This paper discusses the lactate kinetics in CAPD. Four rate constants, lactate metabolic and peritoneal transfer rate constants KL and KLD, and the corresponding bicarbonate constants KH and KHD, were obtained for each patient by computer simulation with a compartment model.
There were no correlations between the rate constants. Also there was poor correlation between each rate constant and the patient's body weight. In particular KH values differed among the patients at a maximum of about three fold. Therefore, the optimum lactate concentration in the dialysate should be determined for each patient.
How to determine the concentration from the patient's own rate constants was established.

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Clinical, blood biochemical, electrophysiological and pathological studies were done for both uremic peripheral neuropathy and uremic myopathy in 25 long-term hemodialysis patients, and the results were compared with 30 patients on conservative therapy. The mean period of hemodialysis was three yearsand three months. Ccr in the conservative therapy group was 4.1±0.4 (mean±SE) ml/min. Of the 25 hemodialysis patients, neurogenic changes were recognized in all 25 (100%) and myogenic changes in six (24%). Of the30 patients on conservative therapy, neurogenic changes were seen in 19 (63%) and myogenic changes in 13 (43%). Four (13%) showed no abnormalities. Mixed changes were seen in both groups. Maximum motor nerve conduction velocity and maximum sensory nerve conduction velocity were more frequently slowed and showed significantly (p<0.001-p<0.02) lower values in the dialysis group compared with those on conservative therapy. Consequently, the two groups exhibited no significant differences in myopathy, whereas peripheral neuropathy was more frequent and more severe in the dialysis group. Accordingly, improvement in or disappearance of peripheral neuropathy cannot be expected with standard hemodialysis.

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Long-surviving dialysis patients have increased in number thanks to improved dialysis treatment methods. On the other hand the grim reality remains that dialysis itself presents therapeutical problems that remain unsolved. One such problem is the psychological state of those patients who have been obliged to observe dietary restrictions in addition to the constraints placed on their free time and everyday modility. These daily life constraints usually induce psychological stress on the patients who eventually become unfit for dialysis treatment, and various researchers have reported on this problem. In the present study 12 dialysis patients were comparatively investigated with regard to psychological aspects after they had been receiving dialysis for total periods of 5 and 10 years.
Method: Social Adjustment Scale and Dialysis Sentence Completion Test devised at our university hospital were employed mainly for the following investigations. Dialysis patients undergoing dialysis for more than 10 years were studied with regard to such conditions and matters as adaptability to overall daily life before initiation of dialysis, attitude toward dialysis treatment and the future, rapport between the patients and medical staff, adaptability to the situation at home and the work place and general understanding of renal disease.
Discussion and Results: It was confirmed that those patients who were best able to tolerate the long-lasting agonizing dialysis treatment had generally been in a better adaptive state during their daily lives before initiation of dialysis and that rapport between then and medical staff had been favorably maintained from that time onwards. Such favorable rapport has previously been thought of as one of the principal factors for the well-being of patients undergoing long-term dialysis treatment. Moreover, it was suggested that if patients were able to face up to the “fear of the disease” for themselves, this was instrumental in helping them establish a “treatmentfirst” concept.
Anxiety about future life and fear of death are also crucial problems for such patients, the solution to which, in our opinion, rests with how much of a useful life they lead, and therefore the degree to which they deal with real-life situations.

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Dialysis-induced hypotension interferes with adequate removal of fluid and sufficient correction of uremia, which might sometimes initiate a vicious cycle in the clinical status.This study was planned to determine the effectiveness for dialysis-induced hypotension of various modes of hemopurification.According to the analysis of the predialysis blood pressure in 374 patients on maintenance hemodialysis, 14.7% were hypertensive, 78.3% were normotensive and 7.0% were hypotensive.Dialysis-induced hypotension occurred equally at 31% in each of the three groups.The occurrence of hypotension during various modes of treatment was 30.9% in the case of conventional dialysis (C.HD), 18.9% in cold dialysate dialysis (cold HD), 17.6% in high-sodium dialysate (145mEq/l) dialysis (HS.HD), 16.7% in hemodiafiltration (HDF) and 15.7% in hemofiltration (HF). The cold HD significantly increased the systolic blood pressure to 127.8±19.6mmHg (mean±1SD), from 106.2±19.9mmHg at the time of C. HD, although it did not increase the diastolic pressure nor the heart rate. From the study of the core temperature, this increase in systolic blood pressure seemed to be due to increased resistance of the peripheral vessels.These results indicate that cold HD was not only effective for dialysis-induced hypotension as well as HS.HD, HF and HDF but also has the advantage of not requiring any special equipment.

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The results of two studies are reported.
I.Bone scintigraphy with Tc-99m-MDP was performed in 41 patients (29 males, 12 females) on maintenance hemodialysis with bone pain or high Alk-Pase. These bone scintigrams were classified into 3 groups, each of which was correlated to laboratory data (serum Ca, , Alk-Pase, c-PTH).
Group I showed increased RI accumulation in the bone, particularly in the calvarium, maxilla, mandible, vertebra and costochondral junction, and was observed in 19 patients (9 males, 10 females). The mean duration of hemodialysis in this group was 8.2 years, and Alk-Pase and c-PTH were increased.
Group II demonstrated unclear bone images because of high background activity and normal or low accumulation of Tc-99m-MDP in the bones, and was observed in 11 patients (10 males, 1 female). The mean duration of hemodialysis was 4.8 years. Alk-Pase and c-PTH were not increased in this group.
Group III showed extraosseous accumulation of Tc-99m-MDP in the lung, kidney or soft tissue. Visceral metastatic calcification was observed in 4 patients (3 males, 1 female). Massive soft tissue localization of Tc-99m-MDP was observed in 7 patients (all males).
The mean duration of hemodialysis in this group was 6.8 years.Hyperphosphatemia and high level of Ca×Pproduct was observed.
Our scintigraphic classification is convenient and might contribute to an understanding of pathophysiological bone change in such patients.
II. Subtotal parathyrodiectomy (PTX) was employed in 11 of 41 patients on chronic hemodialysis with renal osteodystrophy and secondary hyperparathyroidism in order to improve bone lesions.These patients were studied before and after subtotal PTX using 6 different procedures; conventional radiography (phalanges, calvarium, vertebra), microdensitometry (metacarpal bone), bone mineral analysis (radius), measurement of EMI number with X-CT (frontal bone), bone scintigraphy (whole body), and radionucleid (RN) activity ratio (frontal bone/brain) with single photon emission CT (SPECT). Each procedure detected an improvement of the demineralization after subtotal PTX. Mild improvement of bone change was detected using the bone mineral analyzer and X-CT. On the bone scan, the diffuse increased activity in the calvarium, maxilla and mandible was less prominent aftersurgery in all 11 patients. To quantify the bone changes revealed by the bone scan, we devised a new method; the RN activity ratio (frontal bone/brain) with SPECT.The ratio decreased markedly after surgery.This new method seems to be the most useful one for detecting dynamic bone changes sensitively and quantitatively, because the bone scan showed prominent change in the calvarium, and not in the radius, in patients with renal osteodystrophy.

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Aim: Cardiac function during hemodialysis (HD) was evaluated in 5 patients with chronic renal failure (CRF) due to diabetic nephropathy (DN group). The systemic vascular resistance of these patients was examined and compared with that of 10 patients with CRF due to non-diabetic nephropathy (non-DN group) and that of 5 patients with diabetes mellitus (DM) who has no renal dysfunction (DM·non-CRF group).
Subjects and methods: The 5 patients of the DN Group comprised 4 with maintenance HD and 1 with introduc-tion HD, aged between 59 and 67 years with a mean of 62 years. They had been suffering from DM for between 3 and 19 years with a mean period of 11 years. Two of the cases were IDDM and 3 were NIDDM. The method involved insertion of a Swan-Ganz cathether, and calculation of the cardiac index, the left ventricular stroke work index (SWI) and the systemic vascular resistance index (SVRI). Each of these determinations was evaluated before and every one hour after the start of HD and 30 minutes after the finish of the HD.
Conclusion: 1) The mean of the SVRI before the HD was (1.76±0.25)±10³dyn·sec·cm^-5·m², which was lower than the mean of normal cases, and tended to be lower than that of the non-DN group, and furthermore significantly (p<0.05) lower than those of the DM·non-CRF group. 2) Variations of SVRI and SWI during HD were also examined by comparing their respective values against pre-HD levels taken as 100%. The results revealed that the percentage SVRI showed on almost constant tendency regardless of variations in the percentage of SWI and showed a relationship of SVRI%=-0.104×(SWI%) +103.9 (r=-0.170, NS). This was significantly different from the SVRI%=-0.311×(SWI%) +132.5 (r=-0.421, p<0.05) obtained in the non-DN group.

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The oxygen affinity of hemoglobin is important in determining tissue oxygenation, and was shown to be decreased in chronic renal failure to compensate nephrogenic anemia. Acetate hemodialysis (AD) has been reported to increase the oxygen affinity of hemoglobin. What effect bicarbonate hemodialysis (BD) might have, however, was not known. The present study was performed to compare the oxygen affinity of hemoglobin in AD and BD in 8 patients on maintenance hemodialysis.
Serum inorganic phosphorus was decreasd, and red blood cell, 3-diphosphoglycerate showed no change during hemodialysis by either method. There was a significant decrease in P50 (in vivo), an inverse value of the oxygen affinity of hemoglobin, during AD, and a tendency to decrease during BD. The changes in P₅₀ (in vivo) during AD and BD were not significantly different. P₅₀ (in vitro) showed no change during either type of hemodialysis.

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The prognosis for chronic dialysis patients frequently depends on cardiovascular complications. Clinical studies on coronary sclerosis and pericardial effusion are reported here.
(A) Coronary sclerosis: Coronary artery calcification was detected by fluoroscopy in 14 of 65 hemodialyzed patients.The calcifications were divided into 11“diffuse”type and 3 “local” type. A patient with angina pectoris was one of the patients with diffuse type calcification of 3 vessels, LAD, CX and RCA. Coronary calcification was found in 4 of 7 diabetic patients, a markedly higher incidence than in patients hemodialysed because of other renal diseases.All patients with coronary calcification were more than 50 years old, and the duration of hemodialysis was more than 3 years in all patients except one.Coronary artery calcification was detected in 13 of the 20 patients more than 50 years old and the duration of hemodialysis was more than 3 years.Diffuse type calcification of 2 or 3 vessels was found in 8 of these 13 patients, in contrast to 2 of 19 undialyzed patients with chronic renal failure who were more than 50 years old.The incidence of calcification was markedly higher in the former group, even when diabetic patients were excluded.It is suggested that hemodialysis might be one of the risk factors of coronary sclerosis, and that careful management should be provided especially for the older and/or diabetic patients.
(B) Pericardial effusion: Subxiphoid pericardiotomy with drainage was performed under local anesthesia in patients with symptoms of cardiac tamponade or in patients with gradually increasing pericardial effusion estimated as more than 500ml by echocardiogram.In 2 patients, pericardial effusion was considered to be the result of overhydration;C-reactive protein was negative, and the LDH-ratio of pericardial effusion/plasma was as low as 0.5 and 0.6.Ten other patients developed pericardial effusion between 15 days and 6 years after the beginning of hemodialysis.Initial symptoms were fever (37-38°C), chest pain or discomfort, cough and palpitation, and they often preceded cardiomegaly. It was diagnosed as uremic pericarditis; C-reactive protein was strongly positive in all cases, and the LDH-ratio was as high as 2.5-13.4, with an average of 6.0. Neither recurrence nor pericardial adhesion was seen.In some cases, triamcinolone hexacetanide was injected through a catheter into the pericardial cavity repeatedly after pericardiotomy, but it was not shown to be effective. Massive pericardial effusion caused by uremic pericarditis should be removed early, and subxiphoid pericardiotomy with drainage is considered to be a sound and safe procedure of choice as compared with pericardiocentesis.

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The factors affecting electrolyte removal were studied in eight patients during continuous ambulatory peritoneal dialysis (CAPD). There was a highly significant correlation between ultrafiltration volume (UFV) and the amounts of sodium or chloride removed. Mass transfer of sodium and chloride underwent a four-fold increase with the use of 4.25% dextrose solution compared with that using 1.5% solution, along with a corresponding increase in UFV. On the other hand, mass transfers of potassium, inorganic phosphate and magnesium were increased by 1.3, 1. 4 and 2.3 times, respectively using 4.25% solution, compared with 1.5% solution.Dialysate to serum concentration ratios of various electrolytes were significantly lower in 4.25% solution exchanges than in those using 1.5% dextrose, indicating that electrolyte-poor ultrafiltrate was moved into the peritoneal cavity with the use of hypertonic dialysate.This fact must be kept in mind in cases receiving frequent exchanges of hypertonic solution, which causes hypernatremia.A negative calcium mass transfer was noted with the use of 4.25% solution. The net removal of magnesium was thought to be small, resulting in a gradual increase of serum magnesium concentration.A dialysate containing a lower magnesium and possibly higher calcium concentration could be made available to improve mineral homeostasis.

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Changes in the diameter of the inferior vena cava (IVC) detected by ultrasonography have recently eenthought to be a good parameter of the right-side cardiac function.To evaluate the significance of the changes in IVC diameter, IVC diameter was recorded by real-time B-mode ultrasonography in 10 patients with chronic uremia undergoing hemodialysis who had no cardiac or respiratory failure, since their circulating blood volume (CBV) was rapidly changed by the removal of water during hemodialysis.
The maximal diameter of the lVC during expiration (IVC-E) and its minimal diameter during inspiration (IVC-I) were measured during quiet respiration just below the IVC-hepatic vein junction, and the respiratory collapsibility index (Cl) was determined (Cl=[IVC-E-IVC-I]/lVC-E). The relationship between these values and changes in the CBV and body weight during hemodialysis was determined.During hemodialysis both the lVC-E and IVC-I were decreased while the CI was increased by the removal of water.Changes in lVC-E (ΔIVC%) were significantly correlated with percent changes in body weight before and after hemodialysis (ΔBW%)(r=0.631, n=65, p<0.001). The IVC-E was also well correlated with changes in the CBV measured in 4 patients by theradio-isotope method (r=0.819, n=20, p<0.001).The IVC-E decreased gradually in accordance with the removal of water during hemodialysis, and reached a plateau at a certain body weight, and the blood pressure fell markedly when more water was removed and the IVC-E decreased to less than the previous plateau level.Saline infusion and/or elevation of both legs returned the blood pressure to the previous level and the IVC dimension increased again.
On the basis of these results, it was concluded that observation of the IVC by B-mode ultrasonography provides useful information for indirect estimation of the CBV and/or body fluid volume. Changes in IVC diameter during hemodialysis would be a reliable indicator for determining the adequate amount of water to be removed by hemodialysis for each patient.

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In order to assess the toxicity of the potting material of dialyzers, the effect of extracts of potting materials on DNA synthesis of PHA-activated human lymphocytes was studied.DNA synthesis of lymphocytes was inhibited by addition of ethanol and serum extracts of one type of potting material to the culture.The saline and serum extracts of another type of potting material also caused inhibition of DNA synthesis. The extract of the gamma ray-irradiated potting material of the latter type showed a weaker inhibitory effect than that of the non-irradiated material.The inhibition induced by the extract of an ethylene oxide gas treated material of the former type was slightly stronger than that induced by the extract of the nontreated material. The inhibitory factors originating in the potting materials could be at least part of the cause of the immunosuppressive state of dialysis patients.

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This study was carried out by using the Valsalva maneuver to evaluate autonomic nerve function in hemodialysis patients. We examined five normotensive and five hypotentive dialysis patients including one with striato-nigral degeneration.The Valsalva maneuver, which consists of forced expiration against 40mmHg for 15 seconds, was performed with continuous recording of arterial pressure and electrocardiography.The ratio of the R-R intervals was significantly lower in hypotensive than normontensive patients (1.24±0.16vs 1.47±0.14, P<0.05). The changes in arterial pressure during strain and release were significantly lower in hypotensive than normotensive patients (Strain: 53.00±2.74vs 73.00±13.03mmHg, P<0.01, Releare: 43.00±8.37 vs 90.00±14.14mmHg, P<0.001).Moreover, the absence of arterial pressure overshoot (phase IV) was specific in hypotensive patients and this finding was similar to that in striato-nigral degeneration with autonomic dysfunction.
These results indicate that autonomic insufficiency is one of the factors in the hypotension in patients undergoing long-term hemodialysis.

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In order to study the metabolism of guanidino compounds (GCs) in 12 patients with chronic renal failure (CRF) under CAPD treatment, we observed the changes in serum GCs in relation to clinical manifestations and to acid-base balance during the course of CAPD treatment.We also determined The peritoneal clearance of each GC during one session of dialysate exchange.The value of peritoneal clearance of methyl guanidine (MG) was 4.56±1.02 ml/min (mean±SD), which was almost the same as that of urea-N and was higher than that of the other GCs.The values of peritoneal clearance of guanidinosuccinic acid (GSA), guanidinoacetic acid (GAA) and creatinine were 3.76±0.97, 3.72±1.18 and 3.53±0.90ml/min, respectively.In two patients who has experienced CAPD treatment for 22 months, there was marked decrease in the serum GSA level after a initiation of the treatment in spite of the absence of a change in serum GAA and MG levels.The decrease in the serum GSA level during the treatment showed a close correlation with the elevation of the hematocrit and the improvement in metabolic acidosis.The ratio of serum GSA to BUN (GSA/BUN) was 4.30×10^-3at the beginning of the treatment, which was compatible with that (5.24±3.21×10^-3) in patients with chronic renal failure under maintenance hemodialysis (MHD) therapy.After initiation of the treatment the ratio decreased to 2.11±0.98×10^-3, compatible with that (2.02±1.33×103) in patients with CRF under conservative therapy. These results indicate that in CAPD treatment GSA synthesis may be diminished through some mechanisms resulting in a decrease in the serum GSA level and the GSA/BUN ratio.An improvement in metabolic acidosis might be one of several factors contributing to the suppression of GSA production. In the contrast the serum GAA levels showed no change in the course of CAPD treatment.These results are not compatible with the finding in patients under MHD therapy, as we had observed the restoration of serum GAA to the normal level in the latter patients.Further observation of serum GAA levels might be needed in patients under CAPD treatment. There was no change in the serum MG level after initiation of the treatment in spite of a higher peritoneal clearance value.Serum MG concentration may not always indicate the whole body pool of MG, because MG is mainly distributed to the intracellular fluid compartment. In addition, the synthesis of MG from Cr might not be suppressed during the CAPD treatment, because transperitoneal removal of Cr was not effective because of its low peritoneal clearance.

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We measured the levels of glycosylated hemoglobin in patients with chronic renal failure on intermittent hemodialysis by means of affinity chromatography (AC) according to the method of Yue et al., and HPLC with an ion-exchange resin for comparison.
The subjects were 45 patients with chronic renal failure on intermittent hemodialysis (HD group)(22 diabetics and 23 nondiabetics) and 43 patients without nephropathy (Non-HD group)(21 diabetics and 22 normals). The level of glycosylated hemoglobin (G·EHb) and the level of HbA_1a+b, A_1c, or A₁ were measured by AC with PBA 30 resin and HPLC, respectively.
The results were as follows: 1) In both the HD and the Non-HD groups, a significant positive correlation (p<0.001) was noted between the G·Hb level and the level of HbA_1a+b, A_1c, or A₁. 2) In the HD group, a significant positive correlation (p<0.001) was found between the G·Hb level and the level of plasma glucose (PG) before hemodialysis (PG_2h, i. e. PG level 2 hours after breakfast), the mean level of PG_2h during the previous month, and the mean level of PG before and after hemodialysis during the previous month; there was no significant difference in the G·Hb level before and after hemodialysis. 3) While there was a significant positive correlation (p<0.001) between the G·Hb level and the level of PG_2h or HbA₁ in both the HD and the Non-HD groups, the difference in regression lines of each group revealed that the G·Hb level of the subjects in HD group who had a PG level similar to that of the Non-HD group was low and that the G·Hb level of these in the HD group who had a HbA, level similar to that of the Non-HD group was also low.
Therefore, it was confirmed that the levels of glycosylated hemoglobin in the patients with chronic renal failure on intermittent hemodialysis were low as compared with those in the patients who had no nephropathy and it was suggested that the HbA₁level in the former may be affected by a “renal failure” substance which cannot be measured by AC. On the other hand, AC seems be useful for determining if there is a true glycosylation of hemoglobin in the patients with chronic renal failure on intermittent hemodialysis, in view of shortening the measurment time as well as of convenience in manipulation.

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A patient undergoing hemodialysis who had been treated with the angiotensin I -converting enzyme inhibitor, captopril, developed severe taste loss.The hypogeusia improved after cessation of captopril treatment and administration of zinc sulfate.
Case. A 33 year-old man on hemodialysis was given 37.5 mg captopril of daily. Seven weeks later severe taste loss developed. By electrogustometry there was no response in the right major petrosal, glossopharyngeal, caroticotympanical and left major petrosal areas and the threshold of tastewas 26d B in the left glossopharyngeal area and 30 dB in the left caroticotympanical area.In all areas, the 4 primary tastes, sour, sweet, salty and bitter, were disturbed.The serum zinc concentration was 65μg/dl Then captopril was stopped.His taste was slightly improved subjectively and electrogustometrically 7 days cessation of captopril.The whole blood zinc concentration was 361μg/dl on the 65th day after cessation of captopril.Oral zinc sulfate, 150 mg daily, wan prescribed.On the 6th day his taste improved electrogustometrically and there was significant subjective recovery. On the 33th day an electrogustometric response appeared in all areas.
In this case, it is suspected that zinc deficiency induced by captopril treatment was responsible for the taste loss.

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Impaired platelet function in hemodialysis patients is considered to be a major cause of their bleeding tendency. To evaluate their platelet function, we examined collagen-induced platelet aggregation and platelet adhesiveness to glass beads.
Studies were performed in 7 healthy controls (2 males, 5 females) and 11 hemodialysis patients (2 males, 9 females). None of them were suffering from diabetes mellitus.The optimal concentration of platelets in the PRP and the optimal concentration of collagen needed to evaluate platelet aggregation were determined. The optimal concentration of platelets and collagen were 25×10⁴/mm³ and 5μg/ml respectively.
There was no significant difference in collagen-induced platelet aggregation between healthy controls and hemodialysis patients just before dialysis.After hemodialysis, platelet aggregation was found to be impaired. Platelet adhesiveness was increased from 5.3±4.5% to 15.3±10.9% with dialysis. This rise in platelet adhesiveness might be partially due to the increased RBC concentration during hemodialysis.Pre and post dialysis platelet counts were 15.1±4.2×10⁴/mm³ and 17.1±4.6×10⁴/mm³, respectively, and this change was not statistically significant. Since hemoconcentration occurs during hemodialysis, the platelets seem to be destroyed or adsorbed during hemodialysis.
In conclusion, platelet aggregation induceed with collagen was impaired after dialysis, probably as a result of deterioration caused by passage of the platelets through the pump, filters and dialysis membrane.

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There are only 3 papers reporting chronic granulocytic leukemia associated with chronic hemodialysis, although a high incidence of malignancy in uremic or hemodialysis patients has been reported.The authors present a patient under chronic hemodialysis who represented tumor-forming acute exacerbation of chronic granulocytic leukemia (CGL).
A 45-year-old man was admitted to our hospital on August 30, 1983, with the complaints of severe right frontalgia and total ophthalmoplegia.He had been on chronic hemodialysis/since March 1976. In July 1980, he was diagnosed as having chronic granulocytic leukemia because of leukocytosis, hypercellular bone marrow without hiatus leukemicus, a low neutrophil alkaline phosphatase level, and positive Ph' chromosome in bone marrow cells.No symptoms had been observed, and the white blood cell count had been controlled between 30, 000 and 50, 000/mm³ with busulfan until August 1983.Computed tomography (CT) of the brain showed a mass near the sella in July 1983, when he had complained of headache and ophthalmoplegia.
On admission, bone marrow examination and peripheral blood smears were consistent with the chronic phase of CGL.However, a second enhanced CT revealed a bulky mass in the cavernous sinus invading toward the sella and sphenoidal sinus, indicating tumor-forming acute exacerbation of CGL These symptoms improved immediately after cranial irradiation. However, generalized tumor formation had appeared gradually, followed by acute leukemic axacerbation in the bone marrow. He died of hyperkalemia due to gastrointestinal bleeding on January 24, 1984.
The autopsy showed multiple tumors in the subcutis, mediasteinum, thyroid gland, liver, kidney, gastrointestinal tract, bone marrow, and other areas.The microscopic findings were similar to those of the large cell type of non -Hodgkin's lymphoma.

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In a previous study we demonstrated that blood plasma from an anephric rabbit and uremic patients contains solutes which are capable of depressing the sympathetic nerve-mediated smooth muscle contractions of guinea pigs in vitro. The degree of depression was greater in the blood plasma containing solutes with a molecular weight (MW) of less than 500 daltons.
Accordingly, in the first series of the present experiments, the effects of individual uremic toxins urea, uric acid, creatinine and methylguanidine (MG) on the nerve-mediated smooth muscle contractions were examined in vitro. When tested mt concentrations similar to those in blood plasma of patients with severe chronic renal failure (CRF). urea (200mg/dl), creatinine (20mg/dl) and MG (200μg/dl) produced no significant change in the amplitude of contraction, whereas uric acid (10mg/dl) produced a slight but significant increase of 7±5%(mean±S.D., n=7) as compared with the control, i.e., the amplitude of contraction before application of the substances.Simultaneous application of these four substances produced the same slight increase as did the application of uric acid alone.
In the second series, the effects of changing concentrations of some electrolytes in the normal bathing solution (Krebs solution) to those in blood plasma of patients with severe CRF were similarly examined on the contractions. The high K⁺ (9mM) solution produced a significant increase of 14±11%(n=7).On the other hand, the low Ca⁺⁺ (1mM) aulution or high Mg⁺⁺ (2mM) solution caused the contractions to be depressed by 56±25%(n=9) and 13±4%(n=6), respectively.Simultaneous changes in these three electrolyte concentrations in the Krebs solution produced an inhibition of 60±21%(n=8), and this solution containing the afore-mentioned four substances produced an inhibition of 53±24%(n=8), which was smaller by 7% because of the increasing effect of the four substances on the contractions.Thus, the present study indicates the possibility that the depression by the plasma solutes with a low MW observed in the previous study could be attributable to changes in the electrolyte, namely concentrations.However, further studies are obviously necessary to confirm this conclusion.Ca⁺⁺, concentrations.However, further studies are obviously necessary to confirm this conclusion.

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We experienced two cases of acute renal failure complicated by malignant histiocytosis during the past five years.
One patient was a 16-year-old boy, admitted to the hospital with fever, cough with sputum, hepatosplenomegaly and lung infiltration shown on chest X-P. Malignant histiocytosis was suspected from bone marrow aspiration; however the diagnosis was not exact.His condition was complicated by non-oliguric acute renal failure, so sufficient chemotherapy could not be given and he died of acute respiratory failure about one month after admission.Microscopically, a renal specimen at autopsy showed that atypical histiocytes infiltrated into the stroma.
The other pafient was a 49-year-old man, admitted the hospital with high fever and cough.The diagnosis of malignant histiocytosis was established by repeat bone marrow aspiration. He had required hemodialysis eighteen times for a semicoma fous state and nonoliguric acute renal failure probably induced by hypercalcemia, and combined chemotherapy had to be continued.Consequently, his renal function had recovered to almost normal. However, he died of acute respiratory failure and sepsis about three months after admission.At autopsy, a renal specimen showed infiltration of atypical histiocytes into the stroma of the kidney, and marked calcium deposition in the renal tubules.
In these two cases, atypical cell infiltration into the stroma and nonoliguric acute renal failure had occurred. The infiltration can be seen as a characteristic cause of acute renal failure complicated by malignant histiocytosis. Renal function impairment caused by hypercalcemia must also be noted.
Early hemodialysis can permit more effective chemotherapy, which restores renal function and these two treatments can help prolong the survival of the patient.

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We studied low-volume dialysates in hemodialysis.Hemodialysis with a dialysate flow rate of Q_D 300ml/min was tried for a long period (the longest 38 weeks) in 24 cases.In the group using a large-square dialyzer BUN as well as creatinine was increased after 2 months adjusting the volume flow. However, serum creatinine was elevated at 3 months after that.In the group using standard and small-square dialyzers BUN and creatinine were not elevated before dialysis.Serum, Ca, and P did not change.Anemia did not progress.There were significant correlations between the concentration of serum solute and that in the dialysate removed by dialysis the amount of solute in the dialysate was measured after removal by dialysis, Q_D 500ml/min and 300 ml/min, respectively. The removal ability was higher at a flow rate of Q_D 500ml/min. By using four kinds of dialyzers we measured the clearance in the case of flow rates of Q_D 500ml/min, 400ml/min and 300ml/min in arterial pulse and constant flow. In spite of using different Q_D velocity rates and various kinds of dialyzes no differences in the clearances were found.We suggest that a low-dialysate flow of Q_D 300ml/min in both pulse flow and constant flow is possible in practice.

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