Ferritin was used as a tracer in order to study the mechanism by which protein are uptake by the glomerular capillary cell. The permeability of ferritin molecules in glomeruli from normal and experimental nephrotic rats are investigated.1) Striking difference between normal and nephrotic rats is found only at the level of the epithelium. In normal animals, ferritin molecules are found in small numbers in the epithelium. However, in nephrosis the permeability of the glomerular capillary wall is significantly increased, and numerous ferritin molecules are uptake by the epithelium. This function is stimulated particularly when increased quantities of protein permeate into the basemhnt membrane. It is pertinent to add that large ferritin molecules are uptake by the mass of epithelial cytoplasmm which the foot processes of the epithelial cell are lost. Ferritin molecules are uptake by the epitheliam in greater numbers than by the endothelium, base-ment membrane and mesangial cell.2) These findings suggest that the basement membrane and the epithelium are important with. respect to the permeability of the glomerular wall and that the main filtration barriers are the base-ment membrane and the epithelium. Since the epithelium appears to play a part of protein filtration: through the glomerular capillary wall.3) It is detected that ferritin molecules are uptake by the epithelium in pinocytotic vesicles andtrans ported via the small vesicles to large vacuoles which are subsequently transformed into dense bodies, others incorporated as carrier, RNA granules and and endoplasmic reticulum into cytoplasm.4) In normal and nephrotic-nephritic rats, ferritin molecules are picked up by the epithelium, the endothelium, the basement membrane, mesangial cell. Those findings suggest that on the pathogenesis, of glomerulonephritis nephrotoxic substance is incorporated to the destruction of renal glomerular capillary.

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Various clinical findings and histologic changes were seen in patients with nephrotic syndrome, According to the light microscopic glomerular changes, 30 cases of the nephrotic syndrome resulting from lipoid nephrosis and glomerulonephritis were classified into 6 groups. In the group 1, glomeruli showed no remarkable changes or very slight cellular proliferations. In the group 2, slight and partial thickening of the basement membrane were present in nearly the glomeruli. In the group 3, most of glomeruli showed marked diffuse thickening of the basement membrane (Membranous glomerulonephritis). In the group 4, most of the gtomerule showed prolifera-tions of mesangial and endothelial cells with the glomerular lesions belonging to group 2 (Proliferative glomerulonephritis). In the group 5, biopsy specimens revealed lobulation of the glomerular tufts resulting from increased mesangial cells and partially thickened basement membrane (Lobular glome-rulonephritls), In the group 6, biopsy specimens revealed hyalinisation and sclerosis of the lomerul tufts with the glomerular changes belonging to group 4 and 5 (Chronic sclerosmg glomerulonephritis), An attempt was made to classify the relationship between the various clinical and histologic findings and the effects of ACTH and steroid therapy on the patients. The conclusions were as follows. (1) Correlation between clinical and laboratory findings and effects of hormone therapy. The satisfactory effects following hormone therapy were not obtained from the nephrotic patients with hypertension and hematuria. The considerable effects were found in the patients whose protein-uria more than 10.1 gm/day. In the patients whose proteinuria were less than 10 gm/day, only unce-rtain effects were obtained. It was impossible to predict the effects of hormone therapy on the basis of serum total protein, protein pattern and cholesterol. At the remarkable edematous stage, most of patients showed increased N. P. N, value, decreased renal clearance value and P. S. P. test. From these data, therefore, it was also impossible to predict the effects of hormone treatment. In the groups of the nephrotic syndrome with slight or no glomerular changes, it was one of the characteristics in the nephrotic syndrome that various renal functions were able to recover completely after hormone administration, even though renal functions were severly impaired. (2) Correlation between glomerular changes and effects of hormone therapy. In the patients with the short clinical course, the glomerular changes were slight, while the pro-gressive renal changes were seen in the patients with the long history, hematuria or hypertension. It was confirmed that the histologic changes did not always reflect the decreased renal functions at the time of marked edema. The best effects following hormone administration were obtained from the patients whose glomerular changes belonging to the group 1. The good effects were observed in the patients belonging to the group 2, 3 and 4. The poor effects were seen in the patients belonging to the group 5 and 6 showing irreversible glomerular changes. These facts suggested that the degree of glomerular changes were an important factor to decide the effects of hormone therapy, and that the effects of hormone treatment were able to be predicted by the degree of glomerular changes. (3) There was no consistent relation between the initial dosis of hormone and the effects. (4) There was an intimate relationship between duration of hormone therapy and the effects. No complete remission was found in the patients with hormone administration for less than 3 months, but excellent effects were obtained from the patients with hormone therapy for more than 6 months. (5) The shorter the clinical course prior to hormone therapy after the onset of the nephrotic syndrome, the better the effects were. It was essential that the hormone should be administrated to the patients within at le

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Recently the appearance of synthetic angiotensin II and the availability of the method for detemining angiotensin in the blood have recalled the re-evaluation of cause of experimental renal hypertension. Angiotensin II in dog arterial blood is determined before and 3 days to 21 weeks after the constriction of renal artery by means of Goldblatt's method. Therefor, the forst 1 week is regarded as the acute stage of this experimental hypertension and as the chronic stage after that. The following results are obtained on the basis of the study on the relationship between renal fun-ction (GFR, RPF) serume electrolytes (sodium, potassium, chloride) and angiotensin II (Baucher's modification method), catecholamine (Weil-Malharbe & Bone's method) in the blood. 1) Amount of angiotensin II from 20 normal dogs, 13 in acute stage and 18 in chronic stage reveal. 0.0015, 0.0269, 0.042 γ/200 ml of blood respectively. Angiotensin II in acute and chronic stage is significantly higher than that in controls. 2) Amount of angiotensin II shows a negative correlation with RPF (r=-0. 6), and GFR (r=-0.5) 3) Amount of angiotenisn II shows positive correlation with blood pressure (r =0.6) 4) Catecholamine in the blood shows no tendency of increasing in acute stage, whereas a few cases in chronic stage appears to show increased catecholamine. 5) No relationship between serum electrolytes and blood angiotensin II is observed.

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This study reports the quantities of angiotensin in the blood of 10 normal persons, 12 patients with essential hypertension and 10 with renal hypertension. Baucher's method was used for the measurment of angiotensin. The relationships between amount of angiotensin with renal function, blood pressure, findings in the eyeground and blood electrolytes were observed and the following results were obtained. 1) Amounts of angiotensin in 200 ml of blood from 10 normal persons, 12 patients with essential hypertension and 10 patients with renal hypertension ranged from 0∼0.026, 0.011∼0.075 and 0.020∼0.082 r respectively. The increase in the amount of angiotensin was found in all the hypertensive patients. Amount of angiotensin in the blood appears to be significantly higher in essential and renal hypertensive patients than normal group. (t=5.2 p≤0.003 t=5.3 p≤0.003)2) Amount of angiotensin showed a negative correlationship with renal function; correlation coeffi-cients were -0.55 for RPF with amount of angiotensin, -0.49 for GFR and -0.69 for 15 minutes volum of PSP. There was apparently proportional relation between amount of angiotensin and renal dysfunction. 3) A positive correlation was found between amount of angiotensin and blood pressure ; correlation coefficients were +0.35 for systolic blood pressure with amount of angiotensin, +0.48 for diastolic blood pressure and +0.57 for mean blood pressure. There was presumably proportional relation between amount of angiotensin and increase in blood pressure. 4) The amout of angiotensin exhibited a positive correlation with pathological findings in the eyeground. 5) No relation was seen between the amount of angiotensin and blood sodium, potassium and chlorid concentrations. 6) Angiotensin appears to play an important role as a. pressor substance in chronic renal hyperten-sion.

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It is a known fact that alterations of metabolism of phosphate (P) and calcium (Ca) will take place in disorders of the kidney and other endocrine organs as well as the parathyroids. Correlations between the above metabolic abnormalities and the parathyroids, however, are not entirely clear. CP/GFR, relative clearance of P, is interpreted to indicate the activity of the parathyroid glands. The fact that its level becomes increased in hyperthyroidism is of potential value for the diagnosis of hyperparathyroidism. On the other hand, Kleeman and his co-workers have conjectured from the changes of Cca/ GFR, relative clearance of Ca that the parathyroid glands regulate reabsorption of calcium in the kidney. There are some reports in which they have denied the existence of such a mechanism. This is quite controvertial. The author studied metabolism of P and Ca in the kidney using mainly CP/GFR and Cca/GFR as an index and referred to its clinical significance. The present series consists of a total of 67 cases, namely 26 cases of renal diseases, 1 of post operative hypoparathyroidism and pseudohypoparathyroidism, respectively, 3 of pr imary aldosteronism, 3 of pheochromocytoma (chromaflinoma) and 13 of the thyroid diseases. Some other endocrine disorders and the normal control group are also included. Four individuals with abnormal metabolism of P and Ca have been subjected to autopsy. Comparative studies have been undertaken on their histopatho-logical findings of the parathyroids and those of 5 control cases. Particular attention has been made on whether or not hyperfunction of the parathyroid glands exists. Thus, Correlations between the parathyroids and metabolic abnormalities of P & Ca in renal and other miscellaneous endocrine disor-ders have been pursued. CP/ GFR markedly increased in all instances of primary aldosteronism and pheochromocytoma as well as uremia. Cca/GFR was found to be markedly increased in uremia, primary aldosteronism, pheochromocytoma and some of Cushing's syndrome. CP/ GFR & Cca/ GFR in pseudohypoparathyroidism and postoperative hypoparathyroidism showed low value but within normal limits, while those in renal stone, thyroid diseases, Addison's disease and diseases of the pituitary glands are unremarkable in all.. 24-hour urinary excretion of P moderately increased in some of the patients with pheochromocytoma, , hyperthyroidism and renal stone. Ca output in urine markedly increased in 1 of pheochromocytomaa and 1 of Cushing's syndrome, respectively. In 4 instances subjected to the histological examination of the parathyroids in the autopsy series, the parathyroids of 2 uremic cases are enlarged with light color and heavy weight, which possess less fat and increased “Wasserhelle Hauptzelle” in comparisonn with thoseof the control group. The diameter of those “Hauptzellen” is much smaller with a range of 6-15 μ than the one seen in the primary hyperplasia, showing the hyperfunction due to secondary hyperplasia, Namely, from both clinical laboratory examinations and histological findings of the parathyroids, in the 2 uremic patients hyperparathyroidism secondary to renal insufficiency wasconfirmed. In cases of pheochromocytoma and Cushing's syndrome, on the other hand, despite increa-sed level of Ca/GFR, either clinical or histological findings compatible with hyperparathyroidism was not present. In each case of postoperative hypoparathyroidism and pseudohypoparathyroidism, CP/ GFR & Cca/GFR showed low value but within normal limits. It was found, therefore, that relative clearance of P & Ca does not always indicate the function of the parathyroids. CP/GFR & Cca/GFR, however, reflect the reabsorbability of P & Ca in the renal tubuli and even in case where the urinary excretion is not markedly increased, they are considered to be of value in terms of investigation of varying P & Ca disposability in the kidney.

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