Dr. Jerome D. Cohen, Chief Resident in Medicine, the Jewish Hospital of St. Louis, and Instructor in Medicine, Washington University School of Medicine: A 60-year-old white woman was referred to Jewish Hospital in October 1968 for evaluation of renal failure. The patient had been entirely well until 18 months before admission when she first experienced throbbing, bitemporal headaches. The physician found the patient to be hypertensive and she was given a rauwolfia compound. Twelve months prior to hospitalization, anemia was discovered and iron therapy was started although the cause of the anemia was not determined. Six months before hospitalization, the patient complained of back pain unassociated with chills or fever, but accompanied by urinary frequency, dysuria, and nocturia. These symptoms were followed by increasing weakness, fatigue, anorexia, nausea, and vomiting. One month prior to entry the patient was admitted to another hospital for evaluation. At that time the blood pressure