Tadanao Takeda

Renin Release in Patients with Benign Essential Hypertension

In 16 of 28 patients with benign essential hypertension, reduction of mean arterial pressure to 75 to 120 mm Hg by infusion of sodium nitroprusside caused significant increase in renin release estimated by the renal-systemic difference of renin activity and renal plasma flow (RPF). The threshold at which renin release increased was shifted to a range that was intermediate between that previously reported for normotensive subjects and that for patients with renovascular hypertension, but the average magnitude of renin release was almost comparable to that in normotensive subjects. In the other 12 patients, no significant renin release occurred during reduction in pressure of comparable degree.The difference in renin release was difficult to explain by the difference in severity of hypertensive disease or in sodium excretion, but increased renin release was usually associated with a decrease in RBF and a rise in renal vascular resistance, while insignificant release was usually associated with an insignificant change in RBF and a decrease in resistance. The average known duration of hypertension was significantly greater in the unresponsive patients. It is suggested that renal sympathetic nerve activity may be a factor in the variations in renin release in patients with essential hypertension.

Renal Histological Studies in Patients with Takayasu’s Arteritis

Clinical findings and structural alterations of the kidney in 3 patients with Takayasus arteritis (TA) and associated glomerulonephritis are described. Clinical evidence of renal disease included persistent proteinuria and microscopic hematuria in all patients. Renal histology showed proliferative glomerulonephritis in 2 of the 3 patients. In 1 patient in whom sequential examination of the kidney was possible, glomerular changes had progressed in severity, in parallel with the expansion of arterial damage of TA. Prednisolone therapy induced a complete disappearance of systemic symptoms of TA and an improvement of proteinuria and hematuria. These findings suggest that TA, which quite possibly results from an immune response to disseminated antigen(s), may occasionally induced glomerulonephritis as a part of its histological expression.

Effect of ganglion-blocking agents on renin release in hypertensive patients.

In 18 patients with benign essential hypertension, renin release during reduction of arterial pressure due to sodium nitroprusside infusion was measured before and after administration of ganglion-blocking agents (pentolinium or trimethaphan). In 12 patients, renin release induced by reduction in pressure was significantly reduced but not abolished by ganglion blockade. Simultaneously, ganglion blockade significantly reduced renal vascular resistance (RVR) and almost abolished a decrease in renal blood flow (RBF) due to hypotension. In 6 other patients in whom no significant renin release resulted from hypotension, ganglion blockade caused little changes in renin release, RVR or RBF. The results support the hypothesis that renal sympathetic nerve activity is a factor in variations in renin release in patients with essential hypertension. Following ganglion blockade in the responsive patients, the significant reciprocal correlation between renal venous renin activity and sodium excretion rate shifted but still persisted, suggesting that the renin-releasing mechanism related to sodium excretion may be independent of innervation. On the other hand, the correlation between renin activity and the degree of reduction in pressure was insignificant after ganglion blockade. It is concluded that two intrarenal mechanisms, nerve-dependent and nerve-independent, are involved in renin release due to reduction in pressure. Ganglion blockade also exerted an inhibitory effect on renin release due to hypotension in 4 normotensive subjects and 5 patients with renovascular hypertension.

Effect of Angiotensin on the Pressor Response to Tyramine in Normotensive Subjects and Hypertensive Patients

Arterial blood pressure was recorded directly in 11 normotensive subjects, in 11 patients with essential hypertension and in 10 patients with renovascular hypertension. The pressor response to intravenous injections of norepinephrine, tyramine, angiotensin and ephedrine was compared in these three groups. An infusion of angiotensin was then given and the pressor response to injections of norepinephrine, tyramine, and ephedrine was again measured; in some cases, a comparison of the effects of the cold pressor test was made. In normotensive subjects, angiotensin infusion caused a significant increase in the responses to tyramine and ephedrine but not to norepinephrine; this occurred with subpressor doses and was unrelated to the level of blood pressure. In patients with renovascular hypertension, the mean pressor responses to injections of tyramine and ephedrine and the ratio of response to tyramine to that to norepinephrine were significantly increased, and the infusion of angiotensin failed to cause any further increase in these responses. In contrast, in patients with essential hypertension, the average response to injections of tyramine was not significantly increased, but during angiotensin infusion the response to tyramine increased as in normotensive subjects. It is proposed that increased response to tyramine, and lack of the potentiating effect of angiotensin demonstrated in renovascular hypertension, may be caused by increased formation of endogenous angiotensin due to renin secretion in this disease.

Histochemical localization of kallikrein-like Pro-Phe-Arg-naphthylester esterase activity in the rat kidney.

SummaryIn the rat kidney the presence of the kallikrein-like pro-phe-arg-naphthylester esterase activity was demonstrated by a simultaneous coupling azo dye method. The enzyme was identified as a serine-protease because it was inhibited by preincubation with diisopropyl-fluorophosphate and unaffected by sodium iodoacetate. Since kallikrein is a serine-protease and pro-phe-arg-naphthylester is a synthetic and sensitive substrate for kallikrein, the enzyme activity revealed by this method was considered to represent kallikrein, although non-kallikrein esterase activity is not totally excluded. The enzyme activity was localized mainly in the outer stripe of the outer medulla, with focal extensions primarily only in the lower half of the cortex corresponding to the medullary rays.

Angiographic diagnosis of the abdominal masses

pressure and radius of splenic artery in portal hypertension is 0.52, but those between portal flow ( rs+rm) or total hepatic flow are 0.88 and 0.89 in Banti s syndrome, while in cirrhosis no significant relationship is noted. Portal pressure after splenectomy is correlated to rm~.7+rh ~-7 in Banff s syndrome, while in cirrhosis no distinct relationship is recognizable. It is therefore speculated that mechanism of the establishment of portal hypertension in so called Banffs syndrome differs from that of cirrhosis of the liver, and that preoperative differential diagnosis of the disorders in the liver and spleen involving the degree of portal pressure could be settled.

Evaluation of the methods to diagnose the abnormal liver size and shape in liver cirrhosis and fibrosis

(1) We have 52 patients of hepatoma (85.2%) and 4 patients of cholangioma (6.1%) associated with schistosomiasis japonica out of 61 patients with primary of liver, so it comes to 91.8% in total. We found 53.1% of positive reaction by skin test of schistosomiasis japonica to the whole patients being in our hospital. This shows high percentage compared with autopsied patients of carrying schistosomiasis (71.4%) except primary carcinoma of liver and 68.2% of patients over 40 years old (positive skin test of schistosomiasis japonica). (2) Hepatoma associated with schistosomiasis japonica were chiefly observed in male, and no evident differences of mean age between male and female, 5 patients of hepatoma were male under 39 years old. (3) A high percentage were recognized in the group of 21 patients (27.6%) of hepatoma with liver cirrhosis carrying schistosomiasis japonica (76 patients) than 3 patients (7.1%) of hepatoma without carrying 42 patients of schistosomiasis. In those cases, 37.0% of schistosomiasis patients were revealed in autopsy and postmortem liver biopsy, 15.7% were not recognized schistosomiasis. (4) Though, the liver scintiscanning is effective method for diagnosis of liver carcinoma, but it brings various finding of abnormal figure that suggest defect or atrophic liver in spite of normal liver function and histologic examination in the cases of schistosomiasis japonica. We scintiscanned for 29 patients of hepatoma with schistosomiasis japonica, 23 patients (79.3%) were showed the type of right liver defect figure and impressed difficulty to make a correct diagnosis. 6 patients (20.7%) showed defect figure in left liver and a part of portal fissure were easily diagnosed.