Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Treating diabetic nephropathy with low-density lipoprotein (LDL) apheresis reduces proteinuria and improves prognosis. However, its impact on patients' quality of life (QoL) is unclear. This study evaluated the effect of LDL apheresis on QoL in patients with diabetes, proteinuria, and hypercholesterolemia. METHODS: In this nationwide multicenter prospective study, we enrolled 40 patients with diabetes. Inclusion criteria were proteinuria (defined as an albumin/creatinine ratio ≥3 g/g), serum creatinine levels <2 mg/dL, and serum LDL ≥120 mg/dL despite drug treatment. LDL apheresis was performed 6-12 times within 12 weeks. The 36-item Short Form Health Survey (SF-36) was used to analyze QoL. RESULTS: The study enrolled 35 patients (27 men and 8 women; mean age 58.9 ± 11.9 years). A comparison of baseline SF-36 values with those at the end of the course of apheresis found an improvement in the mean physical component summary (37.9 ± 11.4 vs. 40.6 ± 10.5, p = 0.051) and a significant increase in the mean mental component summary (MCS) (49.4 ± 8.4 vs. 52.5 ± 10.9, p = 0.026). A multivariable linear regression analysis revealed a history of coronary heart disease negatively correlated with the MCS increase at the end of the course of apheresis (β coefficient -6.935, 95% confidence interval, 13.313 to-0.556, p = 0.034). CONCLUSION: Our results suggest that LDL apheresis may improve the mental and physical QoL in patients with diabetes, proteinuria, and hypercholesterolemia.

DOI： 10.1159/000527900

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Patients with diabetes mellitus and severe proteinuria present with poor renal prognoses, despite improvements in diabetes and kidney disease therapies. In this study, we designed a low-density lipoprotein (LDL)-cholesterol apheresis treatment for patients with diabetic nephropathy (DN)/diabetic kidney disease and severe proteinuria. This was a multicenter prospective LICENSE study to confirm the impact of LDL apheresis on proteinuria that exhibited hyporesponsiveness to treatment. In addition, we sought to determine the efficacy and safety of LDL apheresis by comparing the outcomes to those of historical controls in patients with diabetes, refractory hypercholesterolemia, and severe proteinuria. METHODS: This was a prospective, multicenter study, including 40 patients with diabetes, severe proteinuria, and dyslipidemia. LDL apheresis was performed 6-12 times over a 12-week period. The primary endpoint was the proportion of patients with a decrease in proteinuria excretion of at least 30% in the 6 months after starting therapy. The secondary endpoints included serum creatinine levels and laboratory variables, which were evaluated 4, 6, 12, 18, and 24 months after therapy initiation. RESULTS: LDL apheresis was performed on 40 registered patients with diabetes. The proportion of cases in which proteinuria decreased by 30% or more after 6 months of LDL apheresis was 25%, which was similar to that of historical controls. The overall survival and end-stage kidney disease-free survival rates were significantly higher in the LICENSE group compared to those in historical controls. CONCLUSION: Our results suggest that LDL apheresis may be effective and safe for patients with diabetes, proteinuria, and dyslipidemia. TRIAL REGISTRATION: Trial registration number: jRCTs042180076.

DOI： 10.1007/s10157-020-01959-9

PubMed

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Publishing type：Research paper (scientific journal)  

A 60-year-old male presented with accelerated hypertension, renal insufficiency, proteinuria, and hematuria. Percutaneous kidney biopsy revealed membranoproliferative glomerulonephritis (MPGN) without any immunoglobulin and complement deposition. On performing electron microscopy, deposits with a tubular, organized structure and approximately 60 nm in diameter were detected in the glomerular subendothelial spaces and mesangial areas. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) demonstrated the significantly increased deposition of fibrinogen and fibronectin in glomeruli. Immunohistochemistry and immunoelectron microscopy demonstrated that the deposits were composed of fibrinogen. Here we report a case of cryofibrinogen -associated GN in which LC-MS/MS and immunoelectron microscopy were useful for diagnosis. When MPGN with organized deposits without the deposition of immunoglobulins and complements is diagnosed, we considered the cryofibrinogen-associated GN in one of the differential diagnosis, and even skin symptoms cannot be detected.

DOI： 10.1016/j.ehpc.2018.12.002

Scopus

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Publishing type：Research paper (scientific journal)   Publisher：American Society of Clinical Oncology ({ASCO})  

DOI： 10.1200/jco.2017.35.4_suppl.653

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Language：Japanese   Publisher：新潟急性血液浄化研究会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10157-016-1334-0

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Zanthoxylum fruit, obtained from the Japanese pepper plant (Zanthoxylum piperitum De Candolle), and its extract (Zanthoxylum fruit extract, ZFE) have multiple physiological activities (e.g., antiviral activity). However, the potential anticancer activity of ZFE has not been fully examined. In this study, we investigated the ability of ZFE to induce autophagic cell death (ACD). ZFE caused remarkable autophagy-like cytoplasmic vacuolization, inhibited cell proliferation, and ultimately induced cell death in the human cancer cell lines DLD-1, HepG2, and Caco-2, but not in A549, MCF-7, or WiDr cells. ZFE increased the level of LC3-II protein, a marker of autophagy. Knockdown of ATG5 using siRNA inhibited ZFE-induced cytoplasmic vacuolization and cell death. Moreover, in cancer cells that could be induced to undergo cell death by ZFE, the extract increased the phosphorylation of c-Jun N-terminal kinase (JNK), and the JNK inhibitor SP600125 attenuated both vacuolization and cell death. Based on morphology and expression of marker proteins, ZFE-induced cell death was neither apoptosis nor necrosis. Normal intestinal cells were not affected by ZFE. Taken together, our findings show that ZFE induces JNK-dependent ACD, which appears to be the main mechanism underlying its anticancer activity, suggesting a promising starting point for anticancer drug development.

DOI： 10.18632/oncotarget.11926

PubMed

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Publishing type：Part of collection (book)  

There have been several lines of evidences for familial aggregation of IgA nephropathy (IgAN), as well as mesangial deposition of IgA, suggesting that the susceptibility to this disease is genetically controlled. In our institute, family histories of hematuria, end-stage kidney disease, and glomerulonephritis are observed in about 10 % of cases with IgAN, even in those without any significant hereditary nephritis or kidney diseases. Recent large-scale genome-wide association studies (GWAS) of sporadic IgAN have identified multiple susceptibility loci, providing an insight into the genetic architecture of this disease, although each of their individual impact to the development of the disease is still not enough. It has been recognized that most of these loci are either directly associated with risk of inflammatory bowel disease (IBD) or maintenance of the intestinal epithelial barrier and response to mucosal pathogens. Further elucidation of the role of genetic variants underlying IgAN, and hologenetic views of gene variants and environmental factors, would be necessary to understand the precise pathogenic mechanism of IgAN in more detail.

DOI： 10.1007/978-4-431-55588-9_3

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：English   Publishing type：Research paper (scientific journal)  

A 47-year-old Japanese man was admitted to our hospital for evaluation of proteinuria, which was detected when he was 37 years of age. His creatinine clearance levels had fallen to 76.3 mL/min/1.73 m2. A kidney biopsy was conducted, and the patient's low plasma α-galactosidase A levels suggested Fabry disease. After genetic counseling, GLA analysis revealed a novel mutation p.L387P. Interview with the patient revealed that both his younger brother and mother suffered from cardiomyopathy and were undergoing cardiological treatment. They also were positive for proteinuria. About 30 years ago, the patient's cousin (aged 25) was diagnosed with Fabry disease. He underwent hemodialysis for 9 years until his death at 42. At that time, the patient and his brother had not been investigated for Fabry disease so their cousin could not act as a proband for the brothers. Eventually, the patient, his mother, and his brother were put on enzyme replacement therapy with agalsidase beta. As this series of cases shows, medical interviews to collate both medical and family history were essential for the discovery of Fabry disease in these patients. In addition, being a treatable genetic disorder, Fabry disease should be listed in the standard differential diagnoses of systemic and familial diseases, including unknown cause of nephropathy or cardiomyopathy, for early detection of the disorder.

DOI： 10.1007/s13730-014-0108-3

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

The sequential or simultaneous presentation of anti-glomerular basement membrane (anti-GBM) glomerulonephritis with membranous nephropathy (MN) has been infrequently reported. Although the mechanism underlying MN superimposed on anti-GBM glomerulonephritis is unknown, the two entities are believed to be interrelated. We report the case of a 75-year-old woman diagnosed with rapidly progressive glomerulonephritis. Renal biopsy revealed crescentic glomerulonephritis with linear and granular staining of immunofluorescent IgG1 and IgG4 granular staining on the capillary loops. Electron microscopy revealed extensive subepithelial deposits. These findings suggested simultaneous development of anti-GBM glomerulonephritis and MN in this case. Serum phospholipase A2 receptor (PLA2R) antibody was negative. The patient was treated with prednisolone and plasma exchange, resulting in resolution of renal insufficiency and a decrease in urinary protein. The rapid decrease in urinary protein and absence of PLA2R antibody suggest that the mechanism of MN associated with anti-GBM glomerulonephritis differs from that of primary MN.

DOI： 10.1007/s13730-013-0094-x

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

A 69-year-old man presented with proteinuria and hematuria. He had received total parenteral nutrition for massive small bowel resection. However, due to the iatrogenic lack of trace elements for the next four years, he developed severe copper-deficiency anemia and neutropenia. In addition, his proteinuria and kidney dysfunction worsened concurrently with the development of nephrotic syndrome and end-stage kidney disease. After receiving trace elements, the patient's anemia and neutropenia improved, and the anuria dramatically resolved. Copper-containing enzymes, including ceruloplasmin have an antioxidant activity. In patients with various types of glomerular injuries, the ceruloplasmin expression is known to be increased. Copper deficiency can worsen nephrotic syndrome by decreasing the ceruloplasmin activity, which protects the glomeruli.

PubMed

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A 77-year-old man developed severe renal insufficiency due to proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, and was started on hemodialysis (HD). Because his renal insufficiency appeared to be irreversible, he was maintained on oral prednisolone (PSL) at 5 mg/day. However, a disease flare-up with alveolar hemorrhage occurred. Serology revealed elevated levels of PR3-ANCA and C-reactive protein (CRP). The patient was given pulse therapy with a quarter dose of methylprednisolone (m-PSL) (250 mg, 3 days), followed by oral PSL at 15 mg/day. As a supplemental treatment, he was given 25 mg of mizoribine (MZR) immediately after each HD session. Subsequently, the levels of PR3-ANCA and CRP decreased, and the alveolar hemorrhage resolved. The dose of MZR to be given was determined by measuring the patient's serum concentrations of MZR at various time points after the HD session. The maintenance dose of MZR was finally set at 50 mg. At present, the oral PSL dosage has been tapered to 10 mg/day, and the patient has achieved a state of remission without any side effects.

DOI： 10.1007/s13730-012-0050-1

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIMS: SM22α, transgelin, has been revealed to be specifically expressed in glomerular epithelial cells and interstitial cells, according to the nature of the renal injury. In this study, quantitative analyses of SM22α positivity were performed to investigate the pathological significance of its expression. METHODS: Kidney samples of adriamycin nephropathy underwent immunohistochemistry with a newly established anti-SM22α monoclonal antibody. The SM22α positivity was quantified by an image analyzer. The correlation of the histological values with biochemical data was investigated statistically. Microstructural localization of SM22α was studied by immunoelectron microscopy. RESULTS: SM22α was expressed along the dense basal microfilaments of degenerating podocytes, and diffusely in interstitial cells. Both the extent and intensity of SM22α expression in glomerular and tubulointerstitial area were correlated with the deterioration of renal function and the severity of proteinuria. Stepwise multiple linear regression analysis revealed that the extent of its positivity in glomerular or tubulointerstitial area was the determinant of the amount of proteinuria or the deterioration of creatinine clearance (Ccr), respectively. Inversely, the deterioration of Ccr was the most important predictor of SM22α expression. CONCLUSION: SM22α expression in podocytes and interstitial cells represented the severity of proteinuria and the deterioration of renal function. SM22α expression in renal tissues might be a hallmark of kidney diseases.

DOI： 10.1159/000329664

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: SM22α (transgelin) has been focused upon as a player in the process of phenotypic changes of types of cells. The SM22α expression in the rat anti-glomerular basement membrane (GBM) nephritis model and differences from an established phenotypic marker for the myofibroblast, α-smooth muscle actin (αSMA), were investigated. METHODS: The rat kidney tissues were processed for histological studies, immunohistochemical and immunoelectronmicroscopy analyses on days 0, 7, 28, 42 and 56 after injection of rabbit anti-GBM serum for the disease induction. RESULTS: Immunohistochemistry with anti-SM22α antibodies (Ab) revealed that kidneys of the nephritic rats on day 7 expressed SM22α in podocytes, crescentic cells and epithelial cells of Bowman's capsule. After 28 days, SM22α was also expressed in peritubular interstitial cells. Double immunofluorescence with anti-SM22α Ab and anti-αSMA Ab showed that SM22α was preferentially expressed in podocytes, whereas αSMA was positive in mesangial cells on day 7. After day 28, both molecules became positive in peritubular interstitial cells. CONCLUSION: SM22α was expressed in epithelial cells of inflamed glomeruli in the early phase, and then also in peritubular interstitial cells in the later phase of anti-GBM nephritis model. SM22α presented unique kinetics of expression distinct from αSMA.

DOI： 10.1111/j.1440-1797.2010.01322.x

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIMS: SM22α, transgelin, is abundantly expressed in smooth muscle tissues and our previous work demonstrated that it is a novel marker of injured glomerular epithelial cells in rat antiglomerular basement membrane nephritis. In this study, we investigated SM22α expression in models of glomerular and interstitial renal injury. METHODS: The 5/6 nephrectomy (Nx) model, ischemia-reperfusion (I/R) model and puromycin aminonucleoside (PAN) nephrosis of rats were studied. Immunohistochemical analyses and immunoelectron microscopic studies of SM22α expression were performed. RESULTS: In the 5/6 Nx model, SM22α was first expressed in peritubular interstitial cells and was also expressed in injured glomerular epithelial cells at 8 weeks. In the I/R model, SM22α expression was induced in peritubular interstitial cells as early as 12 h after I/R with expression sustained at 7 days. However, SM22α was not detected in any glomerular cells or tubular epithelial cells. In PAN nephrosis, SM22α was only expressed in glomerular epithelial cells after 1 week, but expression was transient. CONCLUSION: SM22α was expressed in glomerular epithelial cells and interstitial cells in renal injury. SM22α is differentially upregulated in various models of renal injury and merits further study.

DOI： 10.1159/000320175

PubMed

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We report a case of HELLP syndrome, multiple liver infarctions, and intrauterine fetal death in a woman in the 17th week of pregnancy with SLE and APS who had been in remission on a regimen of low-dose prednisolone and aspirin. An increase in the dosage of corticosteroid together with intravenous heparin infusion led to improvement of the clinical symptoms, laboratory parameters, and multifocal low-density liver lesions detected by computed tomography. Early onset and signs of severe organ involvement are the characteristic features of HELLP syndrome associated with APS, and patients that are at risk should be followed up carefully.

PubMed

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)東京医学社  

当院ではこれまで、腹膜透析(PD)患者の出口部作製後、フィルムで2週間保護し、その後は消毒・ガーゼ保護で入浴時はパックを使用していた(ガーゼ導入法)が、出口部感染を含む皮膚損傷などのトラブルが散見されるようになってきたため、「バイオパッチ」+フィルム固定法(フィルム導入法)を出口部作製後の患者に導入しており、その効果を、ガーゼ導入法(2016年6月～)の患者とフィルム導入法(2018年10月～)の患者の導入後3ヵ月間に生じたトラブル件数の比較から検討した。その結果、導入後3ヵ月間に生じたトラブル件数は、ガーゼ導入法が10件(76.9%)、フィルム導入法で2件(22.2%)と、フィルム導入法で有意に少なかった。

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Language：Japanese   Publisher：新潟医学会  

症例は50歳代、男性。35歳時に、高血圧、心房細動を指摘された。X-6年、うっ血性心不全、大動脈弁輪拡張症にて入院し、翌X-5年3月にBentall手術、MAZE手術が施行された。その際に初めて多発性嚢胞腎、多発性肝嚢胞を指摘された。Cre 1.53mg/dL、eGFR 39mL/min/1.73m2、総腎容積2,421mL(Mayo分類1D)、総肝容積8,614mL(Gigot分類II型)。以後、当院に通院継続したが、X-2年10月にはCre 2.44mg/dL、eGFR 23mL/min/1.73m2、TKV 3,540mL、LV12,674mLと、腎機能、腎腫大、肝腫大はいずれも悪化した。腎嚢胞増大の抑制を目的としてトルバプタン60mgを開始したが、十分な飲水ができず腎機能が悪化し30mgに減量した。動脈塞栓術の適応について、血液透析導入後に慎重に検討する予定であった。X-1年12月、eGFR 15mL/min/1.73m2、未満に至りトルバプタンを中止した。X年1月、胸水の増量、低栄養が進行し入院した。栄養状態が悪化し腎機能も末期腎不全状態まで悪化したため、1ヵ月後に緊急血液透析に導入した。しかし、腹部膨満による呼吸不全からCO2ナルコーシスに陥り、非侵襲的陽圧換気療法でも管理困難であった。透析導入2ヵ月後に死亡した。多発性嚢胞腎、多発性肝嚢胞の嚢胞増大は腹部膨満により低栄養や臓器の圧迫による症状を引き起こす。嚢胞の増大に対する治療は、腎・肝動脈塞栓術、外科的に嚢胞開窓術、またPLDには肝切除術、肝移植術が考慮されるが合併症の割合も低くはない。本例はいずれも十分に検討することができなかったが、多発性嚢胞腎、多発性肝嚢胞の嚢胞増大には、動脈塞栓術か外科的治療の適応について症例毎に慎重に検討すべきである。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00990&link_issn=&doc_id=20210520070005&doc_link_id=%2Fdg3nigta%2F2020%2F013406%2F005%2F0199-0205%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2020%2F013406%2F005%2F0199-0205%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)東京医学社  

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J-GLOBAL

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Language：Japanese   Publisher：(株)東京医学社  

当院におけるシャントマップ(マップ)作成は、5名の臨床工学技士(技士)が超音波診断装置を用いて作成している。今回、マップ作成において作成者間の情報量や測定値のバラツキが示唆されたため、現状把握すべく検討を行った。方法は、同一透析患者について技士5名がマップ作成した際の測定値とマップ描画を技士間で比較した。結果、シャントエコー値の最大値と最小値の差は、[FV]が700mL/min、[RI]が0.04、[吻合径]が3.2mm、[狭窄径]が0.7mmであり、[FV]に最もバラツキがみられた。マップ描画は、おおまかな血管走行や狭窄の位置・種類にバラツキは認めなかったが、狭窄の測定箇所や血管径の記載箇所、血管の太さの描画などにバラツキがみられた。医師3名を対象とし、技士5名が作成したマップについて「PTA実施判断」のアンケートを行った。結果、全てのマップに対し「PTAを実施しない」と答えた医師が1名、5枚中2枚に対して「PTAを実施する」と答えた医師が2名おり、マップにより違いがみられた。また、同じマップでも医師により判断が異なっており、描き手の要因と読み手の要因が浮き彫りとなった。

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Language：Japanese   Publisher：(株)北隆館  

腎臓病と抗酸化作用を有する銅含有酵素セルロプラスミン(Cp)との関連を検討した。正常マウスでボウマン嚢上皮にCpを認めるが、抗糸球体基底膜抗体腎炎モデルで減弱した。血液透析患者のCp高値はエリスロポエチン低反応性ならびにCVDの既往と関連した。Cpの抗酸化作用は糸球体腎炎の活動性、ならびに慢性腎臓病患者における腎性貧血・慢性炎症と関連性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J00974&link_issn=&doc_id=20170904240052&doc_link_id=issn%3D0022-1961%26volume%3D120%26issue%3D3%26spage%3D476&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D120%26issue%3D3%26spage%3D476&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(公社)日本透析医会  

腎コロボーマ症候群(RCS)におけるPAX2遺伝子異常が、胎生期のヒト後腎ネフロン前駆細胞への分化に及ぼす影響を調べるため、RCS患者末梢血Tリンパ球から人工多能性幹細胞(induced pluripotent stem cell、iPS細胞)を樹立し、後腎ネフロン前駆細胞への分化の過程で発現する遺伝子群を健常者と比較した。iPS細胞からの分化開始11日目、14日目でみられる発現遺伝子には差がみられず、ヘテロのPAX2変異では後腎ネフロン前駆細胞への分化は影響を受けないと考えられた。(著者抄録)

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Language：Japanese   Publisher：(株)日本臨床社  

J-GLOBAL

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01126&link_issn=&doc_id=20160620200002&doc_link_id=1520572358341046656&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520572358341046656&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(株)中外医学社  

薬剤による腎障害は,原因薬剤,障害部位,機序など非常に多岐にわたる.本稿では,薬剤性腎障害のいくつかの最近の話題を概説した.糖尿病合併慢性腎臓病患者に対するレニン-アンギオテンシン系阻害薬併用によって急性腎障害発症リスクが上昇することが改めて示唆された.NSAIDsによる腎障害は薬剤毎の差異が明らかでないが,今後の検討課題である.造影剤腎症の予防には生理食塩水投与が推奨されるが,最近,短期スタチン投与による予防効果が示唆された.新規薬剤による巣状分節性糸球体硬化症や,thrombotic microangiopathyの報告があり,注目される.高用量スタチンによる急性腎障害発症のリスクの有無についていずれの報告もあり,今後の検討課題である.高齢者に対する非定形抗精神病薬投与が,急性腎障害さらに全死亡リスクを増加させる可能性が報告され,腎臓専門医も留意すべきである.いずれの薬剤についても,確立されたガイドラインなどはなく,実臨床では患者の病態に即して適応を検討すべきである.(著者抄録)

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Language：Japanese   Publisher：(有)フジメディカル出版  

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Language：Japanese   Publisher：(株)日本メディカルセンター  

症例は66歳男性で、50歳頃より慢性腎臓病、高血圧症、メタボリック症候群を指摘され、二次性副甲状腺機能亢進症と尿毒症に対し炭酸カルシウム、球形吸着炭を開始した。慢性の便秘があり、腎機能低下で血液透析導入となったが、第4病日より腹部膨満感増強、腹痛が生じた。画像所見で横隔膜挙上、S状結腸から口側の腸管拡張を認め、血圧および動脈血酸素飽和度低下より大腸イレウス、ショックと判断した。腹部は膨隆し続け、膀胱内圧は21mmHgと上昇し、腹部コンパートメント症候群と診断した。下部消化管内視鏡でS状結腸内は球形吸着炭を混じた便塊で満たされ、腸管粘膜は虚血状態にあった。経肛門的に結腸閉鎖を解除できず、緊急開腹術を施行した。開腹直後より呼吸不全は改善し、血圧上昇、自尿流出を認めた。小腸部分切除の後、敗血症合併に対する持続的血液濾過透析と直接血液灌流法を行い、腎機能は改善して第62病日に退院した。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J01864&link_issn=&doc_id=20150415050014&doc_link_id=10.19020%2FJ01864.2015209953&url=https%3A%2F%2Fdoi.org%2F10.19020%2FJ01864.2015209953&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：医学図書出版(株)  

AKI(acute kidney injury)の概念は、従来の急性腎不全(Acute renal failure)と比較して、より早期の段階の腎障害を含めるという点などが異なるものである。定義、分類、診断基準の統一を目的とし、これまでRIFLE、AKIN、KDIGOの診断基準、分類が提唱されてきた。これら基準・分類は血清クレアチニン、尿量のみを用いる簡便な内容で、かつこれまでの研究で早期診断や予後予測に有用であることが示されてきた。一方、現在の診断基準・分類には問題点・限界も認識され、さらなる検討を要する。新規バイオマーカーに期待が寄せられている。本稿ではAKIの診断基準と運用について、またAKIのバイオマーカーについて概説する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20150219310002&doc_link_id=%2Faa6icutc%2F2015%2F003901%2F003%2F0009-0015%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F003901%2F003%2F0009-0015%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)メディカルトリビューン  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(株)東京医学社  

小分子物質からアルブミン領域までの溶質除去性能の向上を目的として開発されたFB-210UHβ(以下UHβ)を維持透析患者6名に使用し、その溶質除去特性について、既存の透析器PES-21Sα(以下Sα)と比較検討した。結果、小分子物質からβ2-MG領域までの溶質除去性能には有意差を認めなかった。α1-MGについては、除去量でUHβが136±38.1mg、Sαが81±32.0mg、クリアランスでUHβが10±1.1mL/min、Sαが4±0.7mL/minであり、UHβのほうが有意に高値であった。透析排液中アルブミン漏出量の1透析あたり平均値は、Sαの0.80±0.24gに対してUHβは3.43±0.87gと有意に高値であった。血清アルブミン値は、Sα使用時の4.12±0.16g/dLに対し、UHβでは使用開始1週後3.90±0.17g/dL、1ヵ月後3.78±0.12gと低下したが、その後はほとんど変化なく推移した。

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(NPO)日本高血圧学会  

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Language：Japanese   Publisher：新潟県立新発田病院  

症例は56歳女性。8年前に腰痛、IgG 5.0g/dl、IgG-κM蛋白、Cre 4.51mg/dl、尿蛋白(2+)から多発性骨髄腫(MM)、Durie & Salmon stageIIIBと診断。化学療法で寛解しCre 0.42mg/dl、尿蛋白(-)で退院。3年後の骨髄穿刺で完全寛解(CR)判定。IgG 1.6～2.0g/dl、Cre 0.6～0.7mg/dl、8年後、IgG 2.6g/dl、尿蛋白(+)を認めたがCre 0.74mg/dl。1ヵ月半後、水様下痢、感冒様症状あり非ステロイド系消炎鎮痛剤(NSAID)を内服、2日後、無尿のため当院受診し7kgの体重増加、Cre 5.87mg/dlから急性腎不全と診断、血液透析に導入された。腎生検では、10個中4個が全節性硬化糸球体であった。尿細管腔内にmyeloma castが多数存在し、骨髄腫腎と診断。骨髄穿刺で多発性骨髄腫、再燃と診断された。血液内科でdexamethasone、bortezomib療法を開始後、自尿は増加したが、Creは正常化しなかった。MMの29%は診断時に腎不全をきたしているが、その58%は1年以内にCreは正常化する。しかし、本例は寛解8年後に骨髄腫腎・急性腎不全にて再発し、新規治療法で原病はコントロールされたが維持透析を要した。文献的考察を加え報告する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：新潟県立病院医学会  

症例1は19歳女性で、15歳時に潰瘍性大腸炎(UC)と診断され、メサラジン、整腸剤で治療され良好に経過した。17歳時に学校検診で血尿を指摘され、uRBC5～9/hpf、UP0.5g/日で経過観察された。19歳時、uRBC30～49/hpf、UP0.5g/日と増悪し、経皮的腎生検で入院した。貧血や明らかな腎機能・肝機能障害はなく、血清IgA等、免疫グロブリンや補体価に異常なかった。uRBC10～19/hpfで赤血球変形が認められた。腎生検で全節性硬化はなかったが、巣状、分節性、軽度のメサンギウム細胞増殖と瀰漫性、全節性、軽度のメサンギウム基質増加が認められた。20%の糸球体に癒着、分節性硬化や半月体の分節性病変を認め、IgA腎症、予後比較的不良群と診断された。食事療法に加え、プレドニゾロン(PSL)を3mgから開始し、以後漸減した。腎機能増悪を認めなかったが、経過中にUCが増悪し、PSL増量、タクロリムス投与でUCは緩解した。症例2は79歳男性で、53歳時にUCと診断され、PSL60mgで加療し緩解したためPSLを中止した。UCは再発し、58～67歳時にPSL15mg再投与、以後はメサラジンで治療された。79歳時に浮腫、低タンパク血症からネフローゼ症候群と診断され、腎生検のため入院した。糖尿病性網膜症は認めず、明らかな腫瘍性病変はなく、大腸内視鏡でUCは緩解期で、生検でアミロイドーシスを認めず、腎生検所見より膜性腎症ステージ1～2と診断された。肝炎や悪性腫瘍、薬剤に伴う二次性の膜性腎症は否定的と考え、膜性腎症はステロイドに良好に反応せず、高齢でステロイドの副作用を合併したことや患者の希望でPSLは開始せず、食事療法に加え、ACE阻害薬を開始した。尿タンパクは5～6g/gCreと持続しているが、アルブミンは3g/dlまで漸増し、浮腫も軽快し、コレステロール値も著明な増悪はみられていない。

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Language：Japanese   Publisher：(株)東京医学社  

55歳男。慢性腎不全が進行して51歳時に腹膜透析導入され、以後CAPDを継続していた。今回、便潜血陽性を指摘され、大腸内視鏡検査にて上行結腸肝彎曲よりに0-I sp型の腫瘍性病変を認め、生検で大腸癌、深達度smと診断された。入院時の諸検査より上行結腸癌[A]cSMcN0cH0cM0 cStage Iと術前診断し、腹腔鏡下右半結腸切除術D3郭清を施行した。腫瘍は漿膜面に引きつれを認め、術後診断はMPsN0sH0sP0sM0 sStage Iであった。なお、手術に際しては第3病日より血液透析を週3回併用し、CAPDは手術日早朝に排液した。術後は2日目よりHD週3回を継続し、約2週間でCAPD再開して15日目に退院となった。術後85日目に腹膜機能検査を行ったが、術前と比べ明らかな低下は認めなかった。

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本糖尿病学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

42歳男.2年前に飲酒時の左眼窩部痛を自覚し,非拍動性で鼻汁と流涙を伴っていた.禁酒により症状は消失したが,1年前から飲酒とは関係なく連日夜間出現するようになった.群発頭痛と診断し,発作時のsumatriptanを開始したが,その後発作頻度は増加し,左縮瞳と顔面の異常感覚を来たした.左三叉神経第1枝領域にピリピリする錯感覚があったが,その他の神経学的異常はなく,頭部MRI,MRAでも異常所見を認めなかった.特発性Reader症候群と診断し,入院後も連日頭痛が出現したため,予防を目的に入院第7日目よりprednisolone(PSL)60mgを開始したところ,内服当日より頭痛発作は消失し,sumatriptanは不要となった.PSLは週に10mgずつ減量し,再燃防止のためverapamil 120～240mgを投与した.頭痛の再燃はなく,第27日目にPSL 40mgで退院した

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2005&ichushi_jid=J01550&link_issn=&doc_id=20050427450009&doc_link_id=1520290883252970368&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520290883252970368&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif