A gas chromatographic method was used for the estimation of urinary pregnanetriol (5β-pregnane-3α, 17α, 20α-triol), pregnanetriolone (5β-pregnane-3α, 17α, 20α-triol-11-one) and pregnanetetrol (5β-pregnane-3α, 11β, 17α, 20α-tetrol) in 28 normal subjects and 12 patients with congenital adrenal hyperplasia of simple virilizing type.
After alumina column chromatography of the extract from the urine, hydrolysed by β-glucuronidase, a fraction containing pregnanetriol, pregnanetriolone and pregnanetetrol was made trimethylsilyl-ether derivatives in pyridine, as the solvent. The reaction mixture was dried under nitrogen stream and the residue was dissolved in a known amount of tetrahydrofuran, an aliquot of which was subjected to gas chromatography on SE30 column. This method was proved to be sensitive enough to measure as little as 10μg/day of each of the steroids using 1/10 aliquot of the 24-hour urine.
In normal subjects the mean urinary excretion of pregnanetriol was 0.42±0.20 (S. D.) mg/day and neither pregnanetriolone nor pregnanetetrol was detected. These three steroids were found in all 12 patients with congenital adrenal hyperplasia.
The ratio (pregnanetriolone+pregnanetetrol)/pregnanetriol in patients of 16-month-old infant and 2-year-old boy was 2.33 and 0.56 respectively, while in older patients it was in a range of 0.19 to 0.39. After administration of corticosteroids an increase of the ratio was observed and this may be indicative of the existence of an abnormal 11β-hydroxylase which acts specifically on 21-deoxysteroid, as suggested by Finkelstein. This ratio decreased markedly following the administration of metopirone.
It was also observed that the ratio pregnanetetrol/pregnanetriolone decreased following the metopirone administration and increased with the dexamethasone treatment. The mechanism of these changes of the ratio is obscure, however it might be useful for the index of transformation of 11-hydoxysteroids to 11-ketosteroids in steroid metabolism.

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In an effort to explore the possible role of fibrinolytic enzyme system in the pathogenesis of so-called essential renal bleeding, the author has previously reported several findings for this enzyme system in the blood, urine, and renal tissue of rabbits with renal bleeding produced experimentally by Reilly's phenomenon or by the use of serotonin or bradykinin.
The results indicate that hematuria with concomitant alterations in fibrinolytic enzyme system in Reilly's phenomenon occurs at relatively early stage.
The present report represents an attempt to clarify the pattern of changes in enzyme activators and proactivators of the renal tissue (at 1-1/2, 20, and 30min. post irritation respectively) occurring in Reilly's phenomenon, with particular reference to the effect of streptokinase (SK) on it.
1. Plasma assays for fibrinolytic activity on the standard fibrin-plates with and without SK added revealed the plasma samples obtained 1-1/2min. after irritation to be practically comparable in fibrinolytic activity to those obtained prior to irritation, whereas the inhibitor showed a tendency to increase. At 20min. post irritation, there was practically no evidence of the presence of inhibitor or proactivator in the plasma, while a rise in the activator level was evident. Increased proactivator level was observed, however, in the plasma samples collected at 30min. after irritation.
2. In the renal cortex of healthy rabbits, a plurality of proactivators was demonstrably present in abundance, and activation of the proactivators was found to occur in Reilly's phenomenon as examined with the crude renal tissue preparations obtained 15min. following irritation.
In the medulla of normal kidneys, on the other hand, there was evidence of the presence of plurality of enzyme activators in abundance as well as of small amount of proactivators. And, in response to Reilly's phenomenon, the level of activators in the renal medullary tissue became lowered while that of proactivators subject to activation by streptokinase remained unchanged, wherein activation of proactivators was allayed as the amount of streptokinase added was increased.
3. Using saline and potassium thiocyanate extracts of a series of renal tissues obtained at various time intervals from rabbits following Reilly's phenomenon, assays of the tissue for fibrinolytic activity (according to the method described by Astrup for extraction of a “stable” activator) were performed with particular reference to the influence of SK with the following results:
a) Occurring naturally in abundance in the renal cortex of normal rabbits, a “stable” activator (Astrup) decreased markedly 1-1/2min. post irritation, and thereafter increased gradually to restore even a little greater value than the pre-irritation level at 30min, post irritation.
The proactivator in renal cortex was found to be best extractable with physiologic saline (i. e. 0.9% NaCl). The level of this proactivator was profoundly elevated at 1-1/2min. after irritation, and a gradual decrease of the level followed. I observed evidence of the presence of proactivators in the supernatant of potassium thiocyanate (2M) cortical extracts, as well.
b) The activator in renal medulla was reasonably well obtained by Astrup's potassium thiocyanate extraction, whereas with physiologic saline, it turned out in small quantities. The activator in renal medulla has proven to markedly diminish at 1-1/2 min, post irritation (p. i.), to rise conversely a little higher than the normalcy, at 20 min. p. i., and again to decrease at 30min. p. i.
The proactivator in renal medulla, like that of the cortex, was best extractable with physiologic saline. Its level was lowered at 1-1/2min. p. i. and, thereafter, gradually elevated to a value greater than the normalcy at 30min. post irritation. Evidence indicates that it is present in the supernatant of potassium thiocyanate extracts of the renal medulla, and

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A successful use of ileocystoplasty to enlarge a contracted bladder caused by tuberculosis in a young woman having unilateral kidney (another kidney was extirpated) is reported. 61 months after the operation she progressed through 36 weeks' gestation to a normal spontaneous delivery without difficulty. This is the 11th case of delivery after ileocystoplasty and at the same time, the 4th case of spontaneous delivery in the world.
In selected cases, therefore, it is possible for an otherwise healthy young woman to experience normal pregnancy and delivery after ileocystoplasty.

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Eleven varieties of irrigating solution which differ in constitution and temperature were evaluated to determine which is the most adequate in washing blood out of the donor kidney fast and completely.
1) Change of kidney weight before and after irrigation, flow rate of irrigants through the renal vein and elimination of hemoglobin were examined, and microangiographic study was made. Intrarenal vascularity was observed morphologically immediately after irrigation.
2) Irrigation of the donor kidney with physiological saline solution resulted in significant increase of kidney weight, and interstitial edema. No significant change was noted after irrigation with low molecular weight dextran.
3) Hemoglobin was washed out faster with irrigant which showed higher flow rate through the renal vein. Flow rate was little increased by adding heparin (50mg/l) to the irrigant.
4) Peripheral vascular spasm was noted in irrigation with irrigant without procaine. Addition of procaine (1g/l) reduced the spasm and increased the flow rate of irrigant significantly.
5) In groups with low molecular weight dextran, temperature of irrigant influenced the flow rate, higher flow rate being obtained by higher temperature (not above the body temperature).
6) It is concluded that 30°C or 37°C 10% low molecular weight dextran with procaine (1gm/l) and heparin (50mgm/l) added is the most adequate irrigant.

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Relationship between the renal lesion and the blood pressure change following the injection of submicron crystalline silica suspension (0.02-0.05 micron) into renal artery, was studied in rabbits.
1) In rabbits with injection of the suspension into unilateral renal artery, no hypertension was induced until 7 weeks after.
2) In 4 of the 6 rabbits in which one kidney was removed previously and the suspension was injected into contralateral renal artery, elevation of blood pressure occured within 6 weeks and continued thereafter.
3) In all rabbits in which contralateral kidney was removed 7 weeks after silica injection into unilateral renal artery, continious hypertension was induced within 3 days after the nephrectomy.
4) In all rabbits in which the suspension was injected into contralateral renal artery 6 weeks after unilateral renal artery injection, high blood pressure was developed within 3 days and continued permanently.
5) All rabbits with simultaneous bilateral renal artery injection died within several day.
6) Histological findings: In a few days after injection, the kidneys revealed remarkable congestion. Swelling and cell infiltration in glomeruli, and degeneration of tubules were observed, but no emboli by silica particles was found. About 1 week after injection, the arterioles began to show endothelial reactions which resembled endarteritis obliterans, and subsequently, 4 weeks after injection, multiple small infarcts were resulted by obliteration of small arteries. Furthermore these arteriolar reactions progressed and the infarcts increased in size with the proliferation of interstitial connective tissue, and then old infarcted areas were organized and scarred. One year after injection, the renal tissue lost its normal structures, showing typical scarred kidney.
In short, the main changes began in arterioles in the form of endarteritis obliterans, and progressively spread to larger arteries. The renal infarcts developed gradually by the disturbance of arterial blood flow in the kidney, and this seemed to play an important role in the development of hypertension.

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