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Summary: One hundred and twenty-seven Asian hypertensive patients between the ages of 12 and 40 were investigated for causes of hypertension. Twelve of these patients had renovascular hypertension. Five of these twelve patients were found to have primary arteritis of the aorta, emphasising the importance of this disorder as a cause of renovascular hypertension in an Asian community. One of these cases presented with concurrent manifestations of rheumatic fever. The pathogenic considerations relating to these cases are discussed together with an evaluation of some immunologic phenomena previously described.

Renal biopsy studies were made in 117 unselected patients above the age of 10 with the nephrotic syndrome in a medical unit in Singapore. Ninety per cent of these patients had primary glomerular disease which was classified into 5 categories: lipoid nephrosis (44 patients), diffuse proliferative glomerulonephritis (38), focal glomerulonephritis (8), membranous glomerulonephritis (8) and chronic nephritis (7). There were 10 patients with systemic lupus erythematosus and 2 with Henoch-Schonlein purpura. These findings were compared with those of Western reports, and the significant differences dicussed.

Skeletal-muscle magnesium, estimated as an index of body magnesium store, was significantly lower (p less than 0.05) in 12 patients with advanced chronic renal failure (most of whom showed hypermagnesemia) than in controls matched for sex and age. There is indirect evidence that renal insufficiency sets at a new level the control of magnesium gradient across the cell membrane. Depletion of total-body (intracellular) magnesium was probably due to inadequate intake, as supplied by the modified Giovannetti diet, and impaired absorption, exacerbated by frequent vomiting. Peritoneal dialysis did not contribute greatly to magnesium depletion in the patients. Two patients had clinical features of hypermagnesemia (lethargy, drowsiness, depressed tendon jerks, general flaccidity, relative hypotension and prolonged PR intervals, QRS complexes and QT segments on the electrocardiogram), but no patient had features of magnesium depletion.

Of 127 hypertensive patients aged 12 to 40 investigated by intravenous pyelography, abdominal aortography, and renal biopsy an underlying cause was found in 57%. The proportion with secondary hypertension was higher in young patients and in those with severe hypertension. Primary arteritis of the aorta was an important cause of renovascular hypertension in an Asian population.

Five patients developed fever, "toxaemia", severe skin reactions and eosinophilia, three to six weeks after commencing allopurinol therapy. The presenting feature in these patients was an extensive erythema, progressing to an exfoliative dermatitis, sometimes with oral mucous membrane involvement. One patient developed toxic epidermal necrolysis. The clinical course in two patients was complicated by acute renal failure which necessitated dialysis. The clinical and laboratory features support an acute hypersensitivity mechanism in these allopurinol associated reactions, in agreement with previous studies. Patients with chronic renal failure appear particularly prone to severe, potentially fatal reactions. If these patients need allopurinol, a lower dose than would be normally required should be given.

Summary Ninety hypertensive patients were investigated by intravenous pyelography, abdominal aortography, and renal biopsy. Accessory arteries were present in four of thirty-nine patients with secondary hypertension, whereas sixteen of fifty-one patients with primary hypertension exhibited this anomaly. These differences in distribution are statistically significant, and the relationship between accessory arteries and primary hypertension is discussed.