13年から昭和35年までの23年間に診察した急(発)性糸球腎炎(以下単に腎炎と略記す)患者1095人について,またはその内より観察の前年末に発病せしもの15人を除き,または全経過判明せる541人のみについて9または所要治癒期間明らかなる361人のみについて次の事項を調査した。　I腎炎は内科医のもとでは,6～15才の子供にもつとも多く,年をとる人程少なく,しかし老年者にも僅数:見られた。　腎炎は絶対数も相対数(男女各総患者数に対する男女各腎炎患者の%数)も男子に多い。年令別に分けると,15才までは男児に多く,50才以上ではいちじるしく男子に多いが,15～50才の間は男女同率に発生する(第1表と図)。　II23年間の各年度中の腎炎発生数を年度順にならべ曲線を作ると,2つの高い山とその間に1つの低い谷を整然と作つた。第1の山頂は昭和14年,谷底は24量年,第2の山頂は31年である。なお参考のためこれに観察期(昭和13年)前の毎年の腎炎患者数を見たところ,観察期間内のような大なる山や谷を見出さなかつた(第2表と図)。III腎炎発生は平均して,冬季最多,夏季最少,春秋はその中間である(第3表)。　IV腎炎の原病を8別した。各頻度は1)扁桃炎後腎炎最多,つぎに2)感冒,両者併せて6割強,3)化膿性疾患,4)その他の炎症性疾患,5)猩紅熱＋6)猩紅熱様発疹,7)紫斑病の順である。8)原因不明のものは全体の約1/4あつた。(第4表百分率)。　15才以下の子供に対し15才以上をここでは「大供」または大人と呼ぶ。子供と大人とで腎炎の原病の頻度が相異なつている。扁桃炎後腎炎は大供に多いが,その他の原病による腎炎は子供にいちじるしく多い。(第5表の転帰判明者の列子供大供の数比較)。　原病発生から腎炎発生までの間隔日数が,各原病について大凡定められ,各原病により間隔日数いちじるしく多きものと少きものとある(第4表太線)。　V腎炎の3転帰経過判明せる541人について,治癒(尿変化消失を以つて治癒と看倣す)441人(89.7%),未治39人(7.3/),死亡17人(3.1%)(第5表最下轂参照)。　A治癒者について　(1)治癒率から見た予後イ)一般治癒率は上記のごとく89.7%。ロ)治癒率の年令差は子供(93%)の方が大人(86%)より高い(第5表治癒者最下毀参照)。ハ)性別差は女子にやや高い(89%対91%),(第5表附属A表)。　(2)所要治癒期間から見た予後イ)全例(361人)については,1ヵ月以内と2ヵ月以内の治癒者最多,月を重ねて治る人程少なくなり,計1力年内治癒率87.2%となつた。ロ)1力年内治癒率は子供は90%大人は83%で子供に高い(第5表附属B表)。ハ)男女では差がない(第5表附属B表)。　(3)原病から見た予後イ)原病の異なるにより腎炎の治癒率が多少異なる。ただ紫斑病の腎炎では5人中3人死亡した(第5表紫斑病の列率参照)。ロ)各原病別腎炎の所要治癒期間の相異はいちじるしくない。ただ猩紅熱,紫斑病後の腎炎は長くかかつて治つている(第5表附属C表)。　B未治者について　上記のごとく,転帰判明者541入中39人(7.3%)。この39人中子供12人,大人27人(第5表)。男26人,女13人(第5表附属A表)。高血圧所有者は5人あり(男4人女1人,子供1人,大人尋人)。　C死亡者について　上記のごとく,死亡者総数17人(3.王%)わその内子供5人,大人12人。男10人,女7人。死因は尿毒症9人(この内亜急性腎炎7人)。原病不明の腎炎,紫斑病後腎炎に死者多きこと,その他について述べた。　VI追加調査(第6表AI.II,B)手紙での問合せに対する返事は,治癒者よりはより多く,未治者・死亡者(その家族)よりはより少なく集り,それにより予後が実際より良くなる怖れあるに鑑み,直接診察して定めた患者のみについて,3転帰またはその見込を出して見た。結果は却つて予後一層良好となり,問合せによる予後の良くなることは無きものと認めた。　終に臨み本講演の機会を与えられたる会長慶大名誉教授大森憲太博士に感謝の意を表します。

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