1) Clinical analysis on 21 cases of renal hypertension experienced at Yokohama City University Hospital in the past five years and on 185 reported cases in the past Japanese medical literature are presented.
The conclusion is as follows: No definite preponderance on age and sex was found. Family history, past history, chief complaints, and urinalysis had little contribution to the diagnosis of renal hypertension.
Reno-vascular hypertensive groups were mostly caused by arteriosclerosis, thickening of arterial intima and by aneurysm.
Renal parenchymal hypertensive groups were due to pyelonephritis, hydronephrosis, and hypoplastic kidneys.
2) Several interesting cases including followings are presented: Bilateral renal artery stenosis associated with atypical coarctation of the aorta in 20 year old female was treated by spleno-renal anastomosis and aorto-renal bypass graft. Her hypertension was corrected.
Moderate hypertension, hematuria and polycythemia were found in 33 year old male whose left renal arterial branch was obstructed. Erythropoietin bioassay was not conclusive, however, polycythemia vera and other disorders causing polycythemia were excluded in this case, polycythemia of renal origin was suspected. (renal ischemia→erythropoietin production→polycythemia). Other symptoms were also due to renal ischemia, i. e. increased permeability of capillary bed in glomeruli due to hypoxia caused hematuria and renin released from the ischemic kidney resulted in hypertension through Gold-blatt mechanism.
Hormonally non-functioning giant adrenal cyst causing left renal artery compression and stretching was removed in 62 year old male and hypertension corrected.
3) Intravenous pyelogram (contrast media injected rapidly, films taken also at early phase) was found to be very valuable in detecting renal hypertension when combined with ¹³¹I Hippuran renogram.
Shortening of the longitudinal axis in nephrogram, hypoconcentration, and delay in appearance of nephrogram or pyelogram were usual findings in IVP.
1.5cm or more difference of the longitudinal axis in nephrogram in hypertensives is an absolute indication to subsequently taking renal arteriogram.
More than 2 findings on pyelogram are also indication to arteriogram.
More attention should be given to the ureteric indentations on pyelogram due to compression of the ureter by well developed ureteric arteries as collaterals to the ischemic kidney.
4) Some discussions especially on side effects were made on selective renal arteriogram in comparing with aortogram. Comparison of renal artery stenosis with and without renal ischemia was done.
Renal artery stenosis causing hypertension is prone to have stenosis ratio bellow 0.50, post-stenotic dilatation, and well developed collaterals.
2 cases of renal arterial stenosis without renal ischemia due to hypersensitive angitis are presented.
5) Seperated Renal Function Mannitolization Test (after collection of sparated urine under oral diuresis, rapid infusion of 20% mannitol solution intravenously may reverse Na, Cl, K, Urea-N, or creatinine concentration ratio between ischemic and non-ischemic kidney urine) can prove presense of renal ischemia.
Proposal on SRF index (Separated Renal Function index) was made:
SRF index=number of positive tests indidating ischemic change/total number of tests
Closer the SRF index to 1.0, more reliable that the kidney is ischemic. SRF index can be applied in every occasion of separated renal function tests even if bladder leakage is present.
6) After experimental renal ischemia such as total infarction, partial infarction, or Goldblatt kidneys was produced in rabbits, serum and urinary alkaline phosphatase level changes were investigated.
Alkaline phosphatase, rich in proximal convoluted tubuli was released only transientry under these ischemic conditions.
However, clinically, one third cases of renovascular hypertensives showed e

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In recent years, a considerable number of immunosuppressive procedures have been reported for the protection of the rejection in renal allotransplantation.
The present work is concerned with the examination in renal auto-and allotransplantation in dogs, and proposes a new immunosuppressive method.
The iliac fossa was selected as the allogenous transplanting site on the ground of the results of autotransplantation. The dogs with allotransplanted kidneys have been divided into three groups: 1) Unconditioned, 2) intramuscularly given 5mg of 6-Mercaptopurine (6MP) per one kg of body weight and 3) intravenously given the donor kidney digest with Nagarse in addition to the administration of 6MP. The mean survival of the animals of each group was 9.4, 6.4 and 6.7 days respectively. The results was not successful to prolong the survival, the findings of the allotransplants of the groups administered 6MP were, however, better than those of the control group.
One of the purposes of the work here is to protect the allograft rejection specifically by means of absorption of the antibodies with some antigenetically active substance, that is, the donor kidney digest. So far as known bibliographically, such an idea as above described has not ever been reported in renal transplantation, and should be more investigated concerning the condition of digestion and the selection of enzymes.

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A clinical experience of renal homotransplantation was reported. (Recipient: 33 years old uremic male. Donor: the father of the recipient, 56 years old.) After the transplantation, general condition much improved. Daily urinary output was 2000-3000cc. The patient expired on nineteenth postoperative day, mainly because of massive intestinal hemorrhage and heart failure. Microscopically, transplanted kidney revealed mild perivascular infiltration of lymphoid cells. Majority of glomeruli and tubules maintained normal structure except degeneration of some tubules.

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We studied on the carbohydrate metabolism and the liver function in mobile kidney as a problem of the carbohydrate metabolism in urological diseases.
1) The Betamethasone-Glucose Tolerance Test (BGTT) in mobile kidney indicated positive 23 out of 29 (79.3%), false positive 3 and negative 3 cases.
2) BGTT in the other urological diseases indicated positive 8 out of 16 (50%), false positive 5 and negative 3 cases.
BGTT in the dermatological diseases indicated positive 10 out of 35 (28.5%), false positive 15 and negative 10 cases.
As the controls we picked out the other urological diseases, and the dermatological diseases who aged below 49.
Therefore, it would be considered that higher positivity of the former in BGTT was resulted in higher average age of the former.
3) Impairement of the liver function in serum in mobile kidney indicated positive 12 out of 23 cases (52.5%), and that in controls indicated positive 16 out of 40 cases (40%).
Impairement of the liver function in serum in positive BGTT of mobile kidney indicated positive 12 out of 19 cases (52.3%), and that of controls indicated 4 out of 14 cases (28.6%).
With respect to the level of the total cholesterol in serum, there was no difference between the mobile kidney and controls.
4) In 4 cases of mobile kidney, the decreasing curves of the level of blood sugar in the tolbutamide test were lower than that in 4 controls.
5) The degree of subjective symptom in mobile kidney was not related to the carbohydrate metabolism.
And, BGTT in cases whose kidney drops over 2 vertebrae indicated positive 19 out of 23 cases (82.7%), and that in cases whose kidney drops below 2 vertebrae indicated positive 4 out of 6 cases (66%).
The degree of drop of kidney was to some related to the carbohydrate metabolism.
6) The body weight and the abdominal round upon the height in mobile kidney were smaller than that in controls, and the abdominal length upon the height and the abdominal round in mobile kidney were longer than that in controls.
The cases in mobile kidney were many revealed the slight habit.
But the average of positive BGTT in cases of slight habit in mobile kidney were observed higher than that in controls.
7) From this experiment we observed the impairement of carbohydrate metabolism in mobile kidney.
We are, further, expecting various studies on the fatty substance metabolism and insulin-like substance in mobile kidney.

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On fatty acids, many reports have been issued on gas chromatographical studies in the blood, and some paper chromatographical and no gas chromatographical in the urine. This paper describes the gas chromatography of urinary fatty acids in 30 cases of urosis with pyruia, and 5 normal subjects for control values. The results are summarizd as follows:
1) It was found that the majority of the samples contained both the free and esterified fatty acids while others contained only the free or esterified. Neither type of fatty acid could be found from two subjects who had had nephrectomy for unilateral nephrophthisis.
2) The free fatty acids were detected in 25 of 30 samples and the esterified were in 18 of 30.
3) Results from the 30 patients showed that lauric and palmitic acid wer the most frequently occuring free fatty acids while palmitic and myristic were the most important esterified fatty acids.
4) Results of individual subjects showed that palmitic acid was present in the greatest quantity in the free fatty acid while palmitic and stearic were the most abundant esterified fatty acids. This information was made by peak area comparisons on the gas chromatograms.
5) There was no correlation between quality and quantity of fatty acids in pyuria, and the type of disease or microbe associated with that disease.
6) In normal urine, only free fatty acids are found. Palmitic and palmitoleic acid are the most abundant fatty acids in normal urine.

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1) Clinical study on undescended testicle of 87 cases were done. On HCG treatment of 46 cases, complete descent into the scrotum were noted on 19 testes out of 67 testes (28.4%); in addition another 15 testicles showed some descent but not into the scrotum. In testicular descent bilateral cases responded to HCG much better than unilateral cases.
2) Some delay of the bone age on the cases of undescended testes and male pseudohermaphroditism were noted.
3) Statistical analysis was done on somatic growth of the cases of unilateral undescended testes, bilateral undescended testes and male psuedohermaphroditism. There was no significant difference among these three groups.
4) HCG accelerated the growth of body length but not the body weight statistically. In our clinical experience it also promoted the growth of bone age. These action was not related to the success of the testicular descent.
5) There was no influence on the excretion of urinary 17-ketosteroids during the HCG treatment. HCG administration test in these patients showed no difinite pattern in urinary 17-ketosteroid excretion.
6) Side effect (virilism) of HCG was noted in almost all cases. This seems to be the definite evidence of hormonal effect of HCG through testis. It strongly suggests the increase of androgen which could not be detected with the crude measurement of 17-Ketosteroids in these young patients.
7) The mechanism of descent of testis was thought to be the action of stimulated testis of HCG. The abnormal Gubernaculum Hunterii might be one of the causes for the failure of HCG treatment on the undescended testicle.

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Idiopathic solerosis of the internal urinary sphincter in the adult has long been discussed, but its real nature has not yet been clarified.
The author has experienced 35 cases of this category 10-40 years of age in the past two years. This is to report his view on the subject to help understand its essential nature.
1) Clinical findings
a) Clinical manifestations are almost same as those which have been considered to be since long.
b) Urethrography revealed that narrowing or restriction of the internal meatus urinarius was seen in all the cases.
c) In two cases ureterovesical reflex was disclosed in cystography based on 15cm Gravity method. The phenomenon attests the existance of ureterocele which was found by cytoscopic examination.
d) Edeiken's cystography was observed in 12 cases.
e) Treatment, 20 cases were treated preservedly; 2 cases were by TUR. 15 cases were given surgical treatment: suprapubic cystostomy. That is, the internal urinary sphincter was so completely removed as to allow the operation to reach the depth where perforation appears at the vesicla neck, with part of the bladder muscle layer attached to it. And part of the prostate was removed.
f) Among 20 cases of preserved treatment, 5 cases presented complete disappearance of manifestations, being mild cases originally. Surgically treated 17 cases showed broadening of the internal meatus urinrius, revealed by urethrographies which were taken 1-1.5 years after the operation, and complete improvement in clinical manifestations.
III. Histological findings
Observations were made on removed internal urinary sphincters, prostates, and bladder muscle layers of 15 operated cases, with strict distinction given on each of them.
a) The internal urinary sphincter. In all the cases fibroelastosis was seen in severe state, and it ranged from the one in which the original structure was not entirely identifiable to the one in which the urinary sphincter was surrounded by connective tissues with increased thin muscular bundles. However, no findings were obtained which may suggest adenoma, infarct, supprative lesions, muscular hyperplasie, nor fibromyoma. No sclerotic findings in blood vessels was observed, but congestion was severe in all the cases.
b) The Prostate. Although there were parts which indicated fibroelastosis in the connective tissues of the prostate near the sphincter, there was no marked demacation observable, and it was seen to have transformed into normal prostatic connective tissues. No abnormality was found around prostatic ducts.
c) The bladder muscle layer. Muscular hyperplasie was striking at the bladder muscle layer adjacent to the sphincter, and increase of elastic components were observed in the connective tissues.
Judging from those histological findings, it is conceivable that the primary cause of the subject matter is the transformation of sphincter and that the transformation brings about secondarily changes of the prostate and bladder muscle layer, and that the initial change of the sphincter is congestion.
The author has thus been led to conclude, with the preceding findings, that, first, congestion occures at the sphincter, its continuation produces fibroelastosis, then the subject disease is complicated.

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