Clinical observation on the relation between urological diseases and blood pressure were made of 898 in-patients in the Urological Department of Kumamoto University Hospital from 1954 to 1960, and the following results were obtained.
1) Hypertension was seen in 14.5% of the patients with urological diseases. The frequency of hypertension was significantly high at the age of 39 or less, but was not so in the older age group as compared with normal persons.
2) Hypertension was seen in 7.5% of unilateral renal diseases, 19.8% of bilateral renal diseases and 22.2% of lower urinary diseases.
In the majority of hypertensive cases with bilateral urinary diseases, severe disturbance of renal function due to urinary tract obstruction was noticed and blood pressure was descended by nephroor ureterostomy.
4) Of unilateral urinary diseases, the frequency of hypertension was high in pyelonephritis (37.5%) and renal tumor (31.6%) and less than 10% in other diseases such as urolithiasis, urinary tuberculosis, nephroptosis, hydronephrosis, chyluria and renal hematuria. Generally, hypertension was more frequent in cases with severely involved renal parenchyma. Some cases of renal tuberculosis and pyelonephritic contracted kidney recovered from hypertension by removing the involved kidney.
5) Hypertension was seen in 15.2% of bilateral urolithiasis and 4.8% of unilateral one. Hypertension was more frequent in the cases complicated with urinary infection or hydronephrosis than in non-complicated cases and more frequent in patients with larger or multiple stones than those with smaller ones.
6) Of the diseases of the lower urinary tract, hypertension was the most frequent in chronic obstructive diseases such as prostatic hypertrophy (35.0%). Some relation was observed between blood pressure and the volume of residual urine.
7) Hypertension in chronic obstructive diseases was divided into two types: renal hypertension due to urinary retention and extrarenal hypertension which was occasionally complicated. In the former type, hypertension was releaved by indwelling catheterization.
8) These results show that hypertension due to urinary diseases and releaved by the treatment for them is clearly present although it is not frequent. The common findings in this type of hypertension are urinary infection, atrophy on the renal parenchyma, circulatory disturbances of the renal arteries and obstruction of the urinary tract, but these are not always essential to the development of renal hypertension.

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Serum electrolytes (K, Na, and Cl) were measured in 128 cases of urological diseases (17 of them complicated with renal hypertension, 20, extrarenal hypertension), 52 cases of essential hypertension, 15 normal persons, 11 Goldblatt's rabbits, 7 Goldblatt's dogs, 3 nephrectomized rabbits and 2 nephrectomized dogs, and the relationships among serum electrolytes, renal function and blood pressure were investigated. Futhermore, in some cases, measurements of urine volume and electrolytes, and the load test of isotonic or hypertonic saline were performed. The results were as follows.
1) Serum electrolytes in renal hypertension which were generally in the normal range, showed no significant difference from those of normal persons, those of ptients with non-hypertensive urological diseases and essential hypertension and no correlation with blood pressure or renal function.
2) Urine electrolytes showed no consistent results because of their large daily variations. They seemed not related with blood pressure but related with renal function or renal vascular condition. At least, no specific pattern of urine electrolytes was noticed in renal hypertension.
3) Na and Cl in urine temporally decreased when blood pressure was discending, on the other other hand, temporally increased when blood pressure was increasing.
4) Some cases of hypertension showed diuresis and increased excretion of Na and Cl by load if physiologic saline, but no specific reaction was observed in renal hypertension.
5) Changes in urine volume and urine electrolytes after load of hypertonic saline were not consistent and no specific reaction was observed in renal hypertension.
6) Intravenous or oral continuosus administration of saline in normotensive Goldblatt's rabbits brought a temporal increase in blood pressure 3 to 5 days after the begining of administration.
In conclusion, no specific pattern of electrolyte metabolism in renal hypertension was noticed from observations of serum and urine electrolytes. It seemed that the disturbance of electrolyte metabolism was not the essential factor in the development of renal hypertension.

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The present experiments were performed to evaluate renal peripheral revascularization for the treatment of renal ischemic diseases. Twenty three mongrel dogs and 22 rabbits with normal or Goldblatt's kidney were employed. Nephro-splenopexy, splenic artery implantation to the kidney, and nephro-enteropexy using the serosa and mucosa respectively, were tried. The difficulty of operation, complications and operative risks were compared with those in renal decapsulaton. The following examinations were carried out: body weight, blood pressure, blood picture, blood coagulation time, serum protein fractions and renal function. The development of collateral blood supply was investigated with dye or radiopaque material injection.
1) Renal decapsulation was the easiest operation. The order of increasing difficulty was as follows: nephro-splenopexy, splenic artery implantation to the kidney, nephro-enteropexy using the intestinal serosa and that using the mucosa.
2) In most cases of nephro-enteropexy using the mucosa, the cyst formation between intestinal wall and the surface of the kidney resulted in faulty anastomosis. No faulty anastomosis was observed in other operations.
3) The operative mortality was the highest in the nephro-enteropexy group, being zero in the nephro-splenopexy group. Animals with severe renal insufficiency could not endure nephro-enteropexy. Some animals died of peritonitis.
4) Each operative procedure for renal revascularization did not considerably affect the body weight, blood picture, blood coagulation time, serum protein fractions and electrolytes.
5) Renal decapsulation as well as other operations lowered the blood pressure of hypertensive animals.
6) The effects of renal revascularization on the renal function were not cosistent. Improvement of renal insufficiencs in Goldblatt's kidney could not be expected.
7) Ligation of the renal artery after revascularization resulted immdiately in anuria. It was impossible to maintain normal renal function and to prevent the necrosis of the kidney.
8) Contrast media injected into the splenic or mesenteric artery demonstrated renal arteries and appeared in pelvis. India ink injected into the same artery reached the renal stroma, arteries, veins and glomeruli. When examined by india ink injection, communications between collaterals and renal circulation were not observed within 2 weeks after the operations. It took 4 weeks for completion of anastomosis. These findings were similar in all of the operations tested,
9) No appreciable histologic changes were noted after revascularization. Ligation of the renal artery resulted in an extensive necrosis of the kidney. The enzymatic activity tended to be decreased by revascularization.
These results indicate the collaterals are really developed by peripheral renal revascularization, but not sufficient to maintain normal renal circulation, or to improve renal insufficiency. Therefore, the clinical application of the renal revascularization is of little benefit in the present time, but the fact that renal revascularization lowered the blood pressure of hypretensive animals qualifies further investigation.

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1. According to Seldinger's method, serial selective renal and internal iliac angiography were performed inserting green catheter (Kifa Co. Sweden) or medium sized catheter (B-D Co. U. S. A.) through the femoral artery.
2. Injections were made with 6-8ml. of contrast medium by hand, and 30ml. by automatic injector with the pressure of 3 Kg/cm², into the renal and internal iliac artery respectively. The contrast medium used was 60% Urografin (Renographin) or 60% Conrey.
3. In renal angiography factors unfavorable to insert catheter into the renal artery was the tortuasity and stricture of the artery. Four centimeters of the catheter's tip was convexed drawing an arc with the diameter of 3cm., considering the diameter of the aorta and the angle of the origin of the renal artery.
4. Less valuable was selective angiography of the kidney with multiple arterial supply. These were found 11% on right and 17% on left.
5. Arterial branch which usually supplies upper portion of the kidney initiates from the origin of the renal artery. (12% on right, and 180 on left).
6. These evidences suggest the necessity of performing the general aortography together with this selective angiography.
7. In selective internal iliac angiography, bilateral femoral arteries were catheterized simultaneously and the insertion of the catheters was then attempted into the contra lateral iliac artery beyond the aortic bifurcation.
8. Failure of this technique was approximately 15% when the iliac arteries were so tortuous.
9. This new technique is favorable in visualizing peripheral vesical arteries and in observing the changes of the bladder wall in the capillary phase.
10. Complications of this procedure are avoidable with suitable preoperative care and careful manipulation.
11. In discussion, the authors stressed the prevalence of selective aegiography in the differential diagnosis and the therapeutical indications. The pathological radiogram will be presented in the next paper.

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