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Nakaya I, Sada KE, Harigai M, Soma J, Amano K, Dobashi H, Atsumi T, Yuzawa Y, Fujimoto S, Sugihara T, Takasaki Y, Arimura Y, Makino H. Chemoprophylaxis against Pneumocystis jirovecii pneumonia in Japanese patients with ANCA-associated vasculitis: An observational study. Mod Rheumatol 2023; 33:1137-1144. [PMID: 36197746 DOI: 10.1093/mr/roac124] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study investigated the current practice of prophylactic treatment against Pneumocystis jirovecii pneumonia (PCP) and its effectiveness in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS This study included 319 patients registered from 53 institutions in Japan and newly diagnosed with AAV. During the 2-year observation period, we examined the frequency of usage, effectiveness and safety of prophylactic drugs against PCP. RESULTS Most patients received prophylactic drugs against PCP with the initiation of immunosuppressive agents, and >50% of them remained on chemoprophylaxis against PCP at 2 years after. The initial daily dose of oral prednisolone and the proportion of cyclophosphamide administration were higher in patients who received chemoprophylaxis against PCP than in those who did not. PCP occurred in nine patients (3%) and resulted in the death of four. The incidence rate of PCP in patients who received chemoprophylaxis was 1.13/100 patient-years (95% confidence interval, 0.38-2.68) and that in those who did not was 2.74 (1.04-6.02). The incidence rate ratio was 0.41 (0.11-1.53). CONCLUSIONS The markedly low incidence of PCP may be attributed to the continuous chemoprophylaxis against PCP received by >50% of Japanese patients with AAV, although the effectiveness of chemoprophylaxis against PCP was not statistically confirmed.
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Affiliation(s)
- Izaya Nakaya
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Miki, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Takahiko Sugihara
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
- Division of Rheumatology & Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshinari Takasaki
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Arimura
- Nephrology and Rheumatology, First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Kichijoji Asahi Hospital, Tokyo, Japan
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Kudo H, Suzuki R, Kondo A, Nozu K, Nakamura Y, Mikami H, Soma J, Nakaya I. Association of Familial Fanconi Syndrome with a Novel GATM Variant. TOHOKU J EXP MED 2023; 260:337-340. [PMID: 37286521 DOI: 10.1620/tjem.2023.j046] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fanconi syndrome is a disorder of the proximal renal tubule. Recently, advanced genetic analysis technology has revealed that several genes cause familial Fanconi syndrome. We identified a family with autosomal dominant Fanconi syndrome and chronic kidney disease with a novel glycine amidinotransferase (GATM) variant. Case 1 was a 57-year-old Japanese woman. Her father and two siblings had Fanconi syndrome or chronic kidney disease. She presented to our hospital at the age of 34 years with recurrent glucosuria. Her height and weight were 151 cm and 46.6 kg, respectively. Laboratory tests showed glucosuria, hypophosphatemia, hypouricemia, and normal renal function. Her serum creatinine level gradually increased over the following next two decades, and she developed end-stage renal disease. Case 2, the daughter of Case 1, was a 26-year-old woman. Her height and weight were 151 cm and 37.5 kg, respectively. Glucosuria was detected at the age of 13 years, which led to a referral to our hospital. Urinalysis showed low-molecular-weight proteinuria. She was diagnosed with Fanconi syndrome. At the age of 26 years, she had glucosuria, low-molecular-weight proteinuria, hypouricemia, and normal renal function. Genetic testing of both cases revealed a novel missense variant in GATM. The heterozygous missense variants in GATM have been reported to cause familial Fanconi syndrome, which manifests early in life and progresses to renal glomerular failure by mid-adulthood. The novel GATM variant detected in our cases was suspected to be associated with the development of Fanconi syndrome. GATM variants should be tested in patients with idiopathic Fanconi syndrome.
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Affiliation(s)
- Hiroki Kudo
- Department of Pediatrics, Iwate Prefectural Central Hospital
| | - Ryota Suzuki
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Atsushi Kondo
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Yuki Nakamura
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital
| | - Hitoshi Mikami
- Department of Pediatrics, Iwate Prefectural Central Hospital
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital
| | - Izaya Nakaya
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital
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Soma J, Ishii D, Miyagi H, Ishii S, Motoki K, Kawabata H, Ishitoya S, Hagiwara M, Kokita N, Hirasawa M. Damage control surgery for grade IV blunt hepatic injury with multiple organ damage in a child: a case report. Surg Case Rep 2021; 7:269. [PMID: 34928459 PMCID: PMC8688624 DOI: 10.1186/s40792-021-01348-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae. CASE PRESENTATION An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient's altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient's general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury. CONCLUSION The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.
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Affiliation(s)
- Jun Soma
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Daisuke Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan.
| | - Hisayuki Miyagi
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Seiya Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Keita Motoki
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Hidemasa Kawabata
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Shunta Ishitoya
- Department of Radiology, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Masahiro Hagiwara
- Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Naohiro Kokita
- Department of Emergency Medicine, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
| | - Masatoshi Hirasawa
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan
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Nakaya I, Goto T, Nakamura Y, Yoshikawa K, Oyama J, Tamayama Y, Morooka M, Ito S, Ishioka H, Matsuura Y, Soma J. Temporary central venous catheter at hemodialysis initiation and reasons for use: a cross-sectional study. Ren Replace Ther 2021. [DOI: 10.1186/s41100-021-00318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Creating permanent vascular access (VA) is recommended before hemodialysis initiation in patients with end-stage renal disease (ESRD). Although many patients are still introduced to hemodialysis with temporary central venous catheters (CVCs), the reasons for their use remain unclear. We aimed to clarify the characteristics of Japanese patients introduced to hemodialysis using temporary CVCs, the reasons for their use, and whether this rate can be reduced in the future.
Methods
We conducted this cross-sectional study in an acute care general hospital in Japan. We enrolled 393 patients aged ≥ 18 years who received a permanent VA creation for initiating hemodialysis. We classified participants into the temporary CVC group or the permanent VA group according to the VA type at hemodialysis initiation and compared their backgrounds. We identified why permanent VA could not be used at hemodialysis initiation for patients in the temporary CVC group.
Results
Of the 393 patients, 137 (35%) initiated hemodialysis with a temporary CVC, and arteriovenous fistulas (AVFs) were created as the first VA in all patients during hospitalization following hemodialysis initiation. The remaining 256 patients (65%) initiated hemodialysis via AVF cannulation. The duration of predialysis nephrology care was significantly shorter in the temporary CVC group than that in the permanent VA group. The median time from AVF creation to the first successful cannulation was also shorter in the temporary CVC group (8 vs. 66 days, P < 0.001), but the estimated glomerular filtration rate values at hemodialysis initiation did not differ. Reasons for temporary CVC use were varied and complex. Problems on the part of healthcare providers, patient behavioral issues, and characteristics of causative kidney disease itself were underlying reasons. Delayed referral to a nephrologist was less frequent than expected (16%) and the most commonly reported reason (20%) was that a nephrologist was unable to predict the timing of hemodialysis initiation.
Conclusions
Patients with ESRD should be referred to a nephrologist earlier for AVF creation. However, given the already relatively high rate of hemodialysis initiation with permanent VA in Japan, we considered it surprisingly difficult to further reduce the temporary CVC usage rate in Japan.
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Nakamura A, Sato R, Ando S, Oana N, Nozaki E, Endo H, Miyate Y, Soma J, Miyata G. Orthogonal antibody testing for COVID-19 among healthcare workers in a non-epidemic place and time:Japan's Iwate Prefecture, May 18-31, 2020. Fukushima J Med Sci 2021; 67:27-32. [PMID: 33642419 PMCID: PMC8075555 DOI: 10.5387/fms.2020-21] [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: 12/11/2022] Open
Abstract
Of the 47 prefectures in Japan, Iwate had the fewest cases of coronavirus disease 2019 (COVID-19), with the first diagnosis officially confirmed on July 28, 2020. A baseline serological survey of COVID-19 antibodies is essential to accurately evaluate an epidemic outbreak. The primary purpose of this study was to determine pre-epidemic prevalence of COVID-19 antibodies among healthcare workers, using two laboratory-based quantitative tests. In addition, a point-of-care (POC) qualitative test, rapid, simple, and convenient for primary care clinics, was compared with the laboratory-based tests. All antibody tests were performed on serum from 1,000 healthcare workers (mean age, 40 ± 11 years) in Iwate Prefectural Central Hospital, May 29-31, 2020. A COVID-19 case was defined as showing positive results in both laboratory-based quantitative tests. None of 1,000 samples had positive results in both of the laboratory immunoassays. The POC test showed positive results in 33 of 1,000 samples (3.3%) (95% confidence interval:2.19-4.41), but no samples were simultaneously positive in both laboratory-based tests. In conclusion, COVID-19 cases were not serologically confirmed by a baseline control study of healthcare workers at our hospital in late May, 2020. Moreover, the POC qualitative test may offer no advantage in areas with very low prevalence of COVID-19, due to higher false-positive reactions compared with laboratory-based quantitative immunoassays.
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Affiliation(s)
- Akihiro Nakamura
- Department of Disaster Medicine, Iwate Prefectural Central Hospital
| | - Ryoichi Sato
- Clinical Laboratory, Iwate Prefectural Central Hospital
| | - Sanae Ando
- Clinical Laboratory, Iwate Prefectural Central Hospital
| | - Natsuko Oana
- Clinical Laboratory, Iwate Prefectural Central Hospital
| | - Eiji Nozaki
- Clinical Laboratory, Iwate Prefectural Central Hospital
| | - Hideaki Endo
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Yoshiharu Miyate
- Department of Infection Control and Prevention, Iwate Prefectural Central Hospital
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital
| | - Go Miyata
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
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Matsuura Y, Goto T, Tamayama Y, Nakamura Y, Oyama J, Ishioka H, Yoshikawa K, Nakaya I, Soma J. First case report of monoclonal IgG3-heavy-chain glomerulonephritis with microtubular structures. CEN Case Rep 2020; 10:236-240. [PMID: 33156494 DOI: 10.1007/s13730-020-00550-1] [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: 08/24/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022] Open
Abstract
Our patient was a 69-year-old woman admitted to our hospital for heavy proteinuria and hematuria. A renal biopsy showed findings similar to those of membranoproliferative glomerulonephritis associated with nodular lesions, and immunofluorescence showed marked deposits of IgG, C1q, and C3 on the peripheral capillary walls. IgG3 alone was observed on IgG subclass staining with no κ or λ light chains, and Congo red staining was negative. These findings suggested IgG3-heavy-chain deposition disease (HCDD). However, we did not find a deletion of the first heavy-chain constant domain, which is commonly observed in HCDD. Electron microscopy showed randomly arranged subendothelial microtubular structures with diameters of 70-90 nm. Altogether, the diagnosis of HCDD could not be made, although monoclonal IgG3 deposits in glomeruli were observed. This is the first case report of monoclonal IgG3-heavy-chain glomerulonephritis with subendothelial-based, randomly arranged microtubular structures with diameters of 70-90 nm.
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Affiliation(s)
- Yuki Matsuura
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan.
| | - Taijiro Goto
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Yoshihiko Tamayama
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Yuki Nakamura
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Junji Oyama
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Hirotaka Ishioka
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Kazuhiro Yoshikawa
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Izaya Nakaya
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Japan
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Tezuka Y, Nakaya I, Nakayama K, Nakayama M, Yahata M, Soma J. Methylglyoxal as a prognostic factor in patients with chronic kidney disease. Nephrology (Carlton) 2019; 24:943-950. [PMID: 30407693 DOI: 10.1111/nep.13526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 01/28/2023]
Abstract
AIM Advanced glycation end products and their precursors cause vascular damage through oxidative stress. We investigated the hypothesis that methylglyoxal (MG), 3-deoxyglucosone (3-DG) and pentosidine influence outcomes of chronic kidney disease (CKD) patients. METHODS We conducted a 3 years prospective observational study involving 150 outpatients at CKD stages 3-5. At enrolment, MG, 3-DG and pentosidine plasma concentrations were measured; patients were divided into tertiles according to the concentration of each substance. The primary endpoint was death, a cardiovascular event or end-stage renal disease. Survival analysis was performed using the Cox regression model. RESULTS The patients' mean age was 62 ± 12 years, 97 were men, and 20 had diabetic nephropathy. The mean estimated glomerular filtration rate was 25.0 ± 12.1 mL/min per 1.73 m2 , which negatively correlated with MG but not with 3-DG and pentosidine. Forty-eight patients reached the primary endpoint. Compared with the lowest MG tertile, the hazard ratio for the primary endpoint was 7.57 (95% confidence interval (CI): 1.71-33.54) in the middle tertile and 27.00 (CI: 6.46-112.82) in the highest tertile. When adjusted for characteristics at baseline, the corresponding hazard ratio decreased to 2.09 (CI: 0.37-11.96) and 6.13 (CI: 0.97-38.82), but MG tertile remained an independent risk factor for the primary endpoint. However, 3-DG and pentosidine were not related to the primary outcome. CONCLUSION Methylglyoxal has a close clinical association with CKD. Higher MG concentrations may contribute renal function deterioration in CKD. In CKD patients, MG concentration might be useful when determining the prognosis.
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Affiliation(s)
- Yuta Tezuka
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan.,Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Izaya Nakaya
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Keisuke Nakayama
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masaaki Nakayama
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Mayumi Yahata
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan
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Yamaguchi E, Yoshikawa K, Nakaya I, Kato K, Miyasato Y, Nakagawa T, Kakizoe Y, Mukoyama M, Soma J. Liddle's-like syndrome associated with nephrotic syndrome secondary to membranous nephropathy: the first case report. BMC Nephrol 2018; 19:122. [PMID: 29792170 PMCID: PMC5966895 DOI: 10.1186/s12882-018-0916-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/14/2017] [Accepted: 05/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background Liddle’s syndrome is a rare monogenic form of hypertension caused by truncating or missense mutations in the C termini of the epithelial sodium channel (ENaC) β or γ subunits. Patients with this syndrome present with early onset of hypertension, hypokalemia, metabolic alkalosis, hyporeninemia and hypoaldosteronism, and a potassium-sparing diuretics (triamterene or amiloride) can drastically improves the disease condition. Although elderly patients having these characteristics were considered to have Liddle’s syndrome or Liddle’s-like syndrome, no previous report has indicated that Liddle’s-like syndrome could be caused by nephrotic syndrome of primary glomerular disease, which is characterized by urinary excretion of > 3 g of protein/day plus edema and hypoalbuminemia, or has explained how the activity function of ENaC could be affected in the setting of high proteinuria. Case presentation A 65-year-old Japanese man presented with nephrotic syndrome. He had no remarkable family history, but had a medical history of hypertension and hyperlipidemia. On admission, hypertension, spironolactone-resistant hypokalemia (2.43 mEq/l), hyporeninemic hypoaldosteronism, and metabolic alkalosis, which suggested Liddle’s syndrome, were observed. Treatment with triamterene together with a steroid for nephrotic syndrome resulted in rapid and remarkable effective on improvements of hypertension, hypokalemia, and edema of the lower extremities. Renal biopsy revealed membranous nephropathy (MN) as the cause of nephrotic syndrome, and advanced gastric cancer was identified on screening examination for cancers that could be associated with the development of MN. After total gastrectomy, triamterene was not required and proteinuria decreased. A mutation in the β or γ subunits of the ENaC gene was not identified. Conclusion We reported for the first time a case of Liddle’s-like syndrome associated with nephrotic syndrome secondary to MN. Aberrant activation of ENaC was suggested transient during the period of high proteinuria, and the activation was reversible with a decrease in proteinuria.
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Affiliation(s)
- Eriko Yamaguchi
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Morioka, 020-0066, Japan
| | - Kazuhiro Yoshikawa
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Morioka, 020-0066, Japan
| | - Izaya Nakaya
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Morioka, 020-0066, Japan
| | - Karen Kato
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Morioka, 020-0066, Japan
| | - Yoshikazu Miyasato
- Department of Nephrology, Kumamoto University School of Medicine, Honjyo 1-1-1, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Terumasa Nakagawa
- Department of Nephrology, Kumamoto University School of Medicine, Honjyo 1-1-1, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Yutaka Kakizoe
- Department of Nephrology, Kumamoto University School of Medicine, Honjyo 1-1-1, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Kumamoto University School of Medicine, Honjyo 1-1-1, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, 1-4-1, Morioka, 020-0066, Japan.
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Komatsu H, Fujimoto S, Maruyama S, Mukoyama M, Sugiyama H, Tsuruya K, Sato H, Soma J, Yano J, Itano S, Nishino T, Sato T, Narita I, Yokoyama H. Distinct characteristics and outcomes in elderly-onset IgA vasculitis (Henoch-Schönlein purpura) with nephritis: Nationwide cohort study of data from the Japan Renal Biopsy Registry (J-RBR). PLoS One 2018; 13:e0196955. [PMID: 29738576 PMCID: PMC5940189 DOI: 10.1371/journal.pone.0196955] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 03/06/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical presentation and prognosis of adult and elderly patients with IgA vasculitis (Henoch-Schönlein purpura) accompanied by nephritis (IgAV-N) have not been investigated in detail. We therefore surveyed the features and outcomes of IgAV-N based on nationwide data derived from the Japan Renal Biopsy Registry (J-RBR). METHODS This multi-center cohort study compared the clinicopathological parameters at diagnosis, initial therapies and outcomes between 106 adult (age 19-64 years) and 46 elderly (≥65 years) patients with IgAV-N who were registered in the J-RBR between 2007 and 2012. The primary end-points comprised a 50% increase in serum creatinine (sCr) values or end-stage kidney disease. Factors affecting a decrease in renal function were assessed using Cox proportional hazards models. RESULTS Rates of hypertension, impaired renal function, hypoalbuminemia and crescentic glomerulonephritis were significantly higher among the elderly, than the adult patients. About 80% and 60% of the patients in both groups were respectively treated with corticosteroid and a renin-angiotensin system (RAS) blockade. Both groups had favorable renal survival rates for nine years (93.6% and 91.4% of the adult and elderly patients, respectively). Significantly more elderly than adult patients developed a 50% increase in sCr during a mean observation period of 3.9 years (21.7% vs. 4.7%, p = 0.012), and significantly fewer elderly, than adult patients achieved clinical remission (23.9% vs. 46.2%, p = 0.016). Multivariate analysis selected advanced age (≥65 years) and lower serum albumin values as independent prognostic factors for a decline in renal function, whereas steroid pulse therapy helped to preserve renal function. CONCLUSIONS The renal prognosis of adult and elderly patients with IgAV-N was favorable when treated aggressively with corticosteroid and RAS blockade. However, the course of renal function should be carefully monitored in patients aged over 65 years and those with hypoalbuminemia.
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Affiliation(s)
- Hiroyuki Komatsu
- Department of Nephrology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hitoshi Sugiyama
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Sato
- Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Jun Soma
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Junko Yano
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Seiji Itano
- Division of Nephrology and Hypertension, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Toshinobu Sato
- Department of Nephrology, Sendai Shakai Hoken Hospital, Sendai, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hitoshi Yokoyama
- Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
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Higuchi S, Nakaya I, Yoshikawa K, Chikamatsu Y, Sada KE, Yamamoto S, Takahashi S, Sasaki H, Soma J. Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort. Kidney Int Rep 2017; 2:594-602. [PMID: 29318218 PMCID: PMC5720530 DOI: 10.1016/j.ekir.2017.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Late referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m2 (IGFR10-HD) on patient outcome. Methods We enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free IGFR10-HD. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model. Results The median IGFR10-HD was 159 days (range: 2–1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m2. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed IGFR10-HD was 0.393 (95% confidence interval [CI]; 0.244−0.635; P < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267−0.956; P = 0.036). Discussion A longer HD-free IGFR10-HD was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.
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Kobayashi H, Kanmani P, Ishizuka T, Miyazaki A, Soma J, Albarracin L, Suda Y, Nochi T, Aso H, Iwabuchi N, Xiao JZ, Saito T, Villena J, Kitazawa H. Development of an in vitro immunobiotic evaluation system against rotavirus infection in bovine intestinal epitheliocytes. Benef Microbes 2017; 8:309-321. [PMID: 28042704 DOI: 10.3920/bm2016.0155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The bovine intestinal epithelial cell line (BIE cells) expresses the Toll-like receptor (TLR)3 and is able to mount an antiviral immune response after the stimulation with poly(I:C). In the present study, we aimed to further characterise the antiviral defence mechanisms in BIE cells by evaluating the innate immune response triggered by rotavirus (RV) infection. In addition, we attempted to determine whether immunobiotic bifidobacteria are able to confer protection of BIE cells against RV infection by beneficially modulating the antiviral immune response. RV OSU (porcine) and UK (bovine) effectively infected BIE cells, while a significant lower capacity to infect BIE cells was observed for human (Wa) and murine (EW) RV. We observed that viral infection in BIE cells triggered TLR3/RIG-I-mediated immune responses with activation of IRF3 and TRAF3, induction of interferon beta (IFN-β) and up-regulation of inflammatory cytokines. Our results also demonstrated that preventive treatments with Bifidobacterium infantis MCC12 or Bifidobacterium breve MCC1274 significantly reduced RV titres in infected BIE cells and differentially modulated the innate immune response. Of note, both strains significantly improved the production of the antiviral factor IFN-β in RV-infected BIE cells. In conclusion, this work provides comprehensive information on the antiviral immune response of BIE cells against RV, that can be further studied for the development of strategies aimed to improve antiviral defences in bovine intestinal epithelial cells. Our results also demonstrate that BIE cells could be used as a newly immunobiotic evaluation system against RV infection for application in the bovine host.
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Affiliation(s)
- H Kobayashi
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,2 Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
| | - P Kanmani
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,2 Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
| | - T Ishizuka
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
| | - A Miyazaki
- 3 Viral Disease and Epidemiology Research Division, National Institute of Animal Health, National Agriculture and Food Research Organization, 3-1-5 Kannondai, Tsukuba, Ibaraki 305-0856, Japan
| | - J Soma
- 4 Research and Development Section, Zen-noh Institute of Animal Health, Sakura, Chiba 285-0043, Japan
| | - L Albarracin
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,5 Laboratory of Immunobiotechnology, Reference Centre for Lactobacilli (CERELACONICET), Chacabuco 145, San Miguel de Tucuman, 4000 Tucuman, Argentina
| | - Y Suda
- 6 Department of Food, Agriculture and Environment, Miyagi University, 2-2-1 Hatadate, Taihaku-ku, Sendai, Miyagi 982-0215 Japan
| | - T Nochi
- 7 Infection Immunology Unit, International Education and Research Center for Food Agricultural Immunology (CFAI), Graduate School of Agricultural Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,8 Cell Biology Laboratory, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
| | - H Aso
- 2 Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,8 Cell Biology Laboratory, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
| | - N Iwabuchi
- 9 Food Ingredients Institute, Morinaga Milk Industry Co. Ltd., 5-Chome, Higashihara, 252-8583 Zama-City, Kanagawa, Japan
| | - J-Z Xiao
- 10 Next Generation Science Institute, Morinaga Milk Industry Co. Ltd., 5-Chome, Higashihara, 252-8583 Zama-City, Kanagawa, Japan
| | - T Saito
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
| | - J Villena
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,5 Laboratory of Immunobiotechnology, Reference Centre for Lactobacilli (CERELACONICET), Chacabuco 145, San Miguel de Tucuman, 4000 Tucuman, Argentina
| | - H Kitazawa
- 1 Food and Feed Immunology Group, Laboratory of Animal Products Chemistry, Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan.,2 Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Graduate School of Agricultural Science, Tohoku University, 468-1, Aoba, Aramaki, Aoba-ku, Sendai, Miyagi, 980-0845, Japan
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12
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Sasaki H, Soma J. Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits: A Poorly-Understood Disease Spectrum. Nephrol Ther 2016. [DOI: 10.4172/2161-0959.1000e116] [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] [Indexed: 11/09/2022]
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13
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Iwabuchi M, Nakaya I, Tsuchiya Y, Shibagaki Y, Yamaguchi T, Fukuhara S, Oe Y, Sakuma T, Sato T, Taguma Y, Soma J. Effects of cyclophosphamide on the prognosis of Japanese patients with renal vasculitis associated with anti-neutrophil cytoplasmic antibody-positive microscopic polyangiitis. Clin Exp Nephrol 2015; 20:712-719. [DOI: 10.1007/s10157-015-1200-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022]
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14
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Kumakura S, Nakaya I, Sakuma T, Sato H, Soma J. Crystalline cast nephropathy in a patient with IgD lambda myeloma. Clin Exp Nephrol 2015; 20:491-2. [DOI: 10.1007/s10157-015-1187-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
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15
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Sasaki H, Soma J. Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits: A Poorly-Understood Disease Spectrum. Nephrol Ther 2015. [DOI: 10.4172/2161-0959.s12-001] [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] [Indexed: 11/09/2022]
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Affiliation(s)
- Daisuke Ando
- Department of Nephrology, Iwate Prefectural Central Hospital , Morioka, Iwate , Japan
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Monova D, Monov S, Todorov T, Soderberg D, Kurz T, Weiner M, Eriksson P, Segelmark M, Jakuszko K, Sebastian A, Bednarz Z, Krajewska M, Wiland P, Madziarska K, Weyde W, Klinger M, Naidoo J, Wearne N, Jones E, Swanepoel C, Rayner B, Okpechi I, Endo N, Tsuboi N, Furuhashi K, Matsuo S, Maruyama S, Clerte M, Levi C, Touzot M, Fakhouri F, Monge C, Lebas C, Abboud I, Huart A, Durieux P, Charlin E, Thervet E, Karras A, Smykal-Jankowiak K, Niemir ZI, Polcyn-Adamczak M, Whatmough S, Sweeney N, Fernandez S, Hussain M, Dhaygude A, Jakuszko K, Bednarz Z, Sebastian A, Krajewska M, Gniewek K, Wiland P, Weyde W, Klinger M, Manenti L, Urban ML, Vaglio A, Gintoli E, Galletti M, Buzio C, Monova D, Monov S, Argirova T, Wong I, Ibrahim FH, Goh BL, Lim TS, Chan MW, Hiramtasu R, Ubara Y, Hoshino J, Takaichi K, Ghafoor V, Hussain M, Dhaygude A, Whatmough S, Fernandez S, Sweeney N, Hussain M, Dhaygude A, Sahay M, Soma J, Nakaya I, Sasaki N, Yoshikawa K, Sato H, Kaminskyy V, ZAbi Ska M, Krajewska M, Ko Cielska-Kasprzak K, Jakuszko K, Klinger M, Niemir Z, Wozniczka K, Swierzko A, Cedzynski M, Polcyn-Adamczak M, Sokolowska A, Szala A, Arjunan A, Mikhail A, Shrivastava R, Parker C, Aithal S, Gursu M, Ozari M, Yucetas E, Sumnu A, Doner B, Cebeci E, Ozkan O, Aktuglu MB, Karaali Z, Koldas M, Ozturk S, Marco H, Picazo M, Da Silva I, Gonzalez A, Arce Y, Gracia S, Corica M, Llobet J, Diaz M, Ballarin J, Schonermarck U, Hagele H, Baumgartner A, Fischereder M, Muller S, Oliveira CBL, Oliveira ASA, Carvalho CJB, Pessoa CTBC, Sette LHBC, Fernandes GV, Cavalcante MAGM, Valente LM, Wan Q, Hu H, He Y, Li T, Aazair N, Houmaid Z, Rhair A, Bennani N, Demin A, Petrova O, Kotova O, Demina L, Roccatello D, Sciascia S, Rossi D, Naretto C, Baldovino S, Alpa M, Salussola I, Modena V, Zakharova EV, Vinogradova OV, Stolyarevich ES, Yap DYH, Chan TM, Thanaraj V, Dhaygude A, Ponnusamy A, Pillai S, Argentiero L, Schena A, Rossini M, Manno C, Castellano G, Martino M, Mitrotti A, Giliberti M, Digiorgio C, Di Palma AM, Battaglia M, Ditonno P, Grandaliano G, Gesualdo L, Oliveira CBL, Carvalho CJB, Oliveira ASA, Pessoa CTBC, Sette LHBC, Fernandes GV, Cavalcante MAGM, Valente LM, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Rabrenovi V, Kova Evi Z, Jovanovi D, Rabrenovi M, Anti S, Ignjatovi L, Petrovi M, Longhi S, Del Vecchio L, Vigano S, Casartelli D, Bigi MC, Corti M, Limardo M, Tentori F, Pontoriero G, Zeraati AA, Shariati Sarabi Z, Davoudabadi Farahani A, Mirfeizi Z, Bae E. PRIMARY AND SECONDARY GLOMERULONEPHRITIDES 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu170] [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] [Indexed: 11/13/2022] Open
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Kaneko K, Seta K, Soma J, Kuwahara T, Koizumi M, Kikuchi Y, Sugawara A, Yahata K. Gamma 1-heavy chain deposition disease accompanied by IgG kappa in serum, urine, and bone marrow. CEN Case Rep 2014; 3:44-48. [PMID: 28509245 DOI: 10.1007/s13730-013-0083-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/25/2012] [Accepted: 04/30/2013] [Indexed: 11/24/2022] Open
Abstract
A 32-year-old Japanese woman presented with hypertension, nephrotic syndrome, microhematuria, and severe hypocomplementemia. Her serum creatinine concentration increased from 1.46 mg/dL (129.0 μmol/L) to 3.46 mg/dL (305.8 μmol/L) over 1 month. Renal biopsy revealed Congo red-negative nodular glomerulosclerosis accompanied by mesangial proliferation. There was extensive staining of immunoglobulin (Ig) G in the glomerular and tubular basement membranes and expanded mesangial regions. Staining was negative for IgA, IgM, and kappa and lambda light chains and positive for the gamma 1 IgG subclass. Staining for constant domains of the gamma heavy chains showed a deletion of the first constant domain (CH1). Electron microscopy revealed electron-dense deposits in the glomerular and tubular basement membranes and mesangium. These findings indicated gamma 1-heavy chain deposition disease (HCDD). Serum and urine immunoelectrophoresis revealed an IgG kappa monoclonal band, whereas bone marrow biopsy revealed monoclonal plasmacytosis with positive staining for kappa chains. HCDD associated with kappa light chain is extremely rare. We report the first case of HCDD with IgG kappa detected in the serum, urine, and bone marrow.
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Affiliation(s)
- Keiichi Kaneko
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Koichi Seta
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Jun Soma
- Department of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka-shi, Iwate, 020-0066, Japan
| | - Takashi Kuwahara
- Department of Nephrology, Saiseikai Ibaraki Hospital, 2-1-45 Mitsukeyama, Ibaraki-shi, Osaka, 567-0035, Japan
| | - Mitsuteru Koizumi
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Yuko Kikuchi
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Akira Sugawara
- Department of Nephrology, Osaka Red Cross Hospital, 5-30 Hudegasaki, Ten-noji, Osaka, 543-8555, Japan
| | - Kensei Yahata
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
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Kawamura T, Yoshimura M, Miyazaki Y, Okamoto H, Kimura K, Hirano K, Matsushima M, Utsunomiya Y, Ogura M, Yokoo T, Okonogi H, Ishii T, Hamaguchi A, Ueda H, Furusu A, Horikoshi S, Suzuki Y, Shibata T, Yasuda T, Shirai S, Imasawa T, Kanozawa K, Wada A, Yamaji I, Miura N, Imai H, Kasai K, Soma J, Fujimoto S, Matsuo S, Tomino Y. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transplant 2014; 29:1546-53. [PMID: 24596084 PMCID: PMC4106640 DOI: 10.1093/ndt/gfu020] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [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] [Indexed: 12/16/2022] Open
Abstract
Background The study aim was, for the first time, to conduct a multicenter randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgA nephropathy (IgAN). Methods Patients with biopsy-proven IgAN, proteinuria and low serum creatinine were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were urinary protein excretion and the disappearance of proteinuria and/or hematuria. Results During 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria (odds ratio 2.98, 95% CI 1.01–8.83, P = 0.049), but did not identify an independent factor in achieving the disappearance of hematuria or clinical remission. Conclusions The results indicate tonsillectomy combined with steroid pulse therapy has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Although the antiproteinuric effect was significantly greater in combined therapy, the difference was marginal, and its impact on the renal functional outcome remains to be clarified.
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Affiliation(s)
- Tetsuya Kawamura
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | | | - Yoichi Miyazaki
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hidekazu Okamoto
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kenjiro Kimura
- Division of Kidney and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keita Hirano
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Science, Jikei University School of Medicine, Tokyo, Japan
| | - Yasunori Utsunomiya
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Ogura
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hideo Okonogi
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Ishii
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Hamaguchi
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ueda
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Furusu
- Second Department of Internal Medicine, Nagasaki University Hospital of Medicine and Dentistry, Nagasaki, Japan
| | - Satoshi Horikoshi
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Shibata
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Yasuda
- Division of Kidney and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sayuri Shirai
- Division of Kidney and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Koichi Kanozawa
- Division of Kidney and Hypertension, Department of Internal Medicine, Saitama University Medical Centre, Saitama, Japan
| | - Akira Wada
- Department of Internal Medicine, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Izumi Yamaji
- Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan
| | - Naoto Miura
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Hirokazu Imai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kenji Kasai
- Department of Internal Medicine, Fuji City Central Hospital, Fuji, Japan
| | - Jun Soma
- Department of Internal Medicine, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Shouichi Fujimoto
- Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Seiichi Matsuo
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Nagoya, Nagoya, Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Affiliation(s)
- Michiko Yoshida
- Department of Nephrology, Iwate Prefectural Central Hospital, Japan
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Yahata M, Nakaya I, Sakuma T, Sato H, Aoki S, Soma J. Immunoglobulin A nephropathy with massive paramesangial deposits caused by anti-vascular endothelial growth factor therapy for metastatic rectal cancer: a case report and review of the literature. BMC Res Notes 2013; 6:450. [PMID: 24207130 PMCID: PMC3831868 DOI: 10.1186/1756-0500-6-450] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 08/30/2013] [Accepted: 11/05/2013] [Indexed: 11/15/2022] Open
Abstract
Background Bevacizumab, a recombinant humanized monoclonal antibody for vascular endothelial growth factor, has been widely used in various cancers offering substantial clinical benefit. It is reportedly associated with development of high-grade proteinuria and nephrotic syndrome with the histology of thrombotic microangiopathy, but there has been no report describing the development of immunoglobulin A nephropathy in bevacizumab-treated patients. Case presentation A 68-year-old man with metastatic rectal cancer was treated with bevacizumab. He presented with hematuria and proteinuria 15 and 17 months, respectively, after bevacizumab initiation. Bevacizumab was stopped at 17 months. Renal biopsy at 19 months revealed immunoglobulin A nephropathy, with numerous paramesangial hemispherical deposits and thrombotic microangiopathy. Electron microscopy showed numerous paramesangial electron-dense deposits of various sizes, and subendothelial injuries. Proteinuria almost completely resolved 8 months after bevacizumab cessation, although hematuria persisted. Follow-up renal biopsy 11 months after bevacizumab cessation showed a marked decrease in mesangial immunoglobulin A deposits and paramesangial electron-dense deposits, which correlated with a gradual decrease in serum immunoglobulin A. Conclusion This is the first case report that confirmed histologically the development and resolution of immunoglobulin A nephropathy during and after bevacizumab therapy. This case shows that there may be other mechanisms of glomerular injury by bevacizumab besides glomerular endothelial injury leading to thrombotic microangiopathy.
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Affiliation(s)
| | | | | | | | | | - Jun Soma
- Division of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate 020-0066, Japan.
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Nakaya I, Iwabuchi M, Tsuchiya Y, Shibagaki Y, Yamaguchi T, Fukuhara S, Oe Y, Yahata M, Soma J, Sato T, Taguma Y. THU0213 Cyclophosphamide has no efficacy in japanese patients with renal vasculitis associated with anti-neutrophil cytoplasmic antibody-positive microscopic polyangiitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2178] [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] [Indexed: 11/04/2022]
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Kaleekal T, Soma J, Mankidy B, Scheinin S, Loebe M, Seethamraju H. Primary Graft Dysfunction Mimic – Pulmonary Vein Thrombosis in the Postoperative Lung Transplant Patient. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nakaya I, Yahata M, Takahashi S, Sasajima T, Sakuma T, Shibagaki Y, Soma J. Long-term outcome and efficacy of cyclophosphamide therapy in Japanese patients with ANCA-associated microscopic polyangiitis: a retrospective study. Intern Med 2013; 52:2503-9. [PMID: 24240788 DOI: 10.2169/internalmedicine.52.0199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to elucidate the efficacy of cyclophosphamide (CY) in Japanese patients with antineutrophil cystoplasmic antibody (ANCA)-associated microscopic polyangiitis (MPA). METHODS Sixty-four patients, newly diagnosed with ANCA-associated MPA were included in this retrospective study. The patients were divided into two groups based on whether they received combination therapy of CY and corticosteroid (CS) (CY group, n=29) or CS alone (CS group, n=35) for remission induction. The primary outcome was all-cause mortality. RESULTS Most patients in the CY group were treated with oral CY. Between the two groups, there were no differences in the baseline characteristics except for a higher proportion of male patients in the CY group. The remission rate was not substantially different between the two groups (86.2% in the CY group vs. 91.4% in the CS group). The survival rate was slightly higher in the CY group than in the CS group (not statistically significant; 0.86 vs. 0.77 at 1 year and 0.73 vs. 0.64 at 5 years, p=0.648). In the CY group, the hazard ratio after adjusting for age, sex, Birmingham vasculitis activity score values, serum albumin levels and C-reactive protein (CRP) levels was 0.657 (95% CI, 0.254-1.699; p=0.386). CONCLUSION We observed no increased efficacy of CY in ANCA-positive MPA in the Japanese patients, and hence, its efficacy may be limited in these patients.
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Affiliation(s)
- Izaya Nakaya
- Department of Nephrology, Iwate Prefectural Central Hospital, Japan
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Takahashi S, Soma J, Nakaya I, Yahata M, Sakuma T, Yaegashi H, Sato A, Wano M, Sato H. Systemic and rapidly progressive light-chain deposition disease initially presenting as tubulointerstitial nephritis. CEN Case Rep 2012; 1:117-122. [PMID: 28509073 DOI: 10.1007/s13730-012-0026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/14/2012] [Accepted: 06/10/2012] [Indexed: 10/28/2022] Open
Abstract
A 42-year-old woman was admitted to a hospital after first-time detection of proteinuria and hematuria during a routine medical check-up. Because her serum creatinine level had rapidly increased from 0.9 to 3.2 mg/dl since measurement 3 months earlier, she was referred to our hospital. Renal biopsy revealed extensive tubular atrophy and interstitial fibrosis with mild leukocyte infiltration. Glomeruli showed minimal changes, and no immunoglobulin or complement deposition was observed by immunofluorescence. Oral prednisolone was commenced under the diagnosis of chronic tubulointerstitial nephritis, and she discharged once. However, its effects were transient; her renal function deteriorated rapidly and hemodialysis was initiated 5 months after her initial check-up. On readmission, urinary Bence-Jones protein κ-type was detected, and examination of bone marrow led to a diagnosis of Bence-Jones κ-type multiple myeloma. Light-chain staining using a renal biopsy specimen obtained 2 months earlier showed κ-light-chain deposition on tubular basement membranes but not glomeruli. Despite undergoing chemotherapy with vincristine, doxirubicin, and dexamethasone, the patient died suddenly from a cardiac arrhythmia. Autopsy showed κ-light-chain deposition in the heart, thyroid, liver, lungs, spleen, and ovaries. Congo red staining yielded negative results. Typical light-chain deposition disease (LCDD) characterized by nodular glomerulosclerosis was observed in the kidneys. This case demonstrates that tubulointerstitial nephritis can be an early pathological variant of LCDD, which may be followed by accelerated and massive light-chain deposition in glomeruli.
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Affiliation(s)
- Satoko Takahashi
- Division of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate, 020-0066, Japan
| | - Jun Soma
- Division of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate, 020-0066, Japan.
| | - Izaya Nakaya
- Division of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate, 020-0066, Japan
| | - Mayumi Yahata
- Division of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate, 020-0066, Japan
| | - Tsutomu Sakuma
- Division of Pathology, Iwate Prefectural Central Hospital, Morioka, Iwate, 020-0066, Japan
| | - Hiroshi Yaegashi
- Division of Pathology, Iwate Prefectural Central Hospital, Morioka, Iwate, 020-0066, Japan
| | - Akiyoshi Sato
- Division of Hematology, Iwate Prefectural Central Hospital, Morioka, Iwate, 020-0066, Japan
| | - Masaharu Wano
- Division of Hematology, Iwate Prefectural Central Hospital, Morioka, Iwate, 020-0066, Japan
| | - Hiroshi Sato
- Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Tohoku University, Sendai, Miyagi, 980-8578, Japan
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Abstract
A 25-year-old woman presented with fever, arthralgia and proteinuria exhibiting leukopenia, hypocomplementemia, increased serum IgG and IgG4, and positive antinuclear and anti-double-stranded DNA antibodies. Renal biopsy revealed membranous nephropathy with tubulointerstitial nephritis. IgG subclass immunofluorescence revealed intense IgG4 expression in glomeruli, but no expression of IgG2. Observations resembled membranous lupus nephritis with tubulointerstitial nephritis; however, elevated IgG4, low titers of antinuclear and anti-double-stranded DNA antibodies, IgG4-bearing cell infiltration, and characteristic IgG subclass deposition in glomeruli prompted diagnosis of IgG4-related tubulointerstitial nephritis with membranous nephropathy. It is challenging but important to distinguish lupus nephritis from IgG4-related kidney disease.
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Affiliation(s)
- Mayumi Yahata
- Division of Nephrology, Iwate Prefectural Central Hospital, Japan.
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Watanabe R, Nakaya I, Yahata M, Takahashi T, Sasajima T, Takeuchi K, Oura H, Sakuma T, Tomichi N, Mori Y, Soma J. Pulmonary hypertension confirmed histologically five months prior to scleroderma renal crisis onset. Mod Rheumatol 2011. [DOI: 10.3109/s10165-010-0390-7] [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] [Indexed: 11/13/2022]
Affiliation(s)
- Ryu Watanabe
- Department of Nephrology, Iwate Prefectural Central Hospital,
1-4-1 Ueda, Morioka, Iwate 020-0060, Japan
| | - Izaya Nakaya
- Department of Nephrology, Iwate Prefectural Central Hospital,
1-4-1 Ueda, Morioka, Iwate 020-0060, Japan
| | - Mayumi Yahata
- Department of Nephrology, Iwate Prefectural Central Hospital,
1-4-1 Ueda, Morioka, Iwate 020-0060, Japan
| | - Tohru Takahashi
- Department of Cardiology, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Tomomi Sasajima
- Department of Respiratology, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Kenichi Takeuchi
- Department of Respiratology, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Hiroyuki Oura
- Department of Respiratory Surgery, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Tsutomu Sakuma
- Department of Pathology, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Nobukazu Tomichi
- Department of Pathology, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Yasuki Mori
- Department of Dermatology, Iwate Prefectural Central Hospital,
Morioka, Japan
| | - Jun Soma
- Department of Nephrology, Iwate Prefectural Central Hospital,
1-4-1 Ueda, Morioka, Iwate 020-0060, Japan
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Soma J, Sato K, Nakaya I, Yahata M, Sakuma T, Sato H. Systemic non-amyloidotic fibril deposition disease: a probable variant form of fibrillary glomerulonephritis. Clin Nephrol 2011; 75:74-79. [PMID: 21176754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Fibrillary glomerulonephritis (FGN) is characterized by deposition of non-amyloidotic fibrillary material in glomeruli, and most patients with the disease show heavy proteinuria and hematuria, and progress into end-stage renal failure. We report a 62-year-old woman with FGN who showed mild proteinuria without hematuria and developed rapidly progressive renal failure requiring hemodialysis. Renal biopsy showed severe tubulointerstitial injury associated with non-amyloidotic fibrillary deposits in the tubular basement membrane, interstitium and vessel walls, in addition to glomeruli. The patient died from liver abscess 1 year after the introduction of hemodialysis. Postmortem examination showed the presence of non-amyloidotic fibrillary deposits arranged in tightly packed electron-dense and bundle-shaped structures in many organs. These findings suggest systemic non-amyloidotic fibril deposition in FGN.
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Affiliation(s)
- J Soma
- Department of Nephrology, Iwate Prefectural Central Hospital, Morioka, Japan.
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Abstract
Heavy chain deposition disease (HCDD) is characterized by glomerular and tubular deposition of non-amyloidotic monoclonal heavy chains without associated light chains. We describe a case of gamma1-HCDD who presented with nephrotic syndrome, microhematuria, and hypocomplementemia. Renal biopsy showed lobular and nodular glomerulosclerosis along with IgG and C3 deposition. Electron microscopy revealed electron-dense deposits on the glomerular and tubular basement membranes and mesangium. Congo red staining was negative. Staining was positive for IgG1 on glomerular and tubular basement membranes but negative for IgG2-4, kappa and lambda light chains. Staining for the constant heavy chain domains showed the deletion of the first constant heavy chain domain. Thus, we diagnosed gamma1-HCDD. She was considered to be early-stage HCDD because proteinuria and hematuria were not observed before the nephrotic syndrome onset. Melphalan and prednisolone (MP) therapy reduced proteinuria as well as improved renal function and complement levels. Although renal prognosis of HCDD is poor, aggressive chemotherapy with MP may be effective in early-stage HCDD patients.
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Affiliation(s)
- Yuji Oe
- Department of Nephrology, Iwate Prefectural Central Hospital, Morioka, Japan.
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Abstract
A 64-year-old woman with hypertension and hyperlipidemia was admitted to our hospital for the investigation and management of general fatigue, anorexia, a 5-kg weight loss, and a 4-week history of high-grade fever. She had no symptoms of headache, myalgia, or arthralgia, and the physical examination was unremarkable. The laboratory tests revealed renal dysfunction with urine abnormalities that had not been observed 1 year earlier. A renal biopsy showed granulomatous small arteritis without necrotic lesions or glomerular pathology. An immunohistochemical study of the infiltrating leukocytes showed a predominance of CD4+ T cells followed by CD8+ T cells, and only a few macrophages. The condition drastically improved after treatment with 30 mg/day of oral prednisolone. The granulomatous renal arteritis was considered a variant of giant cell arteritis, because it showed the peculiar finding of a few macrophages in the granulomatous lesions.
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Affiliation(s)
- Ryu Watanabe
- Department of Nephrology, Iwate Prefectural Central Hospital, Morioka
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Miura N, Imai H, Kikuchi S, Hayashi S, Endoh M, Kawamura T, Tomino Y, Moriwaki K, Kiyomoto H, Kohagura K, Nakazawa E, Kusano E, Mochizuki T, Nomura S, Sasaki T, Kashihara N, Soma J, Tomo T, Nakabayashi I, Yoshida M, Watanabe T. Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy: a nationwide survey of TSP therapy in Japan and an analysis of the predictive factors for resistance to TSP therapy. Clin Exp Nephrol 2009; 13:460-466. [PMID: 19449181 DOI: 10.1007/s10157-009-0179-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tonsillectomy and steroid pulse (TSP) therapy was proposed as a curative treatment for IgA nephropathy by Hotta et al. (Am J Kidney Dis 38:736-742, 2001) based on data that about 50% of patients achieved clinical remission (CR) of urinary abnormalities. MATERIALS AND METHODS As a primary survey, we sent a questionnaire and letter to 848 hospitals in Japan, each of which employed a Fellow of the Japanese Society of Nephrology between October and December of 2006, in order to gather information about the prevalence and efficacy of TSP therapy for patients with IgA nephropathy. As a secondary survey, we collected data from both low- and high-CR-rate groups to determine which factors predicted resistance to TSP therapy. RESULTS A total of 2,746 patients received TSP therapy between 2000 and 2006. The CR rates, calculated by measuring urinary criteria 6 and 12 months after TSP therapy, were 32.0% (347/1,085) and 45.6% (452/991), respectively. Analysis of the 30 hospitals in which TSP therapy had been performed on at least ten patients revealed that the CR rates varied from below 10% to 100%. A secondary survey of ten hospitals revealed that, after correction of the CR rate from each hospital, patients could be categorized into three groups: those with a low CR rate (122 patients in four hospitals), a middle CR rate (78 patients in four hospitals), and a high CR rate (103 patients in two hospitals). The CR rate of all patients (N = 303) was 54.1%. A comparison of patient data between the low- and high-CR-rate groups showed a significant difference in age at onset (years; P = 0.05), amount of proteinuria (g/day; P = 0.02), total protein (g/dl; P = 0.02), pathological grade (P = 0.009), and prognostic score as described by Wakai et al. [Nephrol Dial Transplant 21:2800-2808, 2006, (P = 0.04)]. Univariate analysis revealed that there was a significant difference between non-CR and CR subgroups in duration from diagnosis until TSP therapy (6.9 +/- 6.8 versus 5.3 +/- 5.2 years; P = 0.02), amount of proteinuria (1.5 +/- 1.6 versus 0.8 +/- 0.8 g/day; P < 0.0001), serum creatinine (0.99 +/- 0.40 versus 0.87 +/- 0.34 mg/dl; P = 0.006), pathological grade (P = 0.0006), and Wakai et al.'s prognostic score (37.4 +/- 17.8 versus 28.1 +/- 15.1; P < 0.0001). A multivariate logistic analysis demonstrated that resistance to TSP therapy depends on age at onset, amount of proteinuria, hematuria grade, and pathological grade, and a score predicting resistance to TSP therapy could be derived by the formula: [(-0.0330) x (age) + (0.4772) x log (amount of proteinuria) - (0.0273) x (hematuria grade: 0, 1, 2, and 3) + (0.7604) x (pathological grade: 1, 2, 3, and 4) - 0.1894]. A receiver operating characteristic (ROC) curve showed that patients with a resistance score of greater than -0.02 easily resist TSP therapy (sensitivity 69%, specificity 75%, positive likelihood ratio 2.76). CONCLUSION TSP therapy shows promise as a treatment that can bring about CR of urinary abnormalities, but unfortunately the average CR rate is about 50% at 1 year after treatment. Predictive factors for resistance to TSP therapy are age at onset, amount of proteinuria, hematuria grade, and pathological grade. The present study suggests that patients with either early-stage or mild to moderate IgA nephropathy easily achieve CR following TSP therapy, whereas patients with late-stage or severe disease are prone to TSP therapy resistance.
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Affiliation(s)
- Naoto Miura
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Hirokazu Imai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
| | - Shogo Kikuchi
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Shogo Hayashi
- Medical Education Center, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Masayuki Endoh
- Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Tetsuya Kawamura
- Department of Nephrology and Hypertension, School of Medicine, Jikei University, Minato-ku, Tokyo, Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kumiko Moriwaki
- Department of Cardio Renal and Cerebrovascular Medicine, Kagawa University Faculty of Medicine, Miki, Kagawa, Japan
| | - Hideyasu Kiyomoto
- Department of Cardio Renal and Cerebrovascular Medicine, Kagawa University Faculty of Medicine, Miki, Kagawa, Japan
| | - Kentaro Kohagura
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, Nishihara, Okinawa, Japan
| | - Eiko Nakazawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Toshio Mochizuki
- Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Shinsuke Nomura
- Departments of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tamaki Sasaki
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Naoki Kashihara
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Jun Soma
- Department of Nephrology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Tadashi Tomo
- Department of Internal Medicine II, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Iwao Nakabayashi
- Renal Unit, Department of Internal Medicine, Hachioji Medical Center, Tokyo Medical University, Hachioji, Tokyo, Japan
| | - Masaharu Yoshida
- Renal Unit, Department of Internal Medicine, Hachioji Medical Center, Tokyo Medical University, Hachioji, Tokyo, Japan
| | - Tsuyoshi Watanabe
- Department of Internal Medicine III, School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan
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Kudo S, Nakaya I, Yahata M, Soma J. [Massive colonic bleeding and crescentic glomerulonephritis in an elderly man with Henoch-Schönlein purpura]. Nihon Jinzo Gakkai Shi 2009; 51:891-896. [PMID: 19928564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 79-year-old man with an artificial anus constructed during surgical repair of colon perforation of unknown etiology in 1995 was admitted to our hospital for sudden appearance of purpura in the lower extremities. Two weeks before admission, he complained of flu-like symptoms and abdominal pain. He was diagnosed with Henoch-Schonlein purpura (HSP), which responded to treatment with 30 mg day oral prednisolone (PSL). Subsequently, however, rapid deterioration of renal function associated with severe hematuria and proteinuria was noted. Renal biopsy on hospitalization day 14 showed cellular crescent formation in more than half of the glomeruli with granular deposits of IgA, C3 and fibrinogen in the mesangium and on the capillary walls. PSL was tapered to 20 mg day from hospitalization day 14 because of a further decrease in purpura and a decrease in C-reactive protein. On hospitalization day 19, serum creatinine increased to 3.1 mg dL and a massive bloody stool was observed. Colonoscopy revealed extensive oozing from the colonic mucosa around the artificial anus. Since the bleeding was considered to result from HSP activity, methylprednisolone pulse therapy was applied, followed by increasing the dose of oral PSL to 30 mg/day. Co-administration of cyclophosphamide (25 mg day) from hospitalization day 39 led to improvement of renal dysfunction and a decrease in proteinuna at the outpatient clinic.
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Affiliation(s)
- Shun Kudo
- Department of Nephrology, Iwate Prefectural Central Hospital, Iwate, Japan
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Abstract
BACKGROUND Tranilast is an antifibrotic drug known to suppress collagen synthesis by fibroblasts by interfering with the effects of TGF-beta. We recently reported that it slowed the progression rate of advanced diabetic nephropathy (DN) by reducing the accumulation of collagens in renal tissue. The present study was undertaken to examine the effect of tranilast on early-stage DN. METHODS Among out-patients with diabetes mellitus, we selected patients with (i) urinary albumin excretion of 30-1000 mg/g creatinine (/gCr) in the first morning urine, (ii) serum creatinine (SCr) < or =1.2 mg/dl and no haematuria and (iii) currently taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twenty patients fulfilled the criteria, of whom 10 were selected at random and commenced on tranilast [100 mg, 3 times daily; T(+) group]. The remaining 10 patients comprised the T(-) group. Excretion of both urinary type IV collagen (U-IV) and albumin (U-A) in the first morning urine was measured every 3 months. The follow-up period was 1 year. RESULTS At baseline, no significant differences were observed in SCr, HbA(1c), blood pressure and U-A excretion between the T(+) and T(-) groups, but U-IV excretion in the T(+) group was higher than in the T(-) group (6.4 +/- 0.66 vs 3.7 +/- 0.36 microg/gCr, mean +/- SEM, P < 0.01). At 1 year, SCr was not different from the baseline in either group. In the T(+) group, however, excretion rates of both U-IV and U-A tended to decrease with time, and after 1 year, were significantly decreased compared with excretion at baseline (U-A: 279 +/- 78 to 191 +/- 62 mg/gCr; P = 0.049, U-IV: 6.4 +/- 0.66 to 4.4 +/- 0.99 microg/gCr; P = 0.02). In contrast, in the T(-) group, excretion of both U-A and U-IV tended to increase with time. The changes of both U-A and U-IV excretions in the two groups took statistically different trends through tranilast treatment (P = 0.01 and P = 0.04, respectively). CONCLUSIONS Our results suggest that tranilast could be therapeutically beneficial in early-stage DN.
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Affiliation(s)
- Jun Soma
- Department of Nephrology, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka 020-0066, Japan.
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Abstract
Oxidative stress and inflammatory cytokines such as monocyte chemoattractant protein 1 (MCP-1), TGF-beta, and IL-2 are supposed to play crucial roles in the pathogenesis of insulin resistance (IR). Tranilast is an anti-allergic drug which exerts anti-inflammatory and anti-angiogenesis effects through inhibition of expression of MCP-1, TGF-beta, and antigen-induced IL-2 lymphocyte responsiveness. It also possesses a certain antioxidant activity. Considering the above facts and in view of its safety, tranilast may prove invaluable in the treatment of IR.
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Affiliation(s)
- M R Namazi
- Dermatology Department, Shiraz University of Medical Sciences, P.O. Box 71955-687, Shiraz, Iran.
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Soma J, Sato K, Sakuma T, Saito H, Sato H, Sato T, Abbas A, Aucouturier P. Immunoglobulin γ3-heavy-chain deposition disease: report of a case and relationship with hypocomplementemia. Am J Kidney Dis 2004; 43:E10-6. [PMID: 14712467 DOI: 10.1053/j.ajkd.2003.09.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors describe a 54-year-old woman presenting with proteinuria, hematuria, and hypocomplementemia whose renal biopsy results showed diffuse increase in mesangial matrix and nodular formations in several glomeruli with the deposition of immunoglobulin gamma3-heavy-chain and complement components C1q and C3 in the glomeruli and on the tubular basement membranes, without associated light-chain deposits. Staining for the constant domains of gamma-heavy-chain showed a deletion of the first constant domain (CH1). These findings were consistent with those of gamma-heavy-chain deposition disease (gamma-HCDD). The patient was treated monthly with melphalan and prednisolone although a bone marrow aspirate did not show findings suggestive of plasmacytoma. Six courses of melphalan and prednisolone therapy resulted in a marked reduction of urinary protein excretion and marked rise of complement levels. The current case is the fourth HCDD patient reported featuring gamma3-heavy-chain deposition who showed severe hypocomplementemia and responded to chemotherapy with improved renal parameters and complement levels. A review of previously reported cases of HCDD showed that some but not all HCDD cases were associated with hypocomplementemia. The authors also discuss here the relationship of HCDD to hypocomplementemia.
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Affiliation(s)
- Jun Soma
- Department of Nephrology, Iwate Prefectural Central Hospital, Morioka, Japan.
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Soma J, Sato K, Suzuki M, Segawa Y, Miyate Y. Effect of sivelestat, an inhibitor of neutrophil elastase, on rapidly progressive glomerulonephritis. Clin Nephrol 2003; 60:149-50. [PMID: 12940621 DOI: 10.5414/cnp60149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Soma J, Sato K, Sakuma T, Saito H, Sato H. Focal-segmental dense deposit disease with prolonged asymptomatic hematuria. Clin Nephrol 2003; 60:66-8. [PMID: 12872865 DOI: 10.5414/cnp60066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
BACKGROUND Tranilast, N-(3,4-dimethoxycinnamoyl) anthranilic acid, suppresses collagen synthesis by various cells, including macrophages and fibroblasts, by interfering with the actions of transforming growth factor-beta 1. We investigated the effect of tranilast on progression of diabetic nephropathy (DN), since this process is associated with accumulation of collagens in the glomerulus and interstitium. METHODS Tranilast (100 mg, 3 times daily) was administered to 9 outpatients with advanced DN who were receiving an angiotensin-converting enzyme inhibitor or an angiotensin II receptor antagonist and who exhibited a progressive decline in renal function. The decline in renal function before and during tranilast treatment was evaluated for each patient on the basis of the slope in reciprocal serum creatinine (1/S(Cr)) over time. Urinary type IV collagen (U-IV.C) and protein (U-P) excretions were measured just before commencement of tranilast treatment and every 2 months during the treatment. RESULTS One male patient dropped out soon after commencement of tranilast treatment due to development of lung cancer, and hemodialysis was introduced in one female patient 6 months after the start of treatment. In the 8 patients who did not drop out, 1/S(Cr) was significantly less steep during tranilast treatment than before treatment (-0.00748 +/- 0.00700 vs. -0.01348 +/- 0.00636 dl/mg/month, respectively; p = 0.0374). U-IV.C and U-P tended to decrease with time, although the decrease was statistically insignificant. CONCLUSIONS Our data suggest that tranilast treatment may suppress accumulation of collagens in renal tissue and may be therapeutically useful for reducing the progression of advanced DN.
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Affiliation(s)
- Jun Soma
- Second Department of Internal Medicine, Iwate Prefectural Central Hospital, Ueda, Morioka, Japan.
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Soma J, Sato H, Ootaka T, Saito T. Cellular interactions in the pathogenesis of human proliferative glomerulonephritis. The role of beta-2 integrin-expressing leukocytes. Nephron Clin Pract 2003; 92:515-21. [PMID: 12372932 DOI: 10.1159/000064098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jun Soma
- Second Department of Internal Medicine, Iwate Prefectural Central Hospital, Morioka, Japan.
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Jin S, Ootaka T, Soma J, Sato T, Sato H, Ito S, Saito T. Role of beta2 integrins in glomerular leucocytes in Henoch-Schoenlein purpura nephritis: An age-matched comparative study with immunoglobulin A nephropathy. Nephrology (Carlton) 2002. [DOI: 10.1046/j.1440-1797.2002.00108.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ohtaka A, Ootaka T, Sato H, Soma J, Sato T, Saito T, Ito S. Significance of early phenotypic change of glomerular podocytes detected by Pax2 in primary focal segmental glomerulosclerosis. Am J Kidney Dis 2002; 39:475-85. [PMID: 11877566 DOI: 10.1053/ajkd.2002.31391] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In primary focal segmental glomerulosclerosis (FSGS), phenotypic alteration of podocytes is important for the development of cellular lesions (CLs), which precede glomerular scar formation. WT1 and Pax2 are transcription factors involved in kidney development and phenotypic regulation of glomerular epithelial cells. However, the role of WT1 and Pax2 in the development of CLs in primary FSGS is unclear. Using immunohistochemistry, the expression of WT1, Pax2, and cytokeratin (CK), an epithelial marker never found in normal podocytes, was examined in 35 biopsy samples of primary FSGS. Segmental lesions were categorized as: (1) classic segmental scar (CS), (2) CL, and (3) monolayer epithelial (ME) lesion. In normal glomeruli, WT1 was strongly positive in podocytes and weakly positive in parietal epithelium of Bowman's capsule. Pax2 was strongly positive in parietal epithelium of Bowman's capsule, but never expressed in podocytes. Expression of WT1, Pax2, and CK was scantly positive in CSs. WT1 expression was decreased in CLs compared with unaffected podocytes, but Pax2 and CK were strongly expressed in CLs and podocytes of morphologically unaffected tufts in cases with CLs. WT1 expression was strong, as well as Pax2 and CK, in ME lesions. Clinically, urinary protein levels were significantly greater, and the interval from clinical onset to biopsy was significantly shorter in patients with CLs. These results suggest that re-expression of Pax2 in podocytes resulting in phenotypic change to a different epithelial form is one of the important changes for the development of CLs and ME lesions. Alteration from WT1 to Pax2 in podocytes may have an important role in the initiation of glomerular injury in primary FSGS.
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Affiliation(s)
- Akihiko Ohtaka
- Department of Nephrology, School of Medicine, Tohoku University, Sendai, Japan.
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43
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Lombardi M, Kvaerness J, Torheim G, Soma J, Cellerini F, Consalvo M, Landini MC, Cecchi CA, Michelassi C, Skjaerpe T, Jones RA, Rinck PA, L'Abbate A. Relationship between function and perfusion early after acute myocardial infarction. Int J Cardiovasc Imaging 2001; 17:383-93. [PMID: 12025952 DOI: 10.1023/a:1011980503689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To assess the relationship between baseline left ventricle function, functional reserve and resting myocardial perfusion in patients with acute myocardial infarction (AMI). After AMI the presence of dysfunctioning but viable myocardium plays a determinant role in clinical outcome. Regional ventricular function was evaluated by echocardiography both in resting conditions and during dobutamine infusion (10 microg/kg/min). Perfusion was assessed by magnetic resonance imaging in a single slice approach where the first pass of an intravenously injected bolus of gadolinium-based contrast agent was followed through six regions of interest within the myocardium. In each patient a region with normal function was used as reference and the cross-correlation coefficient (CCC), which described the myocardial perfusion relatively to the reference region (CCC = 1 means equivalent perfusion), was obtained for the other five myocardial regions. Twenty-two patients were enrolled into the study. Sixty-one segments had normal function and normal perfusion (CCC = 0.92+/-0.23). The perfusion deficit was more marked in the 29 regions with resting akinesia-dyskinesia than in the 20 hypokinetic regions (CCC = 0.71+/-0.45 vs. 0.84+/-0.23; p < 0.05). Out of the 29 regions with resting akinesia-dyskinesia the 13 segments which showed functional improvement following dobutamine had a higher resting perfusion than the 16 segments which were unresponsive to dobutamine (CCC = 0.83+/-0.32 vs. 0.61+/-0.52, p < 0.05). Similarly, out of the 20 regions with resting hypokinesia the 11 segments having functional reserve showed an higher resting perfusion than the segments which did not (0.96+/-0.21 vs. 0.69+/-0.19; p < 0.05). Early after AMI, the perfusion deficit reflects the severity of the mechanical dysfunction. In regions with baseline dyssynergy resting perfusion is, in general, higher when contractile reserve can be elicited by stress-echo.
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Affiliation(s)
- M Lombardi
- CNR Clinical Physiology Institute, Pisa, Italy.
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Tikku AP, Soma J. Emergence of a new threat: Latex allergy - A case report. Endodontology 2001. [DOI: 10.4103/0970-7212.351798] [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] [Indexed: 11/04/2022] Open
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Soma J, Angelsen BA, Techn D, Aakhus S, Skjaerpe T. Sublingual nitroglycerin delays arterial wave reflections despite increased aortic "stiffness" in patients with hypertension: a Doppler echocardiography study. J Am Soc Echocardiogr 2000; 13:1100-8. [PMID: 11119278 DOI: 10.1067/mje.2000.109686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Venodilatation with consequent reduction in left ventricular filling and end-diastolic wall stress is an important mechanism for the beneficial effects of nitroglycerin in ischemic heart disease and in left ventricular failure. The effects of sublingual nitroglycerin on arterial pulsatile hemodynamics are less well defined. Doppler echocardiography and the calibrated subclavian artery pulse tracing were used to assess hemodynamics in subjects with sustained arterial hypertension (n = 25) before and 5 to 10 minutes after sublingual deposition of 0.5 mg glyceryl trinitrate. Aortic characteristic impedance was calculated by averaging the modulus of the input impedance (ratio of pressure to flow) at high frequencies and by calculating the ratio of pressure and flow increments during upstroke. The pressure wave was split into forward and backward components, and the reflection coefficient (the ratio of backward to forward pressures) was calculated. Parameters of the arterial bed were estimated by using 2- and 3-element Windkessel models. Nitroglycerin delayed the return of arterial wave reflections by 17% (P =.02) and increased aortic characteristic impedance by 20% (P =. 01), but it did not influence total arterial compliance. Mean arterial pressure decreased 7% (P =.0001), but pulse pressure did not change. Stroke volume and the acceleration time of aortic root flow decreased by 13% (P =.0001) and 8% (P =.01), respectively. Cardiac output decreased 7% (P =.01), despite an increase in heart rate of 10% (P =.0001). Peripheral resistance tended to decrease (4%, P =.06). Thus, in subjects with sustained hypertension, sublingual nitroglycerin dilates peripheral, predominantly muscular arteries with a subsequent delayed return of reflected pressure waves. Reflex activation of the sympathetic nervous system with consequent increased acceleration of left ventricular ejection seems to counteract the effect of reduced mean arterial pressure (distending pressure) with respect to the "stiffness" of the aorta.
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Affiliation(s)
- J Soma
- Department of Medicine, Section of Cardiology, University Hospital of Trondheim, Norway.
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Soma J, Ootaka T, Sato H, Ito S, Saito T. Tubulointerstitial changes are less important in membranoproliferative glomerulonephritis than in IgA nephropathy. Nephron Clin Pract 2000; 86:230-1. [PMID: 11015015 DOI: 10.1159/000045764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kurihara I, Soma J, Nakayama K, Sato H, Saito T. Intravenous low-dose iron administration in hemodialysis patients treated with erythropoietin: 1-year follow-up study. Nephron Clin Pract 2000; 86:200-1. [PMID: 11014998 DOI: 10.1159/000045747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kurihara I, Yamaguchi Y, Soma J, Sato H, Ito S, Saito T. [Two aged patients with chronic renal failure and chronic disseminated intravascular coagulation secondary to aortic aneurysms: effect of continuous subcutaneous heparin infusion therapy]. Nihon Jinzo Gakkai Shi 2000; 42:603-7. [PMID: 11155705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
We describe here two cases of chronic disseminated intravascular coagulation(DIC) secondary to aortic aneurysms. The patients were 78- and 84-year-old males, who visited our hospital to receive hemodialysis therapy for chronic renal failure probably due to nephrosclerosis. They had mild bleeding tendency and thrombocytopenia(< 10 x 10(4)/microliter). Coagulation test revealed the findings of chronic DIC in both patients, and computed tomography showed abdominal and thoracoabdominal aortic aneurysms with mural thrombi, respectively. In one patient, subcutaneous hemorrhage after vascular access surgery had continued for a month. However, the hemorrhage and swelling of the limb disappeared after continuous subcutaneous heparin infusion(CSHI) therapy in a daily dose of 10,000-14,000 unit. These findings suggest that chronic DIC secondary to aortic aneurysm should be considered when bleeding tendency and thrombocytopenia are observed in aged patients, and that CSHI is the choice of therapy for the bleeding tendency of chronic DIC.
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Affiliation(s)
- I Kurihara
- Department of Internal Medicine, Miyagino Hospital, Sendai Red Cross Hospital, Japan
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Soma J, Saito T, Taguma Y, Chiba S, Sato H, Sugimura K, Ogawa S, Ito S. High prevalence and adverse effect of hepatitis C virus infection in type II diabetic-related nephropathy. J Am Soc Nephrol 2000; 11:690-699. [PMID: 10752528 DOI: 10.1681/asn.v114690] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Over a 4-yr period in the northeast region of Japan (Tohoku), 3643 patients for whom a renal biopsy was available were screened. In addition, 2370 biopsied patients for whom hepatitis C virus (HCV) serology was available were evaluated. The prevalence of HCV infection was investigated in the 2370 biopsied patients. The highest prevalence of HCV infection was found in type II diabetic-related glomerulosclerosis (II-DGS) (24 of 123; 19.5%). At renal biopsy, clinical and laboratory findings and histologic parameters were comparable between the HCV-positive and -negative II-DGS groups. After renal biopsy, the decline of renal function reflected by the slope of reciprocal serum creatinine (1/S(Cr)) was significantly greater in the HCV-positive group than in the HCV-negative group (P = 0.001). The log-rank test performed on the renal survival curves showed a significant difference in the two groups (P = 0.019). According to a multiple linear regression analysis adjusted for the effect of age, gender, BP, HbA1c, urinary protein excretion, and histologic parameters as covariates, urinary protein excretion (P = 0.011), severe arteriolar hyalinosis (P = 0.006), and HCV infection (P < 0.001) were significantly associated with 1/S(Cr) slope. Finally, HCV infection was randomly examined in 545 outpatients and inpatients with type II diabetes mellitus who did not undergo renal biopsy. Of these, 56 patients were positive for HCV antibody (10.3%), and their proteinuria was heavier than in 489 HCV-negative patients (P = 0.001). This study reveals that HCV infection is present at a high rate in type II diabetic-related nephropathy and may have an adverse effect on the progression of the disease.
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Affiliation(s)
- Jun Soma
- The Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takao Saito
- The Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshio Taguma
- Department of Nephrology, Sendai Shakaihoken Hospital, Sendai, Japan
| | - Shigemi Chiba
- Department of Nephrology, Sendai Shakaihoken Hospital, Sendai, Japan
| | - Hiroshi Sato
- The Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuhiko Sugimura
- The Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Susumu Ogawa
- The Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sadayoshi Ito
- The Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
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Saito T, Ootaka T, Sato H, Soma J, Sato T, Ito S. Do proteinuria and hypertension at biopsy influence long-term outcome of IgA nephropathy? Nephrology (Carlton) 2000. [DOI: 10.1046/j.1440-1797.1999.00092.x] [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] [Indexed: 11/20/2022]
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