In order to investigate the differences between the qualitative changes in urinary protein and the lesions of glomerular basementmembrane, "so called selectivity slope θ" showing the selectivity of glomerular basementmembrane for serum protein, was determined by immunodiff union technic which calculated selectivity from the clcarances of four individual serum protein (albumin, transferrin, IgG, α.2-macroglobulin) and Sephadex gel filtration. Selectivity slopes θ determined by these methods, Were compared with each other, and selectivity slopes in 46 paitients of various renal diseases were calculated by immunodiffusion technic. The results were as follows 1) When urinary protein concentration was over 1.0‰, a correlation was found between the vale es of θ as obtained immunodiff usion technic and Sephadex gel filtration (P<0.01) 2) On nephrotic syndrome, minimal change type showed high selective θ and membranous type showed low selective θ. Thus, it was proved that the histological changes in glomeruli were related with selectivity slopeθ. On chronic nephritis anb diabetic nephropathy, θ showed low values in azotemic group, suggesting that θ was related to the severity of renal damage. In the relationship between θ and trans-R-x (U/S ratios as percentage of transferrin U/S rations), θ showed good correlation with trans-R-α2-M (P<0.01), suggesting an important role of trans-R-α2-M in determining θ, while showed no correlation with trans-R-IgG and trans-R-AI. Urinary protein concetration and urinary output showed no correlation with θ. Creatinine-clearance and PSP (15 min.) showed positive correlation with θ (P <0.01), on the other hand BUN and serum-cerum-creatinine showed negative correlation with θ (P <0.01) . 3) The relationship between θ and steroid effects on nephrotic syndrome was invastigated, but little change observed in selectivity slope θ following the treatment. Comparing with the response to steroid and θ on nephrotic syndrome, the responsive group to steroid showed higher selective θ as compared with non or poor responsive group.

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Excretion amount of endogenous cortis ol, which is calculated from the amount of urinary Porter-Silber Chromogens, and therapeutic effect of ACTH-Z, were studied on patients with nephrotic syndrome, in comparison with that of synthetic corticoids and the results are as follows. 1) The theoretical effect of ACTH-Z given in a dose of 40 units daily for consecutive days is not superior to that of prednisolone given in a daily dose of 40 mg. While in the treatment of patients with nephrotic syndrome, the practical effect of ACTH-Z can not be necessarily said as inferior to that of prednisolone, for instance, a rather beneficial therapeutic effect is obtained with ACTH-Z than whenn prednisolone is given in a dose of 60 mg. This suggests whether it is not reasonable to use anti-inflammatory action as an index in evaluating the two drugs or whether qualitative change as well as quantitative one of endogenous corticosteroid excreted by ACTH-Z administration must be taken into consideration. 2) It must be noted that the therapeutic effect of ACTH-Z is hardly expected in those in whom a lowering of adrenocortical reserve is supposed to exist. 3) From our experiences on 5 cases of nephrotic syndrome, we can hardly agree with the opinionn that use of ACTH-Z must be chosen to the first treatment, in view of the adrenocortical reactivity. In intramuscular administration of ACTH-Z, the incidence of hypersensitivity to the drug as well as pain at injection should be taken care of. It seems, accordingly, reasonable that synthetic corticoids are tried for the first treatment, and. ACTH-Z is in patients who failed to respond to synthetic corticoids. The present paper emphasizes that ACTH-Z has a possible difference in characteristic from synthetic corticoids in treatment of nephrotic syndrome, since all patients responded well to ACTH-Z irrespective of unsuccessful results with prednisolone, except one whose adrenocortical reserve had been already injured.

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Differential renal function studies were performed on clinical cases in which renal hypertension were suspected. The examinations were carried out under oral administration of water, using the plastic whistle tip ureterol catheter with multiple eyes, introduced into the midpoint of each ureter. In this paper, the water metabolism in the kidney was chiefly investigated. The results cf examination in the controls and the unilateral renovascular hypertension are as follows : I. The results in the control group : Thirteen cases were picked up as controls, in which functional and organic chatges in the kidney were not recognized in the radioisotope renography and intravenous pyelography. 1) Under water diuresis, the U-Flow, RPF, GFR, U-Osmo and C-H₂O were a little greater in the right kidney than in the left kidney. 2) The U-Osmo ranged from 16 mOsmo to 301 mOsmo in the right kidney and from 14 mOsmo to 288 mOsmo in the left kidney. The average value was 143 mOsmo in the right kidney and 132 mOsmo in the left kidney. 3) The C-Osmo ranged from 0.53 cc/min to 4.78 cc/min in the right kidney and from 0.41 cc/min to 4.74 cc/min in the left kidney. The average value was 2.24 cc/min in the right kidney and 2.14 ccj min in the left kidney. 4) The C-H₂O ranged from 0.41 cc/min to 15.90 cc/min in the right kidney and from 0.07 cc/min to 15.60 cc/min in the left kidney. The average value was 3.56 cc/min in the right kidney and 3.30 cc j min in the left kidney. II. The results in the unilateral renal artery stenosis : 1) In the stenotic side, the U-Flow, RPF, GFR and C-Osmo were decreased, but U-PAH and U-Osmo were increased. 2) The ratio of U-Osmo of the stenotic kidney to the control was increased more than 1.06. 3) The ratio of U-PAH of the stenotic kidney to the control was increased more than 1.17. 4) The C-H₂O was decreased in the stenotic side, however it gave negative value in some occassions. Even when the values of both side were negative, the absolute values in the stenotic kidney were greater than the opposite side. 5) When the ratios of U-Osmo and U-PAH of the left kidney to right kidney are greater than. 1.06 and 1. 17, unilateral renovascular hypertension of the increased side due to renal ischemia may be suggested and its probability is above 83% or more.

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There has been no established theory about the LDH isozyme pattern in three parts (cortex, medulla, papilla) of Kidney with each different metabolism. This report involves the investigation of the LDH isozyme in three parts of human contracted kidney and rabbit kidney with the stenosis of renal artery. The results are as follows 1) Three parts of normal human kidney have different metabolic form LDH₁ and LDH₂ are predominant in cortex and medulla in other words H-type. On the other hand, LDH₄ and LDH₅ are predominant in papilla, that is M-type. In cortex and medulla of human contracted kidney, LDH₁ and LDH₂ bands reveal reduction. LDH₄ and LDH₅ bands increase relatively and are similar to the LDH Isozyme pattern in papilla. The O₂ consumption of human contracted kidney cortex and medulla, is reduced extremely and there is no change in papilla 2) The LDH Isozyme patterns in rabbit kidney with the prolonged stenosis and complete ligature of renal artery, are different from normal rabbit kidney. In cortex and medulla, the LDH Isozyme pattern is similar to the pattern in human contracted kidney. Because of high level of ishemia, prolonged ishemia and resulting degradation of the kidney tissue, the LDH Isozyme pattern changes from H-type to M-type. As a result of fitting for anaerobic metabolism, LDH₄, LDH₅ develop predominsnt figure and it seems that this phenomenon means the adaptations for keeping renal function as much as possible, and maintaining the constancy of body fluids.

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