Attempts were made to study changes in serum protein and lipoprotein fraction in glomerulonephritis and also in serum protein and lipoprotein metabolism, by determining serum protein and lipoprotein fraction by electrophoresis, serum total lipid, cholesterol, and cholesterolester in 52 patients with glomerulonephritis (including the idiopathic nephrotic syndrom). The clinical diagnosis was done by renal biopsy specimens and laboratory examination. The results were obtained as follows:
(1) Acute glomerulonephritis : The mean urine protein was 0.93 g. per day. The fraction of albumin plus α₁-globulin was slightly decreased, whereas the α₂-and β-globulin fraction were slightly increased and γ-globulin fraction was also moderately increased. The total lipid showed a considerably high value and the lipo-index was higher than those of normal subjects.
(2) Elapsed acute glomerulonephritis : The mean urine protein was 0.60 g, per day. The albumin plus α₁-globulin wa slightly decreased and the α₂- and β-globulin were increased. A significant increase in serum lipid was not noted.
(3) Subacute glomerulonephritis : The mean urine protein was 4.55g, per day. The total protein and albumin plus α₁-globulin were decreased and the α₂-globulin was increased, but there were some variations in γ-globulin. A significant increase in serum lipid was not observed, but tse lipo-indexx showed o significant high value.
(4) Subchronic glomerulonephritis : The mean urine protin was 0.55g, per day. There were slight increases in α₂- and β-globulin. As to the serum lipid the total cholesterol was increased, but the lipo-index did not showed a significant high value.
(5) Glomerulonephritis with the nephrotic syndrome : The mean urine protein was 7.99 g, per day. The total protein and albumin plus α₁-globulin were markedly decreased, whereas the α₂- and β-globulin were extremely increased and γ-globulin was slightly decreased. There were marked increases in total lipid, cholesterol, and cholesterolester, so that the lipo-index showed an extremely high value.
(6) Chronic glomerulonephritis without azotemia : The mean urine protein was 0.33g, per day. The serum protein or lipoprotein fraction and lipid appeared to be normal pattern except a significant high value of the lipo-index.
(7) Chronic glomeruloneporitis with azotemia : The mean urine protein was 4.37g, per day. The total protein and albumin plus α₁-globulin were decreased and the α₂-globulin was increased, and significant changes were not found in total lipid and cholesterol, but the cholesterolester was decreased. The lipo-index showed a high value, but was lower than other tyyes of glomerulonephritis. The characteristic change of serum protein or lipid was observed only in the nephrotic syndrome. According to the relationship between serum protein or lipid and urine protein amount in the nephrotic syndrome, it seemed likely that the cbaracteristic nephrotic pattern of serum protein was mainly attributed to its loss into the urine. It was presumed that such pattern was caused by increase of the serum protein synthesis in the liver in order to compensate loss of serum protein, accompanied with increasing synthesis of lipoprotein, especially low density lipoprotein. Such tendency was observed more or less in ether types of glomerulonephritis.
In subacute and chronic glomerulonephritis with azotemia the typical nephrotic pattern of serum protein was not found, although the urine protein showed a moderately large amount. It might be resulted by disturbance of serum protein synthesis in the liver due to body fluid changes of uremia such as acidosis, azotemia, and retention of various harmful substances.

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The purpose of this paper was to study nephritogenic and immunologic properties of subfractions of nephrotoxic rabbit gamma-globulin. Gamma-globulin was separated from anti-rat kidney rabbit serum by DEAE cellulose chromatography and its pattern was the same as that of normal rabbit gamma-globulin obtained by electrophoresis. The nephrotoxic gamma-globulin was fractionated into three. subfractions by CM cellulose chromatography, according to the method of Palmer. The results were obtained as follows: Although the first fraction (fraction A) and the second fraction (fraction B) were not nephrotoxic, the last fraction (fraction C) showed the ability to, produce nephritic lesions in rat kidney. Fraction C was composed of two fractions (fraction I and II), which were ref ractionated by DEAE cellulose chromatography. Its molecular composition of nephritogenic gamma globulin (fraction C) was II-II-III type, according to Palmer's papain digestion. It was also significantly increased in nephrotoxic serum as compared with that in normal serum, that seemed to result from the immunologic procedures. Immunologic examinations, such as agar double diffusion method and tanned red cell agglutination test, revealed that both fraction I and II had the same serological property. Rats given fraction I by intravenous injection showed prolifrative renal lesions and immediate and severe proteinuria. On the other hand, fraction II produced more slight renal lesions and moderate proteinuria after the latent period. It seemed likely that the difference of renal lesions between both groups was attributed to that fraction I contained much kidney-fixing antibody than fraction II.

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It has been well known that lipid droplets and Maltese cross substances, regarded as cholesterol ester, are found in the proxymal convoluted tubulus of nephrotic kidney. But the source of these lipids is poorly understood. Attempts were made in this paper to determine lipipd pattern and fatty acid composition by thin layer and gas liquid chromatography, lipid synthesis from ¹⁴C-labeled acetate, and oxidation of ¹⁴C-labeled palmitate in the Aminonucleoside nephrotic rat kidney. The results were obtained as follows : There was no difference in total lipid content between normal and nephrotic kidney. But the lipid pattern showed significant difference, namely triglyceride and total cholesterol were increased, and phospholipid were decreased in the cortex of nephrotic kidney. The fatty acid composition of cholesterol ester in nephrotic renal cortex was markedly different from that in normal cortex, namely unidentified substances, such as X, Y, and Z (each relative retention time were 1. 50, 1. 58, 1. 71, although that of C 16 was 1) were increased, and C 18 :1 and C 18 : 2 decreased. There was also significant difference in fatty acid composition between renal cortex and serum in both nephrotic and normal rats. The fatty acid composition of triglyceride in renal cortex and serum showed only slight difference between both groups. As to phospholipid, C 18 and C 18 :1 were decreased, andC 16 was increased in nephrotic renal cortex. The fatty acid composition of phospholipid in renal cortex was also different from that in serum in both groups. In nephrotic renal cortex, ¹⁴C-labeled acetate was more highly incorporated into phospholipid, triglyceride, and cholesterol than in normal renal cortex in vivo and in vitro. The CO₂ production of kidney slice, incubated in the medium containing ¹⁴C-labeled palmitate, was higher in nephrotic rats. The specific activity of ¹⁴CO₂ was lower, but total radioactivity/ 1 mg dry tissue weight was higher, so that the oxidation of fatty acid was accelerated in nephrotic kidney. The lipid metabolism in nephrotic kidney is more active and somewhat different, not only qualitatively but also quantitatively, from that in normal kidney. It seems likely that lipids in the proxymal convoluted tubulus of nephrotic kidney are not infiltrated from serum or reabsorbed from glomerular filtrate, but synthesized or modified in it, accompanied with reabsorption of urine protein.

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Prolonged intermittent deritoneal dialysis was employed in 18 patients with terminal renal diseases, including 15 cases of chronic glomerulonephritis, a case of chronic pyelonephritis and 2 cases of nephrosclerosis, who all could not been attained the improvement of clinical symptoms of uremia with conservative treatments.
(1) It was pointed out that the peritoneal clearance of blood dialysable substances correlated to the dialysis fluid volume up to 3l. at a constant dialysis time. The peritoneal clearances of some substances in 2l. of dialysis fluid volume at the fluid retention time of 60 min, were as follows. Peritoneal clearances of nonprotein nitrogen, urea, potassium and inorganic phosphorus were 24. 5, 25. 0, 20.0 and 16.5 ml/min., respectively.
Protein concentration in the dialysed fluid was about 0.5%, and it was higher in the early exchanged fluid of dialysis than in the late exchanged fluid. The average protein losses by dialyses of 201, and 101. were 22 g. and 15 g., respectively. The protein fraction in dialyzed fluid resembled closely to the serum protein fraction. Serum amino acids were all dialyzed into peritoneal dialysis fluid at the concent-ration of 40-50% of serum within dialysis time of 60 min. Serum NH3 was more dialysable.
(2) The blood chemistries were improved conspicuously as well as edema and congestion of the lung by the intermittent peritoneal dialysis. An excellent improvement of uremic pneumonia was observed in four cases by this procedure. Symptoms of the digestive organs such as anorexia, nausea, vomiting and diarrhea were also ameliorated markedly.
The intermittent peritoneal dialysis was effective to leukocytosis, lymphopenia and hemorrhagic diathesis which occured fresuently in uremic patients, but not effective to anemia.
The hypotensive effect by the isotonic dehydration with intermittent peritoneal dialysis was recognized temporarily in many eases. Disturbances of consciousness were recovered in half of the cases, but the improvement of uremic peripheral neuropathy was difficult in many cases.
(3) The side-affects such as temporary fever, nausea, vomiting and abdominal pain during the peritoneal dialysis occurred in the frequeecy of 10-13%. The formation of hematoma on the abdominal wall was uncommon (0.6%). In a case, ileus arised from the formation of hematoma in the ilium wall.
Hypoproteinemia was occurred in all cases that have received the prolonged periodic peritoneal dialysis. In cases with peritonitis (bacterial, mechanical and chemical origins), protein loss was massive, and hypoproteinemia was then induced strikingly.
Acute digitalis intoxication appeared in some digitalizating cases with the reduction of the blood potassium by the dialysis.
In eight cases among 15 necropsied patients, peritonitis and/or peritoneal adhesion were recognized. The mechanical disturbances of the procedure and the large quantity of protein loss were major limiting factors of dialysis in these patients. The increasement of γ-globulin fraction was observed in many patients with prolonged intermittent peritoneal dialysis.
(4) Three patients survived more than 6 months and 5 patients survived more than 3 months from the onset of dialysis. The longest survivor was maintained for 12 months by dialysis. It was supposed that there was a correlation between the survived period and the duration of uremia before dialysis, serum inorganic phosphorus level, mean blood pressure and glomerular filtration rate.
Considering the side-effect and the limitation of the intermittent peritoneal dialysis, it must be necessary to think over the symptoms and the starting period of dialysis in order to determine the ;indication of this procedure in chronic renal failures.

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For the appraisal of the quantitative analysis of renogram, the correlation cofficients between renal plasma flow (RPF) and renogram factors were studied. The results of this study revealed that this coefficient was very low. We must have doubt about the definition of renogram segment by Winter. Following investigation was undertaken to elucidate the factors which consist of each segments in renogram. Summary and Conclusions of the experimental studies: 1. When the renal artery was constricted, the upper portion of Segment A changed in accordance with the clearance rate. 2. Renal extraction of radio-hippuran was estimated. It reached to 80% in the first thirty seconds, and at that time the urine specimen contained about 1500 counts/ml of radio-hippuran. 3. By direct injection of radio-hippuran into the renal artery, the true renal elimination curve was obtained, i. e. after the injection the summit of the curve was recorded within 15 seconds, then the plateau curve continued for about one minute, and then followed the slow down-hill curve. Segment B was not observed. 4. Para-amino hippuric acid in high concentration was infused in renal artery before the injection of radio-hippuran. The middle portion of the initial elevation was depressed. 5. When renal-pelvic region was covered with lead plate, Segment A was unchanged, while Segment B and C depressed markedly. 6. Segment A is thought to be consisted not only of the vascularity of the kidney but also of the secretory function of the tubules. 7. In Segment B, there also exists the emission of radio-hippuran in the pelvic region. 8. Minute change in renal hemodynamics can not be indicated by renogram.

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The renal infarction is clinically quite rare but reported to be found in 1.4 to 2.5% of all autopsy cases. Most of this entity are associated with various carciovascular diseases and masked by many other clinical symptoms of the latter, so it is rather difficult to have the correct dignosis.
In order get the diagnostic clue for this condition, new experimental method was invented to induced the renal infarction by infusion of Lycopodium applying the selective renal artery catheterization. This method is especially adequate, because of operative invasion.
Applying the technique of the selective angiography, 3.0-4.0 ml of 0.5% suspension of the Lycopodium spores were infused directly into the renal artery of dogs and the main clinical features, blood pressure blood leucocyte count, urinary changes and renal clearance following this procedure were studied succeedingly until 14 days to 2 months.
Result obtained were as follow.
1) Blood pressure : No sustained hypertention was observed in the unilateral infarcted dogs.
2) Urinary findings : In most of the infarcted dogs, transient increase of protein excretion was observed having the peak of proteinuria on the 7 th day after the Lycopodium infusion. The hematuria was also observed proportionally to the severity of proteinuria.
3) Electrophoretic pattern of urinary protein : The pattern of urinary protein analysed by the paper electrophoretic method completely from that of the serum protein. It seems that the marked increase of α₂ and β-globulin and the decrease of albumin were referred to the typical change of the urinary protein. This finding suggests that the proteinuria of this condition should be attributed to the cytolytic process of the tubular epithelial cells.
4) Renal functions (GFR, RPF and RBF) : The decrease of renal clearance was observed on the second day of the experimental period, and these values showed gradual increase there after to the subnormal level.
5) BUN : In the unilaterally infarcted dogs, the increase of the BUN values were slight, owing to the compensation of contra-lateral kidney.
6) Serum enzymes (GOT, GPT and Amylase)Activities on serum tranaminase, and L. D. H, were increased significantly 24 hours after infarction and this state continued for 8 days. No significant change in the serum amylase level was observed.
7) Pathological changes :
Macroscopically, marked contraction of the affected kidneys were observed after 14 days to 30 days. Histologically, swelling and degeneration of the tubular cells and hyperemia were the early findings.The pathy necrosis of the infarcted area ensued thereafter. These findings were similar to those reported previously many authors.
Conclusion : A new method for the experimental renal infarction was introduced. From the results of our investigation, it is clear that the pattern of the proteinuria is taken as a pathognomonic finding in this condition. Clinically, the careful observation of urinary protein its electrophoretic pattern, renal function and serum enzyme levels makes the diagnosis of the renal infarction possible.

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