An extremely rare case of unilateral renal hypertension due to angiomatous tumor of juxtaglomerular cell origin is presented.
A 23-year-old woman was admitted to Niigata University Hospital on April 7, 1967 with complaint of headache, stiff shoulder and hypertension. Physical examination revealed almost healthy except for hypertension, systolic murmur at the cardiac apex and angiosclerosis retinae on the fundus appearance. Blood chemistry showed hypokalemia, but there was neither fatigue, nor polydipsia, nor polyuria. Urinalysis, cystoscopic examination and renal function study were within normal limits. Aldosterone secretion rate was moderately elevated, but plasma renin activity was extremely high. Intravenous pyelography showed a filling defect in the upper part of left renal pelvis, and contrast medium distribution on the aortography was slightly faint in the upperr part of the left kidney. Left nephrectomy was performed on May 15 with a diagnosis of unilateral renal hypertension with secondary aldosteronism.
On cut section of the specimen, a well encapsulated, round and soft tumor (2cm in diameter) was found in the middle portion of the renal parenchyma, just adjacent to the renal pelvis. Pathological report reported that the tumor was vascular in nature and had a similar appearance to hemangiopericytoma. Bowie's staining revealed abundant blue-purplish granules in the cytoplasm of main cellular elements of the tumor. These granules were thought to be identical with the juxtaglomerular cell granules which were characteristically found in cases of renovascular hypertension. The tumor can be designated as “juxtaglomerular cell tumor”.
Following the surgery the blood pressure have been measured normal. Postoperatively, plasma renin activity was also decreased to the normal level. Discharge on June 10, 1967 with definite improvement.

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The investigation of enzymatic distribution of the testes in the infertile male was performed by means of the histochemical stain method in alkaline, acid phosphatase and succinic dehydrogenase. One piece of the tissue obtained by testicular biopsy was prepared by the ordinary hematoxylin-eosin stain method. The other piece was immediately frozen with carbonic acid gas to quick refrigeration. The cryostat sections cut 15μ in thickness were stained by the method described by Burstone (alkaline, acid phosphatase) and Nachlas et al. (succinic dehydrogenase) respectively.
The results are as follows:
1) Normal spermatogenesis
The activity of alkaline phosphatase is remarkably observed in the wall of capillary vessels and periphery of the seminiferous tubules, and that of acid phosphatase is distinct in the periphery of the seminiferous tubules. On the other hand, the localization of succinic dehydrogenase is similarly observed both in the seminiferous tubules and in the interstitial cells.
2) Germinal aplasia
The activity of alkaline phosphatase is observed only in the wall of capillary vessels in the interstitium. The activity of acid phosphatase, however, is prominent both in the Sertoli cells and in the interstitial cells.
3) Germinal arrest and hypospermatogenesis
The distribution of these phosphatase activity is irregularly observed in various degrees in the seminiferous tubules.
4) The activity and the localization of the three kinds of enzymes in the testicular tissue are not influenced by administration of T. D. G. (Gonasteron).

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The purpose of the present report is to investigate the findings and the diagnostic value of renal arteriography in pyelonephritis.
1. By using the experimental pyelonephritis in dogs, the comparative study concerning arteriography in the living and removed kidney, microangiography and the histological findings was carried out, and the following results were obtained.
1) In the acute stage of pyelonephritis, the segmental and interlobar arteries were spread, elongated and separated from each other. The intensity of the nephrogram was diminished and the size was increased. In the chronic stage, the intrarenal arteries were tortuous. The size and the intensity of the nephrogram were diminished according to the localization or the extent of atrophy of the cortex in the affected kidney. In the last stage, the main renal artery was extremly diminished in caliber and ultimately the disappearance of the nephrogram was observed.
2) According to the findings on the postmortem renal arteriogram, the microangiogram and the histological sections, it is concluded that the arteriographic findings in pyelonephritis in vivo indicate the presence of lesion in periarterial tissue, which affects blood supply rather than artery itself, and reveal the localization and the extent of disturbance of renal function.
2. The findings on the renal arteriogram in clinical cases were elaborated and the following results were obtained.
1) In acute pyelonephritis, the segmental and interlobar arteries were spread, elongated and separated from each other, and contrast medium diffused into the branches of peripheral arteries with lack of uniformity. The size of the nephrogram was increased and the intensity was diminished, and the periphery of the nephrogram was indistinct and irregular. In chronic pyelonephritis, the main renal artery and the intrarenal arteries were diminished in caliber. The intrarenal arteries were closed each other and distributed with tortuous and uneven pattern. The size of the nephrogram and the thickness of the renal cortex were diminished.
The above mentioned findings and the inhomogenous nephrogram with areas of marked cortical atrophy were observed in the various extents in connection with the degree of parenchymal destruction.
2) In the cases with pyelonephritis, whose IVP did not reveal the particular findings, the arteriogram showed the distinct findings indicating the presence of acute or chronic parenchymal lesion.
3) The renal arteriogram manifested the presence of asymmetrical and localized lesion in pyelonephritis more than glomerulonephritis and nephrosclerosis. It is concluded that renal arteriography is a more useful diagnostic tool in chronic pyelonephritis, especially in determining the localization and the degree of lesion.

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The renal function test by renal vein catheterization has been performed through the median cubital vein. In order to simplify this method, the author inserted the catheter into the renal vein via femoral vein. In some patients, this catheterization was carried out in the combination with ureteral catheterization.
The subjects of this test were 42 patients (30 males and 12 females), visiting the Urological Clinic of Showa University for 3 years beginning 1964. The test was performed on 84 kidneys in these patients.
1) The extraction ratios of para-aminohippuric acid (PAH) and sodium thiosulfate (Thio).
i) The extraction ratio of PAH in 16 normally functioning kidneys was between 81.3 and 92.2%, averaging 86.7±3.50%.
ii) That of Thio ranged from 19.3 to 34.8%, averaging 25.1±2.67%.
iii) In tuberculous kidneys, the appearance of excretory pyelography has well coincided with the extraction ratio of PAH, revealing that excretion rate of contrast media decreased extremely when the PAH extraction ratio was lower than 40%.
iv) In the cases of renal damage due to obstructive uropathy, tubular function is considered to be impaired first while glomerular function is maintained until the late stage of the disease. The result of the authors study on the extraction ratios of PAH and Thio coincided with this fact.
v) In some cases of obstructive uropathy, the excretion of contrast media is not noted by excretory pyelography, when renal function is fairly well maintained. However, even in such cases, renal function was well revealed by the excretion ratios of PAH and Thio.
vi) Estimation of the extraction ratios of PAH and Thio proved to be useful in the discovery of diseases which are sometimes difficult to find by other laboratory examinations.
vii) The amounts of electrolytes and other substances in renal venous blood and arterial one were so different that the comparison of these values was considered useless.
2) The extraction ratios of PAH and Thio were compared with renal excretion of electrolytes. However, it has been shown that the estimation of electrolytes excretion from the kidney gives no imoortant information on renal function.

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