51
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Sugimoto H, Oshima Y, Oba Y, Ikuma D, Sekine A, Mizuno H, Yamanouchi M, Hasegawa E, Suwabe T, Chu PS, Hasegawa Y, Obara H, Sawa N, Ubara Y. Successful Case of Deceased Donor Liver Transplant for Polycystic Liver Disease. Transplant Proc 2022; 54:2779-2783. [DOI: 10.1016/j.transproceed.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
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52
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Sugimoto H, Sawa N, Yamagiwa H, Kawada M, Ikuma D, Oba Y, Mizuno H, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Nishida A, Kono K, Kinowaki K, Ohashi K, Yamaguchi Y, Ubara Y. A Case of Focal Segmental Glomerulosclerosis Associated With Essential Thrombocythemia. Intern Med 2022. [PMID: 36288989 DOI: 10.2169/internalmedicine.0767-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
A 72-year-old man was admitted for examination of proteinuria (9.14 g/day) and leg edema. Essential thrombocythemia (ET) was diagnosed because of thrombocytosis (platelet count, 57.9×104/μL), elevated megakaryocytes in bone marrow biopsy, and JAK2 V617 mutation. Kidney biopsy led to a diagnosis of focal segmental glomerulosclerosis (FSGS) cellular variant (characterized by glomerular capillaries filled with swollen endothelial cells containing foam cells) in 6 glomeruli, FSGS tip variant in 5 glomeruli, and additional FSGS variants in other glomeruli. Affected glomeruli had anti-CD61 antibody staining-positive megakaryocyte infiltrations. ET mayinduce FSGS because megakaryocyte infiltration increases intraglomerular pressure, resulting in hypertension and proteinuria.
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Affiliation(s)
- Hisashi Sugimoto
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Naoki Sawa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hajime Yamagiwa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masahiro Kawada
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Iijima T, Sawa N, Nakayama Y, Oba Y, Ikuma D, Mizuno H, Yamanouchi M, Suwabe T, Wake A, Kono K, Hoshino J, Ubara Y, Ohashi K. Vincristine, Doxorubicin, and Dexamethasone Induction before Autologous Stem Cell Transplantation in Patients with AL Amyloidosis: A Retrospective Comparison with Frontline Stem Cell Transplantation. Intern Med 2022; 61:2853-2860. [PMID: 35228429 PMCID: PMC9593158 DOI: 10.2169/internalmedicine.9039-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective High-dose melphalan and autologous stem cell transplantation (ASCT) therapy for AL amyloidosis are now associated with reduced mortality based on the application of strict criteria. However, there is no long-term evidence concerning the performance of induction therapy with newer agents, such as bortezomib or daratumumab. Concerns regarding long-term relapse despite treatment with ASCT exist, and missing the opportunity to perform ASCT might occur if induction proves to not be efficacious and cardiac amyloidosis progression deprives the patients of a chance to receive ASCT. We herein report good amyloid control by vincristine, doxorubicin, and dexamethasone (VAD) induction therapy and argue the importance of induction therapy before ASCT. Methods We compared patients who underwent VAD induction and ASCT (VAD+ASCT) with patients who underwent frontline ASCT in our hospital. Patients A total of 26 patients with histologically proven AL amyloidosis were included (18 in the VAD+ASCT group and 8 in the frontline ASCT). Results In the VAD+ASCT group, the 10-year overall survival and renal response rates were 82% and 43%, respectively. The renal response rate at two years in the VAD+ASCT group was significantly better than that in the frontline ASCT group. Although there was no significant difference in the survival rates between the two groups, the time to next treatment or death was significantly better in the VAD+ASCT group than in the the frontline ASCT group. Acute kidney injury was the most frequent reason for failure to receive two courses of VAD, and early mortality was mainly due to gastrointestinal complications. Conclusion Considering that only those who underwent 2 courses of VAD experienced a 10-year renal response, induction therapy was deemed to be directly related to the long-term control of AL amyloidosis.
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Affiliation(s)
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Nakayama
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Atsushi Wake
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
- Department of Hematology, Toranomon Hospital Kajigaya, Japan
- Department of Hematology, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Ushiki T, Mochizuki T, Suzuki K, Kamimura M, Ishiguro H, Suwabe T, Kawase T. Modulation of ATP Production Influences Inorganic Polyphosphate Levels in Non-Athletes’ Platelets at the Resting State. Int J Mol Sci 2022; 23:ijms231911293. [PMID: 36232597 PMCID: PMC9570372 DOI: 10.3390/ijms231911293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/16/2022] Open
Abstract
Platelets produce inorganic polyphosphate (polyP) upon activation to stimulate blood coagulation. Some researchers have linked polyP metabolism to ATP production, although the metabolic linkage is yet to be elucidated. We found evidence for this possibility in our previous study on professional athletes (versus non-athletes), and proposed that the regulatory mechanism might be different for these two groups. To explore this aspect further, we investigated the effects of modulated ATP production on polyP levels. Blood samples were obtained from Japanese healthy, non-athletes in the presence of acid-citrate-dextrose. The platelets in the plasma were treated with oligomycin, rotenone, and GlutaMAX to modulate ATP production. PolyP level was quantified fluorometrically and visualized using 4′,6-diamidino-2-phenylindole. Correlations between polyP and ATP or NADH were then calculated. Contrary to the hypothesis, inhibitors of ATP production increased polyP levels, whereas amino acid supplementation produced the opposite effect. In general, however, polyP levels were positively correlated with ATP levels and negatively correlated with NADH levels. Since platelets are metabolically active, they exhibit high levels of ATP turnover rate. Therefore, these findings suggest that ATP may be involved in polyP production in the resting platelets of non-athletes.
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Affiliation(s)
- Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata 951-8518, Japan
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan
| | - Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Katsuya Suzuki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
| | - Masami Kamimura
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
| | - Hajime Ishiguro
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan
| | - Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan
- Correspondence: ; Tel.: +81-25-262-7559
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55
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Kurihara S, Sawa N, Inui K, Ikuma D, Oba Y, Mizuno H, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Tomita S, Okubo T, Ubara Y. Onion Skin Lesion of the Renal Small Artery in a Patient With Polymyositis and Hemolytic Uremic Syndrome. Kidney Med 2022; 4:100539. [PMID: 36204244 PMCID: PMC9531275 DOI: 10.1016/j.xkme.2022.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shigekazu Kurihara
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Address for Correspondence: S. Kurihara.
| | - Naoki Sawa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Keita Inui
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Ikuma
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan
- Yamaguchi’s Pathology Laboratory, Chiba, Japan
| | - Shigeki Tomita
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Y. Ubara, PhD.
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56
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Nakashima S, Kawada M, Sekine A, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Sawa N, Hoshino J, Ubara Y. Nodular-like glomerular lesion after long-standing chronic renal infection in a patient with medullary sponge kidney and mild hyperglycemia. Endocrinol Diabetes Metab Case Rep 2022. [DOI: 10.1530/edm-22-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 63-year-old Japanese woman was admitted to our institute for the evaluation of proteinuria. The patient was diagnosed with medullary sponge kidney, distal type renal tubular acidosis, and renal infection at the age of 37. Thereafter, the patient had repeated renal infections. Urinary proteinuria appeared at around the age of 61 and gradually increased up to 1.0 g daily. In the same period, glycated hemoglobin (HbA1c) increased to 7.0%. On kidney biopsy, light microscopy showed a nodular glomerular lesion and capsular drop. Linear staining for immunoglobulin G along the glomerular basement membrane was observed by immunofluorescence. Electron microscopy showed thickening of the glomerular basement membrane to a width of 800–900 nm. A class III glomerular lesion was diagnosed according to the Tervaert classification. This case indicates that mild but prolonged hyperglycemia for more than 10 years may also contribute to the formation of nodular lesions, although long-standing repeated chronic renal infection and chronic acidosis may have been a precipitating factor in the formation of diabetic nephropathy, including nodular glomerular lesions. This hypothesis is of interest because nodular lesions specific to diabetes are currently considered to be associated with long-term severe hyperglycemia.
Learning points
Nodular glomerular lesions in diabetes mellitus are thought to be associated with long-term severe hyperglycemia.
This case shows that although mild, long-term hyperglycemia for more than 10 years may also contribute to the formation of nodular lesions and that repeated chronic kidney infections over the years and chronic acidosis may be facilitating factors in the formation of diabetic nephropathy, including nodular glomerular lesions.
This case appears to be idiopathic nodular glomerulosclerosis of the medullary sponge kidney associated with chronic urinary tract infection.
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Affiliation(s)
| | | | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | | | | | - Yuki Oba
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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57
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Yoshimura Y, Suwabe T, Ikuma D, Oba Y, Yamanouchi M, Sekine A, Mizuno H, Hasegawa E, Hoshino J, Kono K, Kinowaki K, Ohashi K, Sawa N, Ubara Y. Renal Cell Carcinoma-Associated Diabetes Mellitus Due to Paraneoplastic Syndrome in Maintenance Hemodialysis: A Case Report. Kidney Med 2022; 4:100477. [PMID: 35637924 PMCID: PMC9142673 DOI: 10.1016/j.xkme.2022.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 59-year-old Japanese woman with a 22-year history of long-term hemodialysis was admitted to our hospital for further examination of hyperglycemia and anemia. Five months before hospitalization, her fasting plasma glucose value was 99 mg/dL and her glycated hemoglobin was 5.7%. On admission, her fasting plasma glucose value was 873 mg/dL, glycated hemoglobin was 16.2%, C-peptide reactivity was 22.3 ng/mL (reference range, 0.5-3.0), and homeostasis model assessment of insulin resistance (HOMA-IR) was 10.6 (reference range, <2.0); the high HOMA-IR indicated high insulin resistance. Intensive insulin therapy was started for hyperglycemia, which required more than 40 units/day. Computed tomography showed a hypervascular lesion 2.2 cm in diameter on the right kidney; therefore, right nephrectomy was performed. Complete resection was confirmed, and the lesion was diagnosed as a clear cell type of renal cell carcinoma (RCC). Immediately after nephrectomy, glycemic control normalized and administration of insulin was discontinued. Fourteen days after nephrectomy, the HOMA-IR decreased to 2.96. RCC that develops in patients receiving long-term hemodialysis has been reported to be dialysis-related RCC, but there have been no reports suggesting a relationship between dialysis-related RCC and diabetes. To our knowledge, this is the first report of RCC presenting with the paraneoplastic syndrome of acute-onset diabetes because of insulin resistance.
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Affiliation(s)
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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58
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Miyamoto R, Sekine A, Fujimaru T, Suwabe T, Mizuno H, Hasegawa E, Yamanouchi M, Chiga M, Mori T, Sohara E, Uchida S, Sawa N, Ubara Y, Hoshino J. Echocardiographic Findings and Genotypes in Autosomal Dominant Polycystic Kidney Disease. Kidney Dis (Basel) 2022; 8:246-252. [PMID: 35702705 DOI: 10.1159/000520300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cystic kidney disease and is well known to have extrarenal complications. Cardiovascular complications are of particular clinical relevance because of their morbidity and mortality; however, unclear is why they occur so frequently in patients with ADPKD and whether they are related to the genotypes. Methods We extracted and retrospectively analyzed clinical data on patients with ADPKD who underwent echocardiography and whose genotype was confirmed by genetic testing between April 2016 and December 2020. We used next-generation sequencing to compare cardiac function, structural data, and the presence of cardiac valvular disease in patients with 1 of 3 genotypes: PKD1, PKD2, and non-PKD1, 2. Results This retrospective study included 65 patients with ADPKD. Patients were divided into 3 groups: PKD1, n = 32; PKD2, n = 12; and non-PKD1, 2, n = 21. The prevalence of mitral regurgitation (MR) was significantly higher in the PKD1 group than in the PKD2 and non-PKD1, 2 group (46.9% vs. 8.3% vs. 19.0%, respectively; p = 0.02). In contrast, no significant difference was found for other cardiac valve complications. Conclusion This study found a significantly higher prevalence of MR in patients with the PKD1 genotype than in those with the PKD2 or non-PKD1, 2 genotypes. Physicians may need to perform echocardiography earlier and more frequently in patients with ADPKD and the PKD1 genotype and to control fluid volume and blood pressure more strictly in these patients to prevent future cardiac events.
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Affiliation(s)
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Takuya Fujimaru
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | | | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Motoko Chiga
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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Mizuno H, Sekine A, Suwabe T, Ikuma D, Yamanouchi M, Hasegawa E, Sawa N, Ubara Y, Hoshino J. Potential effect of tolvaptan on polycystic liver disease for patients with ADPKD meeting the Japanese criteria of tolvaptan use. PLoS One 2022; 17:e0264065. [PMID: 35176098 PMCID: PMC8853523 DOI: 10.1371/journal.pone.0264065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Polycystic liver disease (PLD) is a common extrarenal complication of autosomal dominant polycystic kidney disease (ADPKD), which causes compression-related syndrome and ultimately leads to liver dysfunction. Tolvaptan, a V2 receptor antagonist, is widely used to protect kidney function in ADPKD but its effect on PLD remains unknown. An observational cohort study was conducted to evaluate tolvaptan’s effect on patients with PLD due to ADPKD. After screening 902 patients, we found the 107 ADPKD patients with PLD who met the criteria of tolvaptan use in Japan. Among them, tolvaptan was prescribed for 62 patients (tolvaptan group), while the other was defined as the non-tolvaptan group. Compared with the non-tolvaptan group, the tolvaptan group had larger height-adjusted total kidney volume (median 994(range 450–4152) mL/m, 513 (405–1928) mL/m, p = 0.01), lower albumin level (mean 3.9±SD 0.4 g/dL, 4.3±0.4g/dL, p<0.01), and higher serum creatinine level (1.2±0.4 mg/dL, 0.9±0.2 mg/dL, p<0.01). Although the median change in annual growth rate of total liver volume (TLV) was not statistically different between the tolvaptan group (-0.8 (-15.9, 16.7) %/year) and the non-tolvaptan group (1.7 (-15.6–18.7) %/year)(p = 0.52), 20 (43.5%) patients in the tolvaptan group experienced a decrease in the growth rate of TLV (responders). A multivariable logistic regression model adjusting for related variables showed that older age (odds ratio 1.15 [95% CI 1.01–1.32]) and a higher growth rate of TLV in the non-tolvaptan period (odds 1.45 95% CI 1.10–1.90) were significantly associated with responders. In conclusion, the change in annual growth rate of TLV in ADPKD patients taking tolvaptan was not statistically different compared with that in ADPKD patients without taking tolvaptan. However, tolvaptan may have the potential to suppress the growth rate of TLV in some PLD patients due to ADPKD, especially in older patients or those that are rapid progressors of PLD. Several limitations were included in this study, therefore well-designed prospective studies were required to confirm the effect of tolvaptan on PLD.
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Affiliation(s)
- Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- * E-mail:
| | | | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Junichi Hoshino
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
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60
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Hatano M, Kitajima I, Nakamura M, Isawa K, Suwabe T, Hoshino J, Sawa N, Yamamoto S, Ubara Y. Effect of loaded exercise for renal osteodystrophy. CEN Case Rep 2022; 11:351-357. [DOI: 10.1007/s13730-021-00674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022] Open
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61
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Suwabe T, Ubara Y, Ikuma D, Mizuno H, Hayami N, Yamanouchi M, Sawa N. Autosomal Dominant Polycystic Kidney Disease in which the Polycystic Liver Volume Was Reduced by Rigorous Blood Pressure Control. Intern Med 2022; 61:49-52. [PMID: 34219109 PMCID: PMC8810249 DOI: 10.2169/internalmedicine.7441-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Polycystic liver disease (PLD) is the most common extrarenal manifestation of autosomal dominant polycystic kidney disease (ADPKD). However, current treatments for PLD are only supportive. We experienced a case of enlarged kidneys and liver in a 53-year-old Japanese man with ADPKD who was on hemodialysis. He underwent renal transcatheter arterial embolization (TAE) for enlarged kidneys. His blood pressure (BP) decreased after renal TAE, and his liver volume decreased from 5,259 mL to 4,647 mL (11.6% reduction) within 1 year after renal TAE. This case suggests that rigorous blood pressure control may be beneficial for ameliorating enlarged PLD.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Noriko Hayami
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | | | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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62
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Sawamura M, Sawa N, Yamanouchi M, Ikuma D, Sekine A, Mizuno H, Kawada M, Hiramatsu R, Hayami N, Hasegawa E, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Yamaguchi Y, Ubara Y. Use of biologic agents and methotrexate improves renal manifestation and outcome in patients with rheumatoid arthritis: a retrospective analysis. Clin Exp Nephrol 2021; 26:341-349. [PMID: 34846624 PMCID: PMC8930889 DOI: 10.1007/s10157-021-02160-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022]
Abstract
Background and purpose We examined whether advances in treatment strategies from older disease-modifying antirheumatic drugs (DMARDs) to new biologic agents and methotrexate improved renal complications and outcome in patients with rheumatoid arthritis (RA). Methods We reviewed records of 156 patients with RA who underwent kidney biopsy at our institute between January 1990 and December 2019. All patients were assigned to one of three periods: period 1, 1990–1999 (n = 48); period 2, 2000–2009(n = 57); period 3, 2010–2019 (n = 51). Results Membranous nephropathy, nephrosclerosis, AA-amyloidosis, and IgA nephropathy were the four major renal manifestations of RA. AA-amyloidosis was diagnosed by kidney biopsy in 21 patients: period 1, 7 patients (15%); period 2, 10 patients (18%); and period 3, 4 patients (8%). The 4 patients in period 3 were in the years 2010–2014, and no new case of AA-amyloidosis was recorded from 2015 to 2019. In all 21 of the patients with AA-amyloidosis, neither a biologic agent nor methotrexate was administered. Fifteen of the 21 patients required dialysis, and 13 died in periods 1–3 because of amyloid-related cardiac dysfunction less than 2 years after the initiation of dialysis. Two of them are doing well using biologic agent despite dialysis. The remaining three patients who received a biologic agent or methotrexate does not progress to end-stage renal failure. In addition, the other renal complications showing progression to dialysis also decreased over time. Conclusion Advances in treatment strategies have improved renal outcome and reduced mortality in patients with RA. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02160-2.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan. .,Nephrology Center, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Kawada
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Rikako Hiramatsu
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Noriko Hayami
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.,Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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63
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Noda-Narita S, Kanzaki M, Uesaka Y, Suwabe T, Kinowaki K, Marui Y, Hoshino J, Sawa N, Ubara Y. Paraneoplastic Polymyositis Due to Renal Cell Carcinoma in a Patient with Autosomal Dominant Polycystic Kidney Disease. Intern Med 2021; 60:3577-3580. [PMID: 34053989 PMCID: PMC8666206 DOI: 10.2169/internalmedicine.7417-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 70-year-old man with malaise and muscle weakness that had developed within a month. The patient also had abdominal fullness due to polycystic kidney disease. Severe proximal skeletal muscle weakness and mild elevation of creatinine kinase to 301 IU/L were noted. A muscle biopsy of the right bicep showed polymyositis. Computed tomography showed a right renal mass, and an analysis after right nephrectomy identified clear cell carcinoma. The muscle weakness subsided one month after nephrectomy and intravenous immunoglobulin therapy. Therefore, we suspect that the development of polymyositis in this patient was closely related to renal cell carcinoma.
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Affiliation(s)
- Shoko Noda-Narita
- Department of Neurology, Toranomon Hospital, Japan
- Department of Nephrology, Toranomon Hospital, Japan
| | - Mami Kanzaki
- Department of Neurology, Toranomon Hospital, Japan
| | - Yoshikazu Uesaka
- Department of Neurology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
| | | | - Yuhji Marui
- Department of Nephrology, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
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64
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Cho K, Ushiki T, Ishiguro H, Tamura S, Araki M, Suwabe T, Katagiri T, Watanabe M, Fujimoto Y, Ohashi R, Ajioka Y, Shimizu I, Okuda S, Masuko M, Nakagawa Y, Hirai H, Alexander WS, Shimano H, Sone H. Altered microbiota by a high-fat diet accelerates lethal myeloid hematopoiesis associated with systemic SOCS3 deficiency. iScience 2021; 24:103117. [PMID: 34611611 PMCID: PMC8476681 DOI: 10.1016/j.isci.2021.103117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022] Open
Abstract
The suppressors of cytokine signaling (SOCS) proteins are negative regulators of cytokine signaling required to prevent excessive cellular responses. In particular, SOCS3 is involved in the regulation of metabolic syndromes, such as obesity and diabetes, by suppressing leptin and insulin signals. SOCS3 also suppresses the inflammatory response associated with metabolic stress, but this specific role remains undefined. Wild-type mice on a high-fat diet (HFD) exhibited only fatty liver, whereas systemic deletion of SOCS3 resulted in excessive myeloid hematopoiesis and hepatic inflammation. In addition, depletion of the gut microbiota resulted in considerable improvement in excess granulopoiesis and splenomegaly, halting the progression of systemic inflammation in SOCS3KO mice on the HFD. This result suggests that intestinal dysbiosis is involved in inflammation associated with SOCS3KO. Although contributing to diet-induced obesity and fatty liver, SOCS3 is nevertheless critical to suppress excess myeloid hematopoiesis and severe systemic inflammation associated with intestinal dysbiosis on HFD. SOCS3 suppresses severe systemic inflammation associated with high-fat diet SOCS3 deficiency on high-fat diet accelerates excess myeloid hematopoiesis SOCS3 controls gut dysbiosis on high-fat diet
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Affiliation(s)
- Kaori Cho
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
| | - Takashi Ushiki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan.,Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, Niigata 951-8520, Japan
| | - Hajime Ishiguro
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
| | - Suguru Tamura
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
| | - Masaya Araki
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
| | - Takayuki Katagiri
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
| | - Mari Watanabe
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, Niigata 951-8520, Japan
| | - Yoko Fujimoto
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, Niigata 951-8520, Japan
| | - Riuko Ohashi
- Histopathology Core Facility, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan.,Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Yoichi Ajioka
- Histopathology Core Facility, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan.,Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Ippei Shimizu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shujiro Okuda
- Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Masayoshi Masuko
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
| | - Yoshimi Nakagawa
- Division of Complex Biosystem Research, Department of Research and Development, Institute of Natural Medicine, University of Toyama, Toyama, Toyama 930-0194, Japan
| | - Hideyo Hirai
- Department of Clinical Laboratory Medicine, Kyoto University Hospital, Kyoto, Kyoto 606-8507, Japan.,Laboratory of Stem Cell Regulation, School of Life Sciences, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan
| | - Warren S Alexander
- Blood Cells and Blood Cancer Division, the Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia.,Department of Medical Biology, the University of Melbourne, Parkville, VIC 3052, Australia
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata 951-8510, Japan
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65
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Nishio S, Tsuchiya K, Nakatani S, Muto S, Mochizuki T, Kawano H, Hanaoka K, Hidaka S, Ichikawa D, Ishikawa E, Uchiyama K, Koshi-Ito E, Hayashi H, Makabe S, Ogata S, Mitobe M, Sekine A, Suwabe T, Kataoka H, Kai H, Kaneko Y, Kurashige M, Seta K, Shimazu K, Hama T, Miura K, Nakanishi K, Horie S, Furuichi K, Okada H, Narita I. A digest from evidence-based Clinical Practice Guideline for Polycystic Kidney Disease 2020. Clin Exp Nephrol 2021; 25:1292-1302. [PMID: 34564792 DOI: 10.1007/s10157-021-02097-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoru Muto
- Departments of Urology and Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Toshio Mochizuki
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Haruna Kawano
- Departments of Urology and Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, The Jikei University, Tokyo, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Daisuke Ichikawa
- Department of Nephrology and Hypertension, St Marianna University School of Medicine, Kanagawa, Japan
| | - Eiji Ishikawa
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital, Mie, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Eri Koshi-Ito
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Shiho Makabe
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Soshiro Ogata
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Michihiro Mitobe
- Department of Nephrology, Takeda General Hospital, Fukushima, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Hiroshi Kataoka
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirayasu Kai
- Pathophysiology of Renal Diseases, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Yoshikatsu Kaneko
- Niigata University, Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
| | - Mahiro Kurashige
- Nephrology & Hypertension, Department of Internal Medicine, The Jikei University, Tokyo, Japan
| | - Koichi Seta
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Keiji Shimazu
- Department of Nephrology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Taketsugu Hama
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shigeo Horie
- Departments of Urology and Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University, Ishikawa, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan.
| | - Ichiei Narita
- Niigata University, Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
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66
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Hatano M, Kitajima I, Nakamura M, Isawa K, Suwabe T, Hoshino J, Kinowaki K, Ohashi K, Sawa N, Yamamoto S, Ubara Y. Long-Term Use of Glucocorticoid Exacerbates Bone Lesions in Postmenopausal Women With Rheumatoid Arthritis. Mod Rheumatol Case Rep 2021; 6:14-18. [PMID: 34561701 DOI: 10.1093/mrcr/rxab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/17/2021] [Accepted: 08/22/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Glucocorticoid-induced osteoporosis is osteoporosis arising due to long-term use of glucocorticoids. Current despite decades of intense research, the effects of long-term use of glucocorticoids in humans on bone cells and bone structural changes remain unclear. METHODS We performed postmortem histomorphometric analysis of bone from two female patients with rheumatoid arthritis aged 64y and 85y. Our two patients had been treated with glucocorticoids for 19 years and 14 years, respectively. RESULTS In case 1, all markers of cancellous bone volume were markedly decreased compared with the age-matched reference range. Connectivity of cancellous bone trabecula was absent. Only a few island bones were noted. There was prominent thinning of the cortical bone, and extension of the bone marrow cavity into the cortical bone with prominent cortical porosis. Cortical nodes between the endocortical surface and the trabecula disappeared due to endocortical resorption. Stoppage of lamellar structure was observed because the bone resorption by osteoclasts surpassed bone formation by osteoblasts. Empty lacunae characterized by disappearance of osteocytes were visible. In case 2, all volume markers of cancellous bone were decreased to the same extent as case 1. However, cortical porosis was more prominent than case 1. CONCLUSION These two cases suggest that use of glucocorticoid therapy > 10 y can induce severe osteoporosis in elderly RA women with higher disease activity, and that the disappearance of cancellous bone is the common characteristic. The 85 year-old woman was characterized by cortical porosis.
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Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kazuya Isawa
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.,Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Seizo Yamamoto
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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67
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Hatano M, Kitajima I, Nakamura M, Isawa K, Suwabe T, Hoshino J, Sawa N, Yamamoto S, Ubara Y. Vitamin D-resistant osteomalacia after 10 years of hemodialysis in a patient with rheumatoid arthritis. Rheumatology (Oxford) 2021; 61:e8-e10. [PMID: 34427629 PMCID: PMC8742822 DOI: 10.1093/rheumatology/keab660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kazuya Isawa
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Seizo Yamamoto
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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68
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Hatano M, Kitajima I, Yamamoto S, Nakamura M, Isawa K, Suwabe T, Hoshino J, Sawa N, Ubara Y. Clinical Images: Injury to the articular cartilage affects growth of subchondral bone in a patient with osteoarthritis. ACR Open Rheumatol 2021; 3:817-819. [PMID: 34423925 PMCID: PMC8672183 DOI: 10.1002/acr2.11333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
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69
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Hatano M, Kitajima I, Yamamoto S, Nakamura M, Isawa K, Suwabe T, Hoshino J, Sawa N, Ubara Y. Dialysis-related carpal tunnel syndrome in the past 40 years. Clin Exp Nephrol 2021; 26:68-74. [PMID: 34415463 PMCID: PMC8739450 DOI: 10.1007/s10157-021-02122-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
Purpose and method Patients on hemodialysis develop carpal tunnel syndrome (CTS) due to an accumulation of dialysis-related β2 microglobulin (β2m) amyloid (DRA). In Japan, dialysis technology has progressed remarkably in the past 40 years and has increased the time until patients require surgery for CTS. However, unclear is whether the time from the start of hemodialysis to the first surgery for CTS is associated with β2m clearance by the different hemodialysis techniques. Therefore, we retrospectively evaluated β2m clearance, serum β2m levels, and the change in the length of this period in patients across 4 periods according to the year that first surgery for CTS was performed: period 1, 1982–1989; period 2, 1990–1999; period 3, 2000–2009; and period 4, 2010–2019. Result A total of 222 patients who met the selection criteria were included. Mean β2m clearance was −1.8 ± 16.7% in period 1, and improved to 65.4 ± 8.6% in period 3. Accordingly, the serum β2m value after hemodialysis decreased significantly. The time from the start of hemodialysis to the first surgery for CTS was 12.4 ± 2.9 years in period 1 but increased to 21.8 ± 6.3 years in period 3. In multivariable linear regression analysis, the significant factors contributing to β2m clearance were periods 2, 3, and 4. In particular, the relation between removal of β2m and the extension of the dialysis vintage in period 1 and 2 was remarkable compared with periods 3 and 4. Conclusion Our findings indicate that improvement of β2m clearance via advances in dialysis technology might result in a significant extension in the time between starting HD and the first surgery for CTS.
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Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Seizo Yamamoto
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Kazuya Isawa
- Department of Orthopaedic Surgery, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Minato City, Tokyo, Japan.
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70
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Yamanouchi M, Furuichi K, Hoshino J, Toyama T, Shimizu M, Yamamura Y, Oshima M, Kitajima S, Hara A, Iwata Y, Sakai N, Oba Y, Matsuoka S, Ikuma D, Mizuno H, Suwabe T, Sawa N, Yuzawa Y, Kitamura H, Suzuki Y, Sato H, Uesugi N, Ueda Y, Nishi S, Yokoyama H, Nishino T, Samejima K, Kohagura K, Shibagaki Y, Makino H, Matsuo S, Ubara Y, Wada T. Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death: a nationwide cohort study of biopsy-proven diabetic kidney disease. BMJ Open Diabetes Res Care 2021; 9:9/1/e002241. [PMID: 34385147 PMCID: PMC8362707 DOI: 10.1136/bmjdrc-2021-002241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Data on the association between longitudinal trajectory patterns of albuminuria and subsequent end-stage kidney disease (ESKD) and all-cause mortality in diabetic kidney disease (DKD) are sparse. RESEARCH DESIGN AND METHODS Drawing on nationally representative data of 329 patients with biopsy-proven DKD and an estimated glomerular filtration rate above 30 mL/min/1.73 m2 at the time of biopsy, we used joint latent class mixed models to identify different 2-year trajectory patterns of urine albumin to creatinine ratio (UACR) and assessed subsequent rates of competing events: ESKD and all-cause death. RESULTS A total of three trajectory groups of UACR were identified: 'high-increasing' group (n=254; 77.2%), 'high-decreasing' group (n=24; 7.3%), and 'low-stable' group (n=51; 15.5%). The 'low-stable' group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): 'low-stable', 109 (50-138); 'high-decreasing', 906 (468-1740); 'high-increasing', 1380 (654-2502)), and had the least subsequent risk of ESKD and all-cause death among the groups. Although there were no differences in baseline characteristics between the 'high-decreasing' group and the 'high-increasing' group, the 'high-decreasing' group had better control over blood pressure, blood glucose, and total cholesterol levels during the first 2 years of follow-up, and the incidence rates of subsequent ESKD and all-cause death were lower in the 'high-decreasing' group compared with the 'high-increasing' group (incidence rate of ESKD (per 1000 person-years): 32.7 vs 77.4, p=0.014; incidence rate of all-cause death (per 1000 person-years): 0.0 vs 25.4, p=0.007). CONCLUSIONS Dynamic changes in albuminuria are associated with subsequent ESKD and all-cause mortality in DKD. Reduction in albuminuria by improving risk profile may decrease the risk of ESKD and all-cause death.
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Affiliation(s)
- Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yuta Yamamura
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Akinori Hara
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yasunori Iwata
- Division of Infection Control, Kanazawa University, Ishikawa, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Kitamura
- Department of Pathology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Yoshiki Suzuki
- Health Administration Center, Niigata University, Niigata, Japan
| | | | - Noriko Uesugi
- Department of Pathology, Fukuoka University, Fukuoka, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine School of Medicine, Hyogo, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Kentaro Kohagura
- Dialysis Unit, University of the Ryukyus School of Medicine, Okinawa, Japan
| | - Yugo Shibagaki
- Division of Nephrology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | | | | | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
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Suwabe T, Fuse K, Katsura K, Soga M, Katagiri T, Shibasaki Y, Narita M, Sone H, Masuko M. Intensive oral care can reduce bloodstream infection with coagulase-negative staphylococci after neutrophil engraftment in allogeneic hematopoietic stem-cell transplantation. Support Care Cancer 2021; 30:475-485. [PMID: 34313857 DOI: 10.1007/s00520-021-06447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Bloodstream infection (BSI) is a major complication of allogeneic hematopoietic stem-cell transplantation (allo-SCT). There are several causes of BSI; in particular, severe oral mucositis (OM) can induce BSI due to coagulase-negative staphylococci (CoNS). The OM severity may be reduced with intensive oral care. Thus, we evaluated whether the type of oral care affects the BSI incidence eventually. METHOD We performed retrospective analysis on 206 recipients who underwent allo-SCT from 2006 to 2017 at our institute. Intensive oral care by a dental specialist was performed for 111 recipients (intensive-care group) and self-oral care was performed by 95 recipients (self-care group). Incidence of BSI was assessed by type of the oral care, before neutrophil engraftment (pre-E-BSI) and after neutrophil engraftment (post-E-BSI) period until 180 days after allo-SCT. RESULT A total of 112 BSI occurred in 90 of the 206 recipients and 120 bacteria were identified, with CoNS being the most prevalent. There was no significant difference in the incidence of pre-E-BSI between the self-care and intensive-care groups (30.8% and 30.6%, respectively; P = 0.508). Meanwhile, the incidence of post-E-BSI was significantly lower in the intensive-care group than in the self-care group (14.3% and 28.6%; P = 0.008). In addition, the intensive-care group had significantly lower incidence of post-E-BSI with CoNS than the self-care group (8.5% and 21.5%, respectively; P = 0.009). CONCLUSION Intensive oral care through the period of allo-HCT can significantly reduce the post-E-BSI occurrence, especially due to CoNS.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
| | - Kyoko Fuse
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan.
| | - Kouji Katsura
- Department of Oral Radiology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
| | - Marie Soga
- Department of Oral Radiology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
| | - Takayuki Katagiri
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
| | - Yasuhiko Shibasaki
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
| | - Miwako Narita
- Laboratory of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuo-ku, Niigata, 951-8518, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
| | - Masayoshi Masuko
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuoh-ku, Niigata, 951-8510, Japan
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72
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Yamanouchi M, Furuichi K, Shimizu M, Toyama T, Yamamura Y, Oshima M, Kitajima S, Hara A, Iwata Y, Sakai N, Oba Y, Matsuoka S, Ikuma D, Mizuno H, Suwabe T, Hoshino J, Sawa N, Yuzawa Y, Kitamura H, Suzuki Y, Sato H, Uesugi N, Ueda Y, Nishi S, Yokoyama H, Nishino T, Samejima K, Kohagura K, Shibagaki Y, Makino H, Matsuo S, Ubara Y, Wada T. Serum hemoglobin concentration, as a reflection of renal fibrosis, and risk of renal decline in early-stages of diabetic kidney disease: a nationwide, biopsy-based cohort study. Nephrol Dial Transplant 2021; 37:489-497. [PMID: 34028524 DOI: 10.1093/ndt/gfab185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prognosticating disease progression in patients with diabetic kidney disease (DKD) is challenging, especially in the early stages of kidney disease. Anemia can occur in the early stages of kidney disease in diabetes. We therefore postulated that serum hemoglobin concentration, as a reflection of incipient renal tubulointerstitial impairment, can be used as a marker to predict DKD progression. METHODS Drawing on nationally representative data of patients with biopsy-proven DKD, 246 patients who had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 at renal biopsy were identified: aged 56 (45, 63); 62.6% men; Hb 13.3 (12.0, 14.5) g/dL; eGFR 76.2 (66.6, 88.6) mL/min/1.73 m2; urine albumin-to-creatinine ratio [UACR] 534 (100, 1480) mg/g Crea. Serum hemoglobin concentration were divided into quartiles: ≤12, 12.1-13.3, 13.4-14.5, and ≥14.6 g/dL. The association between serum hemoglobin concentration and the severity of renal pathological lesions was explored. A multivariable Cox regression model was used to estimate the risk of DKD progression (new onset of end-stage kidney disease, 50% reduction of eGFR, or doubling of serum creatinine). The incremental prognostic value of DKD progression by adding serum hemoglobin concentration to the known risk factors of DKD was assessed. RESULTS Serum hemoglobin levels negatively correlated with all renal pathological features, especially with the severity of interstitial fibrosis (ρ =-0.52; P < 0.001). During a median follow-up of 4.1 years, 95 developed DKD progression. Adjusting for known risk factors of DKD progression, the hazard ratio in the first, second, and third quartile (the fourth quartile as a reference) were 2.74 (95% CI 1.26-5.97), 2.33 (95% CI 1.07-5.75), and 1.46 (95% CI 0.71-3.64), respectively. Addition of the serum hemoglobin concentration to the known risk factors of DKD progression improved the prognostic value of DKD progression (the global chi-statistics increased from 55.1 to 60.8; P < 0.001). CONCLUSIONS Serum hemoglobin concentration, which reflects incipient renal fibrosis, can be useful for predicting DKD progression in the early stages of kidney disease.
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Affiliation(s)
- Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yuta Yamamura
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Akinori Hara
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan.,Division of Infection Control, Kanazawa University, Ishikawa, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Kitamura
- Department of Pathology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Yoshiki Suzuki
- Health Administration Center, Niigata University, Niigata, Japan
| | - Hiroshi Sato
- Department of Internal Medicine, JR Sendai Hospital, Miyagi, Japan
| | - Noriko Uesugi
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Kentaro Kohagura
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, Okinawa, Japan
| | - Yugo Shibagaki
- Division of Nephrology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Seiichi Matsuo
- Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
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Koga-Kobori S, Sawa N, Kido R, Sekine A, Mizuno H, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Kinowaki K, Ohashi K, Fujii T, Ubara Y. Fabry Disease on Peritoneal Dialysis with Cardiac Involvement. Intern Med 2021; 60:1561-1565. [PMID: 33361676 PMCID: PMC8188038 DOI: 10.2169/internalmedicine.5992-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from a lack of alpha-galactosidase A (AGALA) activity in lysosomes. We herein report a patient with FD revealed by a renal biopsy who survived seven years after the introduction of peritoneal dialysis despite having severe heart failure due to left ventricular hypertrophy (LVH). FD was diagnosed based on a renal biopsy and biochemical analysis showing a low enzymatic activity of AGALA. A microscopic examination at the autopsy revealed marked hypertrophy and vacuolation of cardiac muscle cells. In our case, cardiac involvement determined the prognosis. Peritoneal dialysis is the modality of choice in the long-term management of dialysis patients with FD.
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Affiliation(s)
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Japan
- Okinaka Memorial Institute, Toranomon Hospital, Japan
| | - Ryo Kido
- Nephrology Center, Toranomon Hospital, Japan
| | | | | | | | | | | | | | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Pathology, Yokohama City University Hospital Graduate School of Medicine, Japan
| | - Takeshi Fujii
- Okinaka Memorial Institute, Toranomon Hospital, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Japan
- Okinaka Memorial Institute, Toranomon Hospital, Japan
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74
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Uchiyama K, Mochizuki T, Shimada Y, Nishio S, Kataoka H, Mitobe M, Tsuchiya K, Hanaoka K, Ubara Y, Suwabe T, Sekine A, Nutahara K, Tsuruya K, Ishimura E, Nakatani S, Sofue T, Tanaka S, Narita I, Maruyama S, Horie S, Muto S. Factors predicting decline in renal function and kidney volume growth in autosomal dominant polycystic kidney disease: a prospective cohort study (Japanese Polycystic Kidney Disease registry: J-PKD). Clin Exp Nephrol 2021; 25:970-980. [PMID: 33928479 DOI: 10.1007/s10157-021-02068-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/22/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Factors affecting decline in renal function and cyst growth in patients with autosomal polycystic kidney disease (ADPKD) are not fully described, particularly in Japan. METHODS This was the first multi-facility, prospective, observational cohort study conducted in ADPKD patients at 14 centers in Japan. Patients in the J-PKD registry were assessed from December 2009 to June 2012 (follow-up until June 2017). Patients' data including estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) were assessed initially and a maximum of five times annually. Contributing factors to eGFR decline and TKV growth were identified using multiple linear regression analysis. RESULTS Of the 340 patients in the J-PKD registry, data analysis was performed for 192 patients in whom serial changes for both eGFR and TKV were obtained. eGFR slope, eGFR change, and TKV change values were as follows: - 2.7 (- 4.2 to - 1.5) (ml/min/1.73 m2/year), - 5.0 (- 9.6 to - 2.3) (%/year), and 4.78 (0.86-8.22) (%/year), respectively. Lower high-density lipoprotein (HDL) cholesterol was an independent predictor of eGFR decline, using both eGFR slope and change (P = 0.04, P = 0.02, respectively), whereas lower hemoglobin and higher uric acid were significantly associated with greater eGFR change only (P = 0.02, P = 0.002, respectively). Younger age and higher fasting blood sugar were independent predictors of greater TKV change (P = 0.01, P = 0.02, respectively). CONCLUSIONS This real-world study in Japan identified risk factors for renal function decline in ADPKD patients. These included lower HDL cholesterol, lower hemoglobin and higher uric acid for eGFR decline, and youth and higher blood sugar levels for TKV growth.
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Affiliation(s)
- Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Mochizuki
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Shimada
- Intelligent Systems Laboratory, SECOM CO., LTD., Mitaka, Tokyo, Japan.,Department of Medical Electronic Intelligence Management, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
| | - Saori Nishio
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Hiroshi Kataoka
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michihiro Mitobe
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Woman's Medical University, Tokyo, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | | | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Kikuo Nutahara
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Eiji Ishimura
- Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - Satoshi Tanaka
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Horie
- Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan.,Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Satoru Muto
- Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan. .,Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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75
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Hatano M, Kitajima I, Yamamoto S, Nakamura M, Isawa K, Hirota Y, Suwabe T, Hoshino J, Sawa N, Ubara Y. New bone-like tissue formation in calcific tendinopathy: A case report. Bone Rep 2021; 14:101062. [PMID: 33898660 DOI: 10.1016/j.bonr.2021.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022] Open
Abstract
Currently, the pathogenesis of nontraumatic heterotopic ossification (HO), e.g., bone-like tissue in calcific tendinopathy remains unclear. Here, we report a 75-year-old, right-handed Japanese woman who had been on hemodialysis for 3 years and was admitted to our hospital to evaluate pain and swelling of the right forearm. She worked as a cook, and her main job over the 3 most recent years had been the frequent and continuous shredding of cabbage. A radiograph showed the highly radiopaque material on the dorsal aspect of the right wrist and in the right shoulder. The biopsy of this radiopaque material revealed HO with marrow, as well as calcified material. Histomorphometric analysis of the HO identified a severe type of osteitis fibrosa with a fibrous tissue volume to total volume of 19.8% (>0.5% required for diagnosis) and an osteoid volume to bone volume of 20.0% (>15% required for diagnosis). We found more woven bone-like tissue than lamellar bone-like tissue. However, the intact parathyroid hormone level was 3-times the normal upper limit with 203 pg/mL, but histomorphometric analysis of the right iliac crest revealed normal bone structure. These findings indicate that the frequent and continuous shredding action with the right hand contributed to the nontraumatic HO localized on the dorsal aspect of the right wrist.
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Key Words
- ALP, alkaline phosphatase
- BAP, bone alkaline phosphatase
- BFR/BV, bone formation rate per unit of bone volume
- BMPs, bone morphogenetic proteins
- BV/TV, trabecular bone volume to total volume
- Bone histomorphometry
- CKD-MBD, chronic kidney disease-mineral and bone disorder
- Calcific tendinopathy
- ES/BS, eroded surface to bone surface
- Fb.V/TV, fibrous tissue volume to total volume
- HO, heterotopic ossification
- Heterotopic ossification
- N.Oc/BS, number of osteoclasts to bone surface
- New bone-like tissue formation
- O.Th, osteoid thickness
- OS/BS, osteoid surface to bone surface
- OV/BV, osteoid volume to bone volume
- OV/TV, osteoid volume to tissue volume
- Ob.S/BS, osteoblasts surface to bone surface
- PTH, parathyroid hormone
- Tb.Th, trabecular thickness
- W.Th, trabecular unit wall thickness
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Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Seizo Yamamoto
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kazuya Isawa
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Hirota
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshihumi Ubara
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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76
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Mitobe M, Kawamoto K, Suzuki T, Suwabe T, Shibasaki Y, Masuko M, Inoue K, Miyoshi H, Ohshima K, Sone H, Takizawa J. DA-EPOCH-R therapy for high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements in a patient with renal dysfunction. J Clin Exp Hematop 2021; 61:42-47. [PMID: 33551436 PMCID: PMC8053571 DOI: 10.3960/jslrt.20043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, also known as double-hit lymphoma, has been reported as refractory to R-CHOP therapy and requires more intensive regimens. However, intensive and safe regimens for patients with renal dysfunction are unknown. Herein, we report the successful use of DA-EPOCH-R therapy for double-hit lymphoma in a 64-year-old man with renal dysfunction. The patient had lymphoma-induced bilateral ureteral obstruction. Although renal dysfunction remained after removing the obstruction using R-CHOP therapy, we completed six cycles of DA-EPOCH-R therapy without any major adverse events. DA-EPOCH-R therapy may be a safe regimen for renal dysfunction patients.
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Affiliation(s)
- Masaki Mitobe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Keisuke Kawamoto
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Takaharu Suzuki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Yasuhiko Shibasaki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Masayoshi Masuko
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Kanako Inoue
- Department of Pathology, School of Medicine, Kurume University, Kurume, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, School of Medicine, Kurume University, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, Kurume, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
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77
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Suwabe T, Oguro M, Ubara Y, Ikuma D, Mizuno H, Hayami N, Yamanouchi M, Sawa N. Repetitive Refractory Renal Cyst Infection in Autosomal Dominant Polycystic Kidney Disease for which Renal Transcatheter Arterial Embolization Was Effective in Preventing Recurrence. Intern Med 2021; 60:3261-3265. [PMID: 34657906 PMCID: PMC8580762 DOI: 10.2169/internalmedicine.6974-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Renal cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat and can be fatal. While nephrectomy is the standard therapy for severe refractory renal cyst infection, it can be associated with severe adverse events. We experienced a case of repetitive renal cyst infection in a 58-year-old Japanese man with ADPKD on dialysis. He underwent renal transcatheter arterial embolization (TAE) four months after the last episodes of renal cyst infection, and his renal cyst infection has not recurred since renal TAE. This case suggested that renal TAE is effective for preventing repetitive renal cyst infection.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masahiko Oguro
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Noriko Hayami
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | | | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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78
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Terakawa K, Sawa N, Mizuno H, Sekine A, Hayami N, Ikuma D, Kawada M, Hiramatsu R, Sumida K, Yamanouchi M, Hasegawa E, Suwabe T, Hoshino J, Kinowaki K, Ohashi K, Fujii T, Ubara Y. Renal Squamous Cell Carcinoma-related Polymyositis in a Patient with Autosomal Dominant Polycystic Kidney Disease. Intern Med 2021; 60:1237-1242. [PMID: 33853995 PMCID: PMC8112967 DOI: 10.2169/internalmedicine.5375-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 74-year-old Japanese woman diagnosed with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our institute for the further examination of right-side groin pain developing in the past week. The patient was diagnosed with polymyositis (PM). Diagnostic imaging showed a mass lesion measuring 8 cm and a renal stone in the right kidney. Immediately following surgical resection of the right kidney, the patient's serum CK decreased to the normal range. A histopathological analysis showed well-differentiated squamous cell carcinoma. In conclusion, this case showed a close relationship between the occurrence of squamous cell carcinoma and the development of PM in an ADPKD patient.
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Affiliation(s)
- Kanako Terakawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Noriko Hayami
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Masahiro Kawada
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Rikako Hiramatsu
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Keiichi Sumida
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | | | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Pathology, Yokohama City University Hospital Graduate School of Medicine, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
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79
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Sawamura M, Sawa N, Fujiwara H, Yamanouchi M, Hayami N, Sekine A, Mizuno H, Hasegawa E, Suwabe T, Hoshino J, Kinowaki K, Fujii T, Ubara Y. Abatacept Improves Intractable Protein-Losing Enteropathy Secondary to AA Amyloidosis in a Patient With Rheumatoid Arthritis. Mayo Clin Proc Innov Qual Outcomes 2020; 4:815-820. [PMID: 33367218 PMCID: PMC7749240 DOI: 10.1016/j.mayocpiqo.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 71-year-old Japanese woman with a history of rheumatoid arthritis of 50 years’ duration was admitted to our hospital with refractory diarrhea. Endoscopic biopsy revealed AA amyloid deposition in the large intestine. Although the patient had been prescribed 5 tumor necrosis factor inhibitors over the past 10 years, rheumatoid arthritis was poorly controlled, with a Disease Activity Score 28 using C-reactive protein score of 6.52 on admission. Treatment with tocilizumab (8 mg/kg every 2 weeks) was initiated, but this was ineffective. After 3 months, abatacept (cytotoxic T-lymphocyte–associated antigen 4 immunoglobulin) was initiated (750 mg/mo) and the patient’s diarrhea began to improve. After 3 months of abatacept treatment, serum albumin, C-reactive protein, and serum amyloid A levels had all decreased to within normal ranges. After 3 years of abatacept treatment, a repeat biopsy of the large intestine revealed a marked improvement in amyloid deposition. Interleukin 6 is a key factor in AA amyloid formation, but this case suggests that T-cell activation increases the production of cytokines (including interleukin 6) via a mechanism involving cytotoxic T-lymphocyte–associated antigen 4, resulting in a second key factor of AA amyloid formation.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Hideomi Fujiwara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Noriko Hayami
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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80
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Suwabe T, Chamberlain AM, Killian JM, King BF, Gregory AV, Madsen CD, Wang X, Kline TL, Chebib FT, Hogan MC, Kamath PS, Harris PC, Torres VE. Epidemiology of autosomal-dominant polycystic liver disease in Olmsted county. JHEP Rep 2020; 2:100166. [PMID: 33145487 PMCID: PMC7593615 DOI: 10.1016/j.jhepr.2020.100166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background & Aims Isolated autosomal-dominant polycystic liver disease (ADPLD) is generally considered a rare disease. However, the frequency of truncating mutations to ADPLD genes in large, population sequencing databases is 1:496. With the increasing use of abdominal imaging, incidental detection of hepatic cysts and ADPLD has become more frequent. The present study was performed to ascertain the incidence and point prevalence of ADPLD in Olmsted County, MN, USA, and how these are impacted by the increasing utilisation of abdominal imaging. Methods The Rochester Epidemiology Project and radiology databases of Mayo Clinic and Olmsted Medical Center were searched to identify all subjects meeting diagnostic criteria for definite, likely, or possible ADPLD. Annual incidence rates were calculated using incident cases during 1980–2016 as numerator, and age- and sex-specific estimates of the population of Olmsted County as denominator. Point prevalence was calculated using prevalence cases as numerator, and age- and sex-specific estimates of the population of Olmsted County on 1 January 2010 as denominator. Results The incidence rate and point prevalence of combined definite and likely ADPLD were 1.01 per 100,000 person-years and 9.5 per 100,000 population, respectively. Only 15 of 35 definite and likely incident ADPLD cases had received a diagnostic code, and only 8 had clinically significant hepatomegaly. The incidence rates were much higher when adding possible cases, mainly identified through radiology databases, particularly in recent years and in older patients because of the increased utilisation of imaging studies. Conclusions Clinically significant isolated ADPLD is a rare disease with a prevalence <1:10,000 population. The overall prevalence of ADPLD, however, to a large extent not clinically significant, is likely much higher and closer to the reported genetic prevalence. Lay summary Isolated autosomal-dominant polycystic liver disease (ADPLD) is generally considered a rare disease. However, we demonstrate that it is a relatively common disease, which is rarely (<1:10,000 population) clinically significant. Isolated autosomal-dominant polycystic liver disease (ADPLD) is generally considered a rare disease. Truncating mutations to ADPLD genes are fairly common (1:496) in large, population sequencing databases. We identified 35 individuals meeting diagnostic criteria for definite or likely ADPLD and 99 additional patients with possible ADPLD. The point prevalence of definite or likely ADPLD on 01/01/2010 was 9.5/100,000 or 36.0/100,000 population if adding possible cases. Clinically significant isolated ADPLD is rare (<1:10,000 population), but the overall prevalence is likely much higher.
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Affiliation(s)
- Tatsuya Suwabe
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Bernard F King
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adriana V Gregory
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Charles D Madsen
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Xiaofang Wang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Fouad T Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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81
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Sawamura M, Sawa N, Yamanouchi M, Ikuma D, Sekine A, Mizuno H, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Nagashima Y, Ubara Y. Renal epithelial and stromal tumor with a multiple cystic lesion localized in the upper portion of the right kidney. CEN Case Rep 2020; 10:230-235. [PMID: 33145653 PMCID: PMC8019406 DOI: 10.1007/s13730-020-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022] Open
Abstract
A 60-year-old Japanese woman was admitted because of the polycystic mass with right flank pain localized in the upper portion of the right kidney. Right nephrectomy was performed because the mass lesion had continuously increased in size over the past 10 years. A surgical specimen showed histology consistent with a mixed epithelial and stromal tumor, which is closely related to multilocular cystic nephroma, and was diagnosed by a defined capsule between the cystic mass lesion and normal renal tissue by CT and MRI, and histology. Localized renal cystic disease that does not have a capsule was excluded from differential diagnosis.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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82
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Iijima T, Mori T, Sohara E, Suwabe T, Hoshino J, Ubara Y. A patient with congenital nephrogenic diabetes insipidus due to AVPR2 mutation complicated by persisting polydipsia under hemodialysis treatment. CEN Case Rep 2020; 10:226-229. [PMID: 33125666 DOI: 10.1007/s13730-020-00549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022] Open
Abstract
A 17-year-old boy was referred to our institution for a re-evaluation of congenital nephrogenic diabetes insipidus. A water restriction test revealed no urine concentration or volume reduction and a subsequent pitressin test revealed a lack of an anti-diuretic response. Nephrogenic diabetes insipidus was confirmed, and the patient was treated using trichlormethiazide 4 mg, indomethacin 175 mg, and desmopressin 20 μg. His blood pressure and weight were not controlled owing to polydipsia and polyuria secondary to acquired excessive water drinking behavior. Repeated admissions for weight control were necessary and despite consultation with a psychiatrist for his obsessive water drinking behavior, he had end-stage renal failure after 30 years of treatment. Genetic testing revealed AVPR2 mutation (c. T866C: p. L289P) that had previously been reported as a pathogenic mutation. His excessive drinking behavior persisted, leading to hyponatremia even after initiation of hemodialysis. There was also difficulty in achieving body weight control, which was managed by repeated admissions with restriction of water intake, being the mainstay of management.
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Affiliation(s)
- Takashi Iijima
- Department of Nephrology, Nephrology Center, Toranomon Hospital Kajigaya, Kajigaya 1-3-1, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Nephrology Center, Toranomon Hospital Kajigaya, Kajigaya 1-3-1, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan
| | - Junichi Hoshino
- Department of Nephrology, Nephrology Center, Toranomon Hospital Kajigaya, Kajigaya 1-3-1, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Nephrology Center, Toranomon Hospital Kajigaya, Kajigaya 1-3-1, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan
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83
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Sekine A, Hoshino J, Fujimaru T, Suwabe T, Mizuno H, Kawada M, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Mandai S, Chiga M, Kikuchi H, Ando F, Mori T, Sohara E, Uchida S, Sawa N, Takaichi K, Ubara Y. Genetics May Predict Effectiveness of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease. Am J Nephrol 2020; 51:745-751. [PMID: 32784291 DOI: 10.1159/000509817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/25/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Tolvaptan is the only therapeutic drug for autosomal dominant polycystic kidney disease (ADPKD). The influence of mutations in polycystic kidney disease 1 and 2 genes (PKD1 and PKD2) on the treatment effects of tolvaptan is not well documented in the literature. METHODS We retrospectively evaluated the relationship between genotype and the efficacy of tolvaptan in 18 patients with ADPKD who had been treated at Toranomon Hospital and undergone genetic testing between April 2016 and February 2020. RESULTS The annual change in estimated glomerular filtration rate (ΔeGFR/y) from before to after tolvaptan was from a median of -5.5 to -2.5 mL/min/1.73 m2 in the PKD1 truncating group, -3.3 to -2.4 mL/min/1.73 m2 in the PKD1 non-truncating group, -3.1 to -1.6 mL/min/1.73 m2 in the PKD2 group, and -1.9 to -2.6 mL/min/1.73 m2 in the group with no PKD1/2 mutation. The median degrees of improvement of ΔeGFR/y were 2.5 (45%), 0.4 (10%), 0.6 (28%), and -0.7 (-37%) mL/min/1.73 m2, respectively. Compared with the group of patients with any PKD1/2 mutation, the group with no PKD1/2 mutation showed significantly less improvement in ΔeGFR/y with tolvaptan (0.6 vs. -0.7 mL/min/1.73 m2, respectively; p = 0.01) and significantly less improvement in the annual rate of increase in total kidney volume (TKV) with tolvaptan (-6.7 vs. -1.1%, respectively; p = 0.02). CONCLUSION Patients with ADPKD and no PKD1/2 mutation showed less improvement in ΔeGFR/y and the annual rate of increase in TKV with tolvaptan. Detecting PKD1/2 mutations may be useful for predicting the effectiveness of tolvaptan.
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Affiliation(s)
- Akinari Sekine
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan,
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,
| | - Takuya Fujimaru
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoko Chiga
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Kikuchi
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumiaki Ando
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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84
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Suwabe T. Cyst infection in autosomal dominant polycystic kidney disease: our experience at Toranomon Hospital and future issues. Clin Exp Nephrol 2020; 24:748-761. [PMID: 32700112 PMCID: PMC7474715 DOI: 10.1007/s10157-020-01928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat and can be fatal. However, much is still unknown about cyst infection. Positron emission tomography (PET) is generally recommended for detecting infected cysts, but it has the disadvantages of limited availability, high cost, and radiation exposure. We have devised magnetic resonance imaging (MRI) diagnostic criteria for cyst infection. Lipid-soluble antibiotics such as fluoroquinolones show good penetration into cysts and are recommended for cyst infection. However, we reported that fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. We should, therefore, reconsider the empirical use of fluoroquinolones for ADPKD patients with cyst infection. We have suggested a new antibiotic strategy according to the severity of cyst infection. It may be important to consider the drug half-life in serum in addition to the drug susceptibility when selecting antibiotics Cyst drainage is necessary for some patients with refractory cyst infection; however, cyst drainage can be associated with severe adverse events. We suggest adaptation criteria for cyst drainage in patients with cyst infection in ADPKD. Most causative bacteria of cyst infection are enterobacteria, and hematogenous spread via bacterial translocation in the intestine is considered the main cause of cyst infection. Therefore, intestinal flora may be important for cyst infection. The role of the intestinal flora in cyst infection in ADPKD is unknown and should be explored in future research.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan.
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85
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Watanabe S, Sawa N, Mizuno H, Hiramatsu R, Hayami N, Yamanouchi M, Suwabe T, Hoshino J, Fujii T, Hirai T, Hasegawa T, Amizuka N, Ubara Y. Bone histomorphometric and immunohistological analysis for hyperostosis in a patient with SAPHO syndrome: A case report. Bone Rep 2020; 13:100296. [PMID: 32728600 PMCID: PMC7382311 DOI: 10.1016/j.bonr.2020.100296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/22/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022] Open
Abstract
A 56-year-old Japanese woman with a history of palmoplantar pustulosis was admitted for examination due to left femur pain. Radiography and computed tomography showed thickening of the bone on the outer portion of the left femur. Bone scintigraphy of the left femur showed intense radioactive uptake. Consequently, the patient was diagnosed with SAPHO syndrome. Bone histomorphometric analysis of the left femur showed cancellous bone with thickened cortical bone. Whilst normal bone shows cancellous bone with double labeling (normal turn over), and cortical bone with no labeling (low turn over, adynamic state), this case presented with both cancellous and cortical bone with marked double labeling (indicating high turn over), abundant osteoid and woven bone. Immunohistological analysis showed that cells lining the bone surface consisted of osteoblasts and were positive for alkaline phosphatase (ALP). Few to little of these cells were positive for tartrate-resistant acid phosphatase (TRAP)-5B, cathepsin K and matrix metallopeptidase 9 (MMP-9). These results indicate that, in this case study, excessive production of osteoblasts contributed to hyperostosis of the left femur, with abundant osteoid and woven bone. This type of bone formation in SAPHO syndrome is not lamellar bone seen in normal bone, but rather fragile and mechanically weak bone, resulting in bone pain. Doxycycline may be a therapeutic option for bone pain in this patient.
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Key Words
- ALP
- ALP, alkaline phosphatase
- ANA, antinuclear antibody
- Almoplantar pustulosis
- C3, complement component 3
- C4, complement component 4
- CCP, cyclic citrullinated peptide
- CH50, total complement
- CT, computed tomography
- Hyperostosis
- IgA, immunoglobulin A
- IgG, immunoglobulin G
- IgM, immunoglobulin M
- MMP-9, matrix metallopeptidase 9
- Osteoblasts
- PPP, palmoplantar pustulosis
- RF, rheumatoid factor
- SAPHO syndrome
- SAPHO, synovitis-acne-pustulosis-hyperostosis-osteitis
- SCCH, sternocostoclavicular hyperostosis
- TRAP-5B, tartrate-resistant acid phosphatase 5B
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Affiliation(s)
- Shun Watanabe
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | | | - Noriko Hayami
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | | | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Toshihide Hirai
- Department of Orthopaedic Surgery and Spinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tomoka Hasegawa
- Hard Tissue Developmental Biology Department Graduate School of Dental Medicine and Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Norio Amizuka
- Hard Tissue Developmental Biology Department Graduate School of Dental Medicine and Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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86
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Inui K, Sawa N, Suwabe T, Mizuno H, Yamanouchi M, Hiramatsu R, Hayami N, Hoshino J, Kinowaki K, Fujii T, Ohashi K, Ubara Y. Long term administration of tocilizumab improves renal amyloid A (AA) amyloidosis deposition in Familial Mediterranean fever. Mod Rheumatol Case Rep 2020; 4:310-311. [PMID: 33087008 DOI: 10.1080/24725625.2020.1739193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Keita Inui
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | | | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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87
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Mizuno H, Sawa N, Watanabe S, Ikuma D, Sekine A, Kawada M, Yamanouchi M, Hasegawa E, Suwabe T, Hoshino J, Takaichi K, Kinowaki K, Fujii T, Ohashi K, Nagata M, Yamaguchi Y, Ubara Y. The Clinical and Histopathological Feature of Renal Manifestation of TAFRO Syndrome. Kidney Int Rep 2020; 5:1172-1179. [PMID: 32775816 PMCID: PMC7403508 DOI: 10.1016/j.ekir.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a severe subtype of idiopathic multicentric Castleman’s disease, characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, and organomegaly. Renal complication of this disease can be life-threatening and sometimes requires hemodialysis, but it has not been elucidated in detail. Methods Case-series was designed to evaluate the renal histology of patients with TAFRO syndrome treated at our hospital. Results Seven patients were eligible to the criteria. All of them had severe diuretic-resistant anasarca and 6 of 7 had mild proteinuria (<1 g daily). On light microscopy, all patients showed glomerular endotheliopathy characterized by endothelial cell swelling and a double contour of the glomerular basement membrane with mesangiolysis or mesangial loosening. Immunofluorescent staining and electron microscopy did not detect immune deposits in any patient. Electron microscopy revealed endothelial cell swelling with diffuse expansion of the subendothelial space, loss of mesangial architecture, and loss of endothelial cell fenestrations. Treatment with glucocorticoids and molecular-targeting agents, including tocilizumab and rituximab, improved renal dysfunction and anasarca. In 4 of 7 patients with persistent thrombocytopenia, hemorrhagic events occurred despite platelet transfusion or thrombopoietin receptor antagonist therapy. Conclusion Severe diuretic-resistant anasarca with mild proteinuria and severe glomerular endotheliopathy were common characteristics of renal dysfunction due to TAFRO syndrome. In addition, endothelial changes mediated via interleukin (IL)-6 and vascular endothelial growth factor (VEGF) that lead to vascular hyperpermeability and water leakage might contribute to anasarca, because molecular-targeting therapy directed against IL-6 or VEGF improved renal dysfunction and severe endothelial damage.
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Affiliation(s)
- Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Correspondence: Hiroki Mizuno, Nephrology Center, Toranomon Hospital, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Pathology, Hospital of Yokohama City University, Yokohama, Kanagawa, Japan
| | - Michio Nagata
- Department of Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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88
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Oda Y, Sawa N, Suwabe T, Hoshino J, Ubara Y. Renal Transcatheter Arterial Embolization for ADPKD. Kidney Int Rep 2020; 5:546-549. [PMID: 32274461 PMCID: PMC7136319 DOI: 10.1016/j.ekir.2020.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yasuhiro Oda
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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89
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Kunizawa K, Hiramatsu R, Hoshino J, Mizuno H, Ozawa Y, Sekine A, Kawada M, Sumida K, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Sawa N, Ubara Y, Takaichi K. Denosumab for dialysis patients with osteoporosis: A cohort study. Sci Rep 2020; 10:2496. [PMID: 32051451 PMCID: PMC7016112 DOI: 10.1038/s41598-020-59143-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/24/2020] [Indexed: 11/22/2022] Open
Abstract
Evidence for the efficacy of denosumab in HD patients is limited. Accordingly, here we report a study on the safety and efficacy of denosumab in these patients. We prospectively followed 324 patients (121 HD and 203 non-HD patients) receiving denosumab between June 2013 and May 2018, assessing changes in bone mineral density (BMD) and bone metabolic markers, and noting side-effects. Annual changes in BMD at the lumbar spine in HD and non-HD patients from baseline were, respectively, 6.7 ± 11.1% and 7.5 ± 10.2% (p = 0.60), those at the femoral neck were 4.3 ± 7.9% and 3.1 ± 9.5% (p = 0.32), and those at the distal radius were −0.5 ± 6.4% and 0.2 ± 13.0% (p = 0.66). The prevalence of hypocalcemia (<8.5 mg/dL) was significantly higher in HD than in non-HD patients (35.6% vs 5.4%, p < 0.001). The median elapsed time between the first injection of denosumab and the occurrence of hypocalcemia was 7 days in HD patients. The decrease of serum calcium was greater in patients with higher TRACP5b, corticosteroid use, and those without CaCO3 supplementation. Our study suggests that denosumab was equally as effective in HD as non-HD patients. However, careful hypocalcemia monitoring, for at least 4 weeks, is recommended for HD patients.
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Affiliation(s)
- Kyohei Kunizawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Department of Nephrology, Kyorin University, Tokyo, Japan
| | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan. .,Nephrology Center, Toranomon Hospital, Tokyo, Japan. .,The Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
| | | | - Yuko Ozawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | | | - Noriko Hayami
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,The Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Nephrology Center, Toranomon Hospital, Tokyo, Japan.,The Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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90
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Shibasaki Y, Suwabe T, Katagiri T, Fuse K, Narita M, Sone H, Masuko M. The Glasgow prognostic score divides high-risk hematopoietic cell transplantation-specific comorbidity index patients into stratified subgroups in allogeneic hematopoietic cell transplantation. Ann Hematol 2020; 99:671-673. [PMID: 32009181 DOI: 10.1007/s00277-020-03936-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Yasuhiko Shibasaki
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata City, Japan. .,Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Japan. .,Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Japan
| | - Takayuki Katagiri
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Japan
| | - Kyoko Fuse
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Japan
| | - Miwako Narita
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Japan
| | - Masayoshi Masuko
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata City, Japan
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91
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Kawabe Matsukawa M, Suzuki Y, Ikuma D, Suwabe T, Uesaka Y, Sugimoto I. [Acyclovir encephalopathy in a peritoneal dialysis patient despite adjusting the dose of oral acyclovir: a case report]. Rinsho Shinkeigaku 2019; 59:834-839. [PMID: 31761838 DOI: 10.5692/clinicalneurol.cn-001355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report a case of acyclovir encephalopathy in a 77-year-old man who was introduced to peritoneal dialysis three years earlier. He developed herpes zoster and was treated with acyclovir (ACV) at 800 mg daily per oral. Two days later, he developed consciousness disturbance, hallucinations and asterixis. Acyclovir was stopped and continuous ambulatory peritoneal dialysis (CAPD) was switched to hemodialysis, which resulted in the resolution of his symptoms. Because the optimal dose of ACV varies among individuals depending on the bioavailability of ACV and metabolic enzyme activity, ACV encephalopathy can occur even when the acyclovir dose is modified according to the renal function of the affected patient. Because CAPD provides a poorer ACV clearance than hemodialysis, CAPD patients tend to have a higher risk of developing ACV encephalopathy and to recover more slowly. If CAPD patients develop ACV encephalopathy, a temporary change in the type of dialysis to hemodialysis should be considered.
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Affiliation(s)
| | - Yuya Suzuki
- Department of Neurology, Toranomon Hospital Kajigaya
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92
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Suwabe T, Shukoor S, Chamberlain AM, Killian JM, King BF, Edwards M, Senum SR, Madsen CD, Chebib FT, Hogan MC, Cornec-Le Gall E, Harris PC, Torres VE. Epidemiology of Autosomal Dominant Polycystic Kidney Disease in Olmsted County. Clin J Am Soc Nephrol 2019; 15:69-79. [PMID: 31791998 PMCID: PMC6946081 DOI: 10.2215/cjn.05900519] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of autosomal dominant polycystic kidney disease (ADPKD) remains controversial. Incidence rates in Olmsted County, Minnesota, during 1935-1980 were previously reported. The current work extends this study to 2016. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Rochester Epidemiology Project and radiology databases of Mayo Clinic and Olmsted Medical Center (healthcare providers for Olmsted County) were searched to identify all subjects meeting diagnostic criteria for definite, likely, and possible ADPKD. Annual incidence rates were calculated using incident cases during 1980-2016 as numerator and age- and sex-specific estimates of the population of Olmsted County as denominator. Point prevalence was calculated using prevalence cases as numerator and age- and sex-specific estimates of the population of Olmsted County on January 1, 2010 as denominator. Survival curves from the time of diagnosis were compared with expected survival of the Minnesota population. RESULTS The age- and sex-adjusted annual incidence of definite and likely ADPKD diagnosis during 1980-2016 was 3.06 (95% CI, 2.52 to 3.60) per 100,000 person-years, which is 2.2 times higher than that previously reported for 1935-1980 (1.38 per 100,000 person-years). The point prevalence of definite or likely ADPKD on January 1, 2010 was 68 (95% CI, 53.90 to 82.13) per 100,000 population. Much higher incidence rates and point prevalence were obtained when possible ADPKD cases were included. Contrary to the previous Olmsted County study, patient survival in this study was not different from that in the general population. CONCLUSIONS The point prevalence of definite and likely ADPKD observed in this study is higher than those reported in the literature, but lower than genetic prevalence based on estimates of disease expectancy or on analysis of large population-sequencing databases.
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Affiliation(s)
| | | | | | | | - Bernard F King
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; and
| | | | | | | | | | | | - Emilie Cornec-Le Gall
- Genetics, Functional Genomics and Biotechnology, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Brest, University Hospital of Brest, Brest, France
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93
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Oda Y, Yamanouchi M, Mizuno H, Hiramatsu R, Suwabe T, Hoshino J, Sawa N, Ohashi K, Fujii T, Ubara Y. Significant polar vasculosis in a patient with a 30-year history of type 2 diabetes. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190092. [PMID: 31743098 PMCID: PMC6865358 DOI: 10.1530/edm-19-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/03/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY We report the renal histology of a 66-year-old man with hypertension, cardiovascular disease, and a 30-year history of type 2 diabetes mellitus with proliferative diabetic retinopathy, diabetic neuropathy, and diabetic foot status post toe amputation. Urinary protein excretion was 1.4 g/gCr, serum creatinine level 0.86 mg/dL, estimated glomerular filtration rate 69 mL/min/1.73 m2, and HbA1c 13-15%, despite using insulin. Light microscopy showed global glomerulosclerosis in 37% of the glomeruli, but the remaining glomeruli were intact. Significant polar vasculosis was present, while arteriolar sclerosis was mild. Electron microscopy revealed a thickened glomerular basement membrane, which is compatible with the early stage of diabetic glomerulopathy. The presented case was unique because glomerular changes seen typically in diabetes were not seen in the patient, despite the long-standing history of diabetes and diabetic comorbidities, while prominent polar vasculosis was found. Polar vascular formation helps preserve the glomeruli by allowing hyperosmotic blood bypass the glomeruli; this decreases intraglomerular pressure and minimizes glomerular endothelial damage. LEARNING POINTS A 66-year-old man with a 30-year history of type 2 diabetes mellitus with poor glycemic control underwent renal biopsy, which showed scarce glomerular changes typically seen in diabetic kidney disease and instead revealed significant polar vasculosis. Past studies demonstrated that the increased small vessels around the vascular hilus in diabetic patients originated from the afferent arterioles and drained into the peritubular capillaries. Polar vascular formation may preserve glomerular function by allowing the blood flow to bypass the glomeruli and decreasing the intraglomerular pressure, which minimizes endothelial damage of the glomerular tufts.
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Affiliation(s)
- Yasuhiro Oda
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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94
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Ikuma D, Oguro M, Hoshino J, Mizuno H, Sekine A, Kawada M, Hiramatsu R, Sumida K, Hasegawa E, Hayami N, Yamanouchi M, Suwabe T, Sawa N, Takaichi K, Ubara Y. Efficacy of Secukinumab for Plaque Psoriasis in a Patient on Hemodialysis. CEN Case Rep 2019; 9:55-58. [PMID: 31654299 PMCID: PMC6990267 DOI: 10.1007/s13730-019-00426-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022] Open
Abstract
Secukinumab is effective to treat plaque psoriasis. However, the safety and efficiency of secukinumab have not been clarified in patients on hemodialysis. We report a 60-year-old Japanese woman. Plaque psoriasis was diagnosed at the age of 25 years and hemodialysis was started at the age of 39 years. Her skin lesions persisted despite use of topical agents such as maxacalcitol and betamethasone. Accordingly, administration of secukinumab was started at a dose of 150 mg. The psoriasis area and severity index (PASI) score decreased from 49.8 to 14.8 after 2 weeks and to 0 after 6 weeks, with remission being maintained after 28 months. No adverse reactions were seen. This case indicates that secukinumab may be effective for severe psoriasis in patients on hemodialysis for end-stage renal disease.
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Affiliation(s)
- Daiuske Ikuma
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan.
| | - Masahiko Oguro
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Masahiro Kawada
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Rikako Hiramatsu
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Noriko Hayami
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
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95
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Oda Y, Sawa N, Hasegawa E, Mizuno H, Kawada M, Sekine A, Hiramatsu R, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Takaichi K, Kinowaki K, Ohashi K, Fujii T, Ubara Y. PKD1-associated autosomal dominant polycystic kidney disease with glomerular cysts presenting with nephrotic syndrome caused by focal segmental glomerulosclerosis. BMC Nephrol 2019; 20:337. [PMID: 31455242 PMCID: PMC6712641 DOI: 10.1186/s12882-019-1524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) may manifest non-nephrotic range proteinuria, but is rarely complicated with nephrotic syndrome. Limited number of reports describe the histology of ADPKD with nephrotic syndrome in detail. Case presentation We encountered a 23-year-old man with polycystic kidney disease (PKD) with small kidney volume and nephrotic syndrome, which eventually progressed to end-stage renal disease. Renal histology showed typical focal segmental glomerulosclerosis and remarkable glomerular cyst formation, but did not reveal tubular cysts. PKD1 mutation was detected in him and his father, who also had PKD with small kidney volume. Conclusions In contrast to tubular cysts which develop along ADPKD progression, glomerular cysts may likely be associated with ADPKD with slower volume progression manifesting small kidney volume. Although previous investigations report that ADPKD with smaller kidney volume is attributed to slower decline in renal function, coexistence of nephrotic-range proteinuria implies complication of other glomerular diseases and needs histological evaluation since it may lead to poor renal outcome.
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Affiliation(s)
- Yasuhiro Oda
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masahiro Kawada
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Rikako Hiramatsu
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Noriko Hayami
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Keiichi Kinowaki
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.,Department of Pathology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
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96
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Fuse K, Uemura S, Tamura S, Suwabe T, Katagiri T, Tanaka T, Ushiki T, Shibasaki Y, Sato N, Yano T, Kuroha T, Hashimoto S, Furukawa T, Narita M, Sone H, Masuko M. Patient-based prediction algorithm of relapse after allo-HSCT for acute Leukemia and its usefulness in the decision-making process using a machine learning approach. Cancer Med 2019; 8:5058-5067. [PMID: 31305031 PMCID: PMC6718546 DOI: 10.1002/cam4.2401] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 12/23/2022] Open
Abstract
Although allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is a curative therapy for high‐risk acute leukemia (AL), some patients still relapse. Since patients simultaneously have many prognostic factors, difficulties are associated with the construction of a patient‐based prediction algorithm of relapse. The alternating decision tree (ADTree) is a successful classification method that combines decision trees with the predictive accuracy of boosting. It is a component of machine learning (ML) and has the capacity to simultaneously analyze multiple factors. Using ADTree, we attempted to construct a prediction model of leukemia relapse within 1 year of transplantation. With the model of training data (n = 148), prediction accuracy, the AUC of ROC, and the κ‐statistic value were 78.4%, 0.746, and 0.508, respectively. The false positive rate (FPR) of the relapse prediction was as low as 0.134. In an evaluation of the model with validation data (n = 69), prediction accuracy, AUC, and FPR of the relapse prediction were similar at 71.0%, 0.667, and 0.216, respectively. These results suggest that the model is generalized and highly accurate. Furthermore, the output of ADTree may visualize the branch point of treatment. For example, the selection of donor types resulted in different relapse predictions. Therefore, clinicians may change treatment options by referring to the model, thereby improving outcomes. The present results indicate that ML, such as ADTree, will contribute to the decision‐making process in the diversified allo‐HSCT field and be useful for preventing the relapse of leukemia.
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Affiliation(s)
- Kyoko Fuse
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Shun Uemura
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Suguru Tamura
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Tatsuya Suwabe
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Takayuki Katagiri
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Tomoyuki Tanaka
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Takashi Ushiki
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Yasuhiko Shibasaki
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Naoko Sato
- Department of Hematology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Toshio Yano
- Department of Hematology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Takashi Kuroha
- Department of Hematology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Shigeo Hashimoto
- Department of Hematology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Tatsuo Furukawa
- Department of Hematology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Miwako Narita
- Laboratory of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Hirohito Sone
- Faculty of Medicine, Department of Hematology, Endocrinology and Metabolism, Niigata University, Niigata, Japan
| | - Masayoshi Masuko
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan
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97
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Shima N, Hayami N, Mizuno H, Kawada M, Sekine A, Sumida K, Hiramatsu R, Yamanouchi M, Hasegawa E, Suwabe T, Hoshino J, Sawa N, Takaichi K, Ohashi K, Fujii T, Minota S, Ubara Y. Arteriovenous fistula-related renal bleeding 5 days after percutaneous renal biopsy. CEN Case Rep 2019; 8:280-284. [PMID: 31214889 PMCID: PMC6820813 DOI: 10.1007/s13730-019-00408-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/07/2019] [Indexed: 11/25/2022] Open
Abstract
A 32-year-old Japanese woman was admitted to our hospital for evaluation of microscopic hematuria with a positive family history. Percutaneous renal biopsy was performed under real-time ultrasound guidance using a 16-gauge automated needle and three specimens were obtained. She had no risk factors for hemorrhage. However, macroscopic hematuria developed from 5 days after biopsy and persisted for 4 days. Her Hb decreased markedly from 15.0 to 8.1 g/dL. Enhanced computed tomography revealed urinary tract hematoma, while the early arterial phase showed inflow of contrast medium into the left renal vein from a pseudoaneurysm on a branch left renal artery. Renal transcatheter arterial embolization was performed using platinum microcoils and the arteriovenous fistula was occluded. The patient did not require blood transfusion. Severe renal bleeding that causes urinary tract hematoma usually occurs within 24 h after renal biopsy, but the possibility of late-onset renal bleeding should be kept in mind.
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Affiliation(s)
- Natsuki Shima
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Noriko Hayami
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Masahiro Kawada
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Rikako Hiramatsu
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.,Department of Pathology, Yokohama City University Hospital Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Seiji Minota
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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98
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Toriu N, Sekine A, Mizuno H, Hasegawa E, Yamanouchi M, Hiramatsu R, Hayami N, Hoshino J, Kawada M, Suwabe T, Sumida K, Sawa N, Takaichi K, Ohashi K, Fujii T, Matoba S, Ubara Y. Renal-Limited Thrombotic Microangiopathy due to Bevacizumab Therapy for Metastatic Colorectal Cancer: A Case Report. Case Rep Oncol 2019; 12:391-400. [PMID: 31244641 PMCID: PMC6587198 DOI: 10.1159/000500716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022] Open
Abstract
An 88-year-old Japanese man received bevacizumab for colorectal cancer with liver and peritoneal metastasis, during which nephrotic range proteinuria occurred (7.66 g/day). Renal biopsy showed endothelial damage with subendothelial swelling and a double contour of the glomerular basement membrane, which indicated a diagnosis of thrombotic microangiopathy (TMA). After bevacizumab was stopped, proteinuria decreased to 1 g/day. During the clinical course, this patient had no extrarenal manifestations. This case suggests that renal injury induced by bevacizumab is characterized by nephrotic range proteinuria and histological TMA, and is a renal-limited condition that differs from systemic TMA related to thrombotic thrombocytopenic purpura.
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Affiliation(s)
- Naoya Toriu
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Rikako Hiramatsu
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Noriko Hayami
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Kawada
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Keiichi Sumida
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.,Department of Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Shuichiro Matoba
- Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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99
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Sakoh T, Sekine A, Mori T, Mizuno H, Kawada M, Hiramatsu R, Hasegawa E, Hayami N, Yamanouchi M, Suwabe T, Sawa N, Ubara Y, Fujimaru T, Sohara E, Shinichi U, Hoshino J, Takaichi K. A familial case of pseudohypoaldosteronism type II (PHA2) with a novel mutation (D564N) in the acidic motif in WNK4. Mol Genet Genomic Med 2019; 7:e705. [PMID: 31044551 PMCID: PMC6565545 DOI: 10.1002/mgg3.705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/28/2019] [Accepted: 04/07/2019] [Indexed: 11/07/2022] Open
Abstract
Background There have been still few case reports of pseudohypoaldosteronism type II (PHA2), also known as Gordon's syndrome, genetically diagnosed, and this is the first report of familial PHA2 case in Japan with a novel D564N mutation in WNK4. Methods A 29‐year‐old woman was admitted to our hospital due to hyperkalemia (serum potassium: 6.4 mmol/L). She had mild hypertension (135/91 mm Hg), a bicarbonate level at the lower limit of the normal range (HCO3: 22 mmol/L) with a normal anion gap, low plasma renin activity (0.2 ng ml‐1 hr‐1), and high urinary calcium excretion (505.4 mg/g Cre). A hereditary condition was suspected because her mother also had the same symptoms. We performed a comprehensive genetic analysis for major inherited kidney diseases with next‐generation sequencing including the genes responsible for PHA2 (WNK1, WNK4, KLHL3, and CUL3). Results Genetic analysis revealed that the patient and her mother had a novel missense mutation (D564N) in the acidic motif in WNK4, which leads to the diagnosis of PHA2. Administration of trichlormethiazide (1 mg/day) effectively ameliorated her blood pressure (114/69 mm Hg), plasma bicarbonate (25 mmol/L), serum potassium (4.3 mmol/L), and urinary calcium excretion (27.2 mg/g Cre). Conclusion We report the first Japanese familial case of PHA2 with WNK4 mutation. D564N mutation in WNK4 is a novel genetic cause of PHA2 with a relatively mild phenotype.
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Affiliation(s)
| | | | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Takuya Fujimaru
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Uchida Shinichi
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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100
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Mitobe M, Kawamoto K, Suzuki T, Kiryu M, Nanba A, Suwabe T, Tanaka T, Fuse K, Shibasaki Y, Masuko M, Miyoshi H, Ohshima K, Sone H, Takizawa J. Anaplastic large cell lymphoma, with 1,25(OH) 2D 3-mediated hypercalcemia: A case report. J Clin Exp Hematop 2019; 59:22-28. [PMID: 30918141 PMCID: PMC6528141 DOI: 10.3960/jslrt.18033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hypercalcemia due to malignant tumors including malignant lymphomas is relatively common. Among cancer patients with hypercalcemia, humoral hypercalcemia of malignancy is the most common and accounts for about 80% of all cases with hypercalcemia. 1,25-dihydroxyvitamin D3(1,25(OH)2D3)-mediated hypercalcemia is relatively rare. Although malignant lymphoma has been also reported to cause 1,25(OH)2D3-mediated hypercalcemia, it is not known whether there is any association between 1,25(OH)2D3-mediated hypercalcemia and any specific histological type of malignant lymphoma. We herein report a case of an anaplastic large cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK) -negative with 1,25(OH)2D3-mediated hypercalcemia, which has never been previously reported. An 80-year-old Japanese man was admitted to our department due to acute exacerbation of hypercalcemia. He was diagnosed with ALCL, ALK-negative. Serum 1,25(OH)2D3 level was high and seemed to be associated with the lymphoma because the serum calcium and 1,25(OH)2D3 levels improved in response to chemotherapy. Histological findings showed that many CD68 positive macrophages were observed in the microenvironment of tumor cells. Lymphoma cells or tumor microenvironmental cells may produce 1,25(OH)2D3 because several previous reports showed the source of 1,25(OH)2D3 can be either lymphoma or tumor microenvironmental cells. Moreover, because 1,25(OH)2D3-mediated hypercalcemia has been reported regardless of the specific histological type of lymphoma, tumor microenvironmental cells may be involved in this condition. However, we could not identify the source of 1,25(OH)2D3 in this case. The association between 1,25(OH)2D3 production and prognosis in malignant lymphomas is yet unknown; further studies are needed to elucidate the clinical characteristics of malignant lymphoma with 1,25(OH)2D3-mediated hypercalcemia.
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