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Morita K, Shinzato T, Endo Y, Suzuki M, Yoshida H, Sone J, Nagai K. A case of unusual renal manifestation in a patient with neuronal intranuclear inclusion disease treated with steroids. Clin Case Rep 2023; 11:e7730. [PMID: 37564608 PMCID: PMC10410123 DOI: 10.1002/ccr3.7730] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disorder characterized by intranuclear inclusions. Kidney injury involvement and successful treatment for NIID have rarely been reported. A NIID patient developed crescentic IgA nephropathy. Steroid therapy resolved digestive symptoms and recovered renal function. Steroids are considered for concomitant symptoms of NIID.
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Affiliation(s)
- Keisuke Morita
- Department of NephrologyShizuoka General HospitalShizuokaJapan
| | | | - Yuzo Endo
- Department of Diagnostic PathologyShizuoka General HospitalShizuokaJapan
| | - Makoto Suzuki
- Department of Diagnostic PathologyShizuoka General HospitalShizuokaJapan
| | | | - Jun Sone
- Department of Neuropathology, Institute for Medical Science of AgingAichi Medical UniversityAichiJapan
| | - Kojiro Nagai
- Department of NephrologyShizuoka General HospitalShizuokaJapan
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2
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Shibata K, Shinzato T, Toma S, Nakai S, Kobayashi Y, Hashimoto T, Tamura K. Novel Capped-Needle Device: A Novel Safety Feature to Eliminate Air Bubbles in Hemodialysis. Blood Purif 2023; 52:54-59. [PMID: 35468597 PMCID: PMC9909616 DOI: 10.1159/000524357] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Air bubbles in the dialysis circuit are rarely visible after automatic priming; however, they are often visible after the needles are manually connected to the circuit. To prevent this issue, we thought to prime needles with a circuit at automatic priming by the hemodialysis machine. In order to achieve this idea, we designed and manufactured a novel capped needle to connect the needles to the extracorporeal circuit before the automatic priming of the hemodialysis machine. This study investigated the effectiveness of this novel capped needle and compared it with the conventional method for preventing air bubble contamination. METHODS We tested novel capped needles ten times to evaluate whether the dialysis machine works appropriately and removes air bubbles even with the attached capped needle. Next, we performed 25 trials using the conventional method, in which skilled nurses manually connect the needle. In both methods, we thoroughly counted the air bubbles with our naked eyes. We predicted that the capped needle would leave few bubbles in the circuit. In order to evaluate fewer bubbles, we conducted an additional experiment using a microparticle counter to measure the size and number of the bubbles. RESULTS We thoroughly searched for air bubbles during each of the ten tests but could not find any bubbles visible to the naked eye. In the conventional method, bubbles were visible in 29 out of 50 cases. The bubble count was significantly lower in the capped-needle method than in the conventional method (p < 0.0001, Pearson's χ2 test). In the additional experiments using the microparticle counter, the average remaining air volume in the extracorporeal circuit was 0.0999 ± 0.2438 nL when the priming was performed using the novel capped needles. CONCLUSION The novel capped needle eliminated all visible bubbles efficiently and effectively; therefore, it could be a valuable device for hemodialysis treatment. The reduction of air from the dialysis circuit may improve patient prognosis.
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Affiliation(s)
| | | | | | - Shigeru Nakai
- Faculty of Clinical Engineering Technology, Fujita Health University School of Health Sciences, Toyoake City, Japan
| | - Yusuke Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama City, Japan
| | - Tatsuo Hashimoto
- Graduate School of Dentistry, Kanagawa Dental University, Yokosuka City, Japan
| | - Koichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama City, Japan
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Shibata K, Shinzato T, Nakai S, Toma S, Kobayashi Y, Hashimoto T. MO774: Clean Buttonhole Puncture Prevents Infection. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac080.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The buttonhole (BH) puncture has been criticized for the problem of infection. We considered that at least one of the causes for the higher infection rate in the BH technique might be insufficient removal of scabs. The scab pushed into the BH by a dull needle provides optimal temperature, moisture and nutrition for the germs, and protects them from immune system attack. We considered that the infection would be established if enough bacteria were inside when the scab was dissolved. Usually, scabs covering the BH entry site are removed with needles or forceps, and this procedure tends to injure the entry site so that scabs stick more firmly to the site after that. We reported the effect of the moist wound healing procedure on the BH entry site to solve this problem from the 49th ERA-EDTA congress. Since that time, we have continued this method to the BH entry site in Yokohama Minami Clinic. After transferring to the Toshin Clinic in 2019, we faced the problem of difficulty in performing the BH method because nurses were not familiar with removing the scab. For this reason, we had to ask patients who wanted the BH procedure to soak the scabs in the bathtub and wash it with a nylon towel until the scab was gone.
METHOD
This study was conducted at Toshin Clinic from April 2021 to November 2021. In most patients, fistula vessels were punctured by either the BH or the rope-ladder method. But, in some patients, however, fistula vessels were punctured by both methods. For the BH method, supercath clump cath P painless needles were used. After hemostasis was achieved, we put a small amount of white petroleum jelly. We instructed patients to wash the puncture site at home, especially when they took a bath, using a nylon towel until the blistered scabs were gone. Patients were also instructed to apply the white petrolatum on the site after washing the site. Thanks to this method, in many patients, scabs could be wiped off easily.
RESULTS
At the end of November 2021 119 patients were punctured by the rope ladder method (79 males/40 females, 70.2 years old, 107 months on dialysis) and 35 patients by the BH method (29/6, 68.9 years old, 93.3 months). We have punctured 66 925 times by the rope-ladder method and 8011 by the BH method. One local infection requiring hospitalization debridement occurred in the rope-ladder group and one local infection occurred in the BH group. There was no significant difference between the two groups (P = 1.0, Pearson's chi-squared test).
CONCLUSION
Infection can be prevented by continued moist treatment of the BH and vigorous self-cleaning. I would like to call this method the "clean buttonhole method" because it keeps the BH clean in appearance, unlike the conventional dirty BH method where the scabs are dried and have to be plucked off.
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Affiliation(s)
| | | | - Shigeru Nakai
- Kutsukake Nursery, Faculty of Clinical Engineering Technology, Toyoake, Japan
| | | | - Yusuke Kobayashi
- Yokohama City University Hospital, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
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Aoki T, Nakai S, Uchino J, Shibata K, Shinzato T, Masakane I, Toma S, Fukui H, Matsuoka T, Kato S, Ookawara S, Ito T. Comparison of Body Fluid Volumes Determined by Kinetic Modeling and by Bioimpedance Spectroscopy. Blood Purif 2022; 51:866-874. [DOI: 10.1159/000521563] [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] [Received: 06/10/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> The bioimpedance spectroscopy (BIS) method is used in individual patients requiring body fluid volume measurement. In a hemodialysis facility, however, regular screening of body fluid volumes is also necessary. Such screening, by kinetic modeling, may become possible by calculating distribution volumes of urea and uric acid from regular blood test results. <b><i>Objective:</i></b> The aim is to compare uric acid distribution volumes with BIS-extracellular volume, urea distribution volume with BIS-total body water, and difference between urea and uric acid distribution volumes with BIS-intracellular volume. <b><i>Methods:</i></b> We reanalyzed stored blood test data of 53 hemodialysis patients obtained together with BIS data of the same patients in our previous study. <b><i>Results:</i></b> Significant correlations were found between urea distribution volume and total body water predicted by the BIS method, between uric acid distribution volume and extracellular volume predicted by the BIS method, and between the difference of uric acid distribution volume from urea distribution volume and intracellular volume predicted by the BIS method. In Bland-Altman analysis, comparison of each pair showed no systematic error. The mean difference between each pair was minimal. <b><i>Conclusion:</i></b> Fluid volumes in different body compartments can be estimated by kinetic modeling as well as by the BIS method.
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Shimizu T, Katano S, Nishida S, Kinoshita Y, Shinzato T, Sakuma Y, Iwami D. Development of strangulation ileus associated with the ureter of the transplanted kidney 18 years after kidney transplantation. IJU Case Rep 2021; 4:307-309. [PMID: 34497991 PMCID: PMC8413218 DOI: 10.1002/iju5.12333] [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: 04/05/2021] [Accepted: 06/06/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION After kidney transplantation, patients should be treated with caution and monitored for surgical complications. Among the possible surgical complications, strangulation ileus after kidney transplantation is rare. CASE PRESENTATION A 59-year-old woman who had undergone kidney transplantation at 41 years of age presented to our hospital with lower abdominal pain. She was diagnosed with strangulation ileus and underwent emergency surgery. In the lower right abdomen, the small intestine was compressed by cord-like tissue running from the intraperitoneal space to the retroperitoneal space. We confirmed that the cord-like tissue was the ureter of the transplanted kidney. The necrotic small intestine was resected, and ureter-ureteral anastomosis of the ureter of the transplanted kidney was performed. CONCLUSION All surgical procedures, including ureteroneocystostomy, require careful attention. The occurrence of some postoperative surgical complications can be prevented by carefully performing the kidney transplantation procedure.
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Affiliation(s)
- Toshihiro Shimizu
- Department ofRenal Surgery and TransplantationJichi Medical UniversityTochigiJapan
| | - Saki Katano
- Department ofRenal Surgery and TransplantationJichi Medical UniversityTochigiJapan
| | - Sho Nishida
- Department ofRenal Surgery and TransplantationJichi Medical UniversityTochigiJapan
| | - Yoshitaka Kinoshita
- Department ofRenal Surgery and TransplantationJichi Medical UniversityTochigiJapan
| | - Takahiro Shinzato
- Department ofRenal Surgery and TransplantationJichi Medical UniversityTochigiJapan
| | - Yasunaru Sakuma
- Department ofGastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
| | - Daiki Iwami
- Department ofRenal Surgery and TransplantationJichi Medical UniversityTochigiJapan
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Shibata K, Shinzato T, Toma S, Nakai S, Tamura K. MO665THE BRAND-NEW NEEDLE CAP ELIMINATES ALL VISIBLE AIR BUBBLES DURING THE AUTOMATIC PRIMING PROCESS OF HEMODIALYSIS MACHINES. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab099.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The air contamination from the dialysis circuit into the patient's body is an unsolved serious problem. Recently, Automatic priming function of dialysis machines is widely used. There are rarely any air bubbles left in the extracorporeal circuit after automatic priming of the dialysis machines. To use this method, the arterial and venous sides of the extracorporeal circuit are connected to create a closed circuit so that dialysate can circulate and overflowed through a line from this closed circuit. However, air bubbles may enter when disconnecting the closed extracorporeal circuit and attaching the needles. We tried to solve this problem by simply connecting the arterial and venous needles to the extracorporeal closed circuit before the process of automatic priming process. To prime the whole extracorporeal circuit with needles, we had made a brand-new suitable cap of the needle, which is tightly connected with a needle and has an open end. (Fig) This special cap allows the needle to be incorporated into the closed circuit prior to the automatic priming process, allowing the dialysis machine to completely remove the air during priming process. The purpose of this study is to present the details of this new method and compare its effectiveness in preventing air bubble contamination between the traditional method and this new method.
Method
A prospective, non-randomized, comparative study was conducted to verify whether air remained grossly visible after the needle was connected to the extracorporeal circuit.
The traditional method: DCS-100NX (Nikkiso Co Ltd, Tokyo Japan) was used for extracorporeal circuit priming. After the automatic priming was finished. Nurses disconnect the arterial and venous side of the extracorporeal circuit and connect both ends to the needles by hands. The nurse operates the dialysis machine to blow the small amount of dialysate out of the needle and tried to remove the air. It takes nearly 2minutes in each case. We examined the extracorporeal circuits consecutively.
New cap-based method: The needles were connected to the closed circuit with the new cap and auto-primed by the dialysis machine N100. Automatic priming, including the needle were performed consecutively.
In each method, we thoroughly checked for any remaining macro bubbles with the naked eye. Since bubbles in the extracorporeal circuit on the arterial side are likely to be supplemented by the air trap chamber, only bubbles on the venous side were compared.
Results
The study was conducted in October 15th to 24th 2020 at the Yokohama Minami Clinic.
The traditional method: We checked 50 extracorporeal circuits consecutively. There were bubbles in the venous side of the extracorporeal circuits 29 times out of 50 times.
New cap-based method: 10 consecutive automatic priming, including the needle was performed. DCS-100NX was used as the dialysis machine. There were no bubbles visible to the naked eye in the arterial and venous side of the circuit.
Statistical Results
There was a statistically significant difference of the bubble count between the traditional method and new cap-based method. (p=0.0001, Pearson's chi-square test)
Conclusion
All visible bubbles were removed automatically by simply connecting the needles using this brand-new cap before a process of automatic priming. This easy-to-use and highly effective cap could be considered an essential device for hemodialysis treatment like seat belts in automobiles.
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Affiliation(s)
| | | | | | - Shigeru Nakai
- Fujita Health University, Graduate School of Health Sciences
| | - Koichi Tamura
- Yokohama City University Hospital, Department of Medical Science and Cardiorenal Medicine, Japan
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Nakai S, Ozawa K, Shibata K, Shinzato T. MO656CORRELATION BETWEEN CHANGES IN THE BODY FLUID VOLUME CALCULATED BY THE URIC ACID KINETIC MODEL AND CHANGES IN THE BODY WEIGHT*. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab099.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Uric acid (UA) is a solute unable to cross the cell membranes in general tissues by any of simple diffusion, facilitated diffusion or active transport. These facts imply that UA distribution volume (UDiV) equals to the extracellular fluid volume (ECFV). We have developed a method for calculating UDiV from serum uric acid levels before and after hemodialysis based on a uric acid kinetic model (Shinzato T, Int J Artif Organs 2020). Urea is evenly distributed throughout the body fluids. Therefore, the total body fluid volume (TBFV) can be calculated by using the same method as the calculation of UDiV for the serum urea level. The remaining body fluid volume, which is TBFV minus UDiV, is considered to reflect the intracellular fluid volume (ICFV). In this study, we clarified the relationship between the amount of change over time in UDiV and ICFV calculated by the uric acid kinetic model and the amount of change over time in the actual body weight of hemodialysis patients.
Method
Subjects were 1,101 patients with chronic maintenance hemodialysis. UDiV and ICFV before and after dialysis were calculated for two time points, December 2019 and June 2020.
Results
The amount of change in UDiV per body during the dialysis session showed a very good correlation with the amount of body weight change during the same dialysis (UDiV change = 0.950 x body weight change - 0.158, R-square 0.90, p < 0.0001). The amount of change in ICFV during the 6 months from December 2019 to June 2020 showed a good correlation with the amount of change in post-dialysis body weight during the same period (ICFV change = 0.270 x post-dialysis body weight change + 0. 240, R-square 0.21, p <0.0001).
Conclusion
These results suggest that the body fluid volume calculated by the uric acid kinetic model has high accuracy.
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Affiliation(s)
- Shigeru Nakai
- Fujita Health University School of Health Sciences, Faculty of Clinical Engineering Technology, Toyoake, Aichi, Japan
| | - Kiyoshi Ozawa
- Shinzinkai Yokosuka Clinic, Internal medicine, Yokosuka city, Kanagawa, Japan
| | - Kazuhiko Shibata
- Meishinkai Toshin Clinic, Internal medicine, Yokohama city, Kanagawa, Japan
| | - Takahiro Shinzato
- Daiko Biomedical Engineering Research Institute, Nagoya city, Aichi, Japan
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Shimizu T, Sugihara T, Kamei J, Takeshima S, Kinoshita Y, Kubo T, Shinzato T, Fujimura T, Yagisawa T. Predictive factors and management of urinary tract infections after kidney transplantation: a retrospective cohort study. Clin Exp Nephrol 2020; 25:200-206. [PMID: 33030613 DOI: 10.1007/s10157-020-01974-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most common infectious complications in kidney transplant recipients. The aims of our study were to identify possible predictive factors for UTI and advocate for the management of UTI after kidney transplantation (KT). METHODS Between January 2013 and December 2018, 182 adult patients with end-stage kidney disease who underwent KT were retrospectively analyzed. Patients who had urinary symptoms and positive urine culture were diagnosed with UTI. The types of urinary bacteria causing UTIs were also examined. RESULTS UTIs occurred in forty-one patients (25.1%), and the median time to UTI onset (UTI-free survival) after KT was 189 days. The Cox hazard regression analysis showed that the predictive factors for UTI onset were as follows: posttransplant urinary catheterization, including indwelling urinary catheterization and clean intermittent catheterization; a maximum bladder capacity before KT of less than 150 ml; and a low serum albumin level at 1 month after KT. The most common causative agent was Escherichia coli (56.6%), followed by Enterococcus spp. (15.6%) and Klebsiella spp. CONCLUSIONS Kidney transplant recipients with prolonged postoperative malnutrition, posttransplant voiding dysfunction and/or urinary storage disorder had an increased risk of UTI. Bladder function tests, such as uroflowmetry, postvoid residual urine tests, and urodynamic tests, were needed to predict UTI. For patients with malnutrition, care should be taken to ensure sufficient calorie intake. Kidney transplant recipients who develop UTI should be treated as complicated UTI patients.
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Affiliation(s)
- Toshihiro Shimizu
- Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-city, Tochigi, 329-0498, Japan.
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Shimotsuke-city, Tochigi, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Shimotsuke-city, Tochigi, Japan
| | - Saki Takeshima
- Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-city, Tochigi, 329-0498, Japan
| | - Yoshitaka Kinoshita
- Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-city, Tochigi, 329-0498, Japan
| | - Taro Kubo
- Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-city, Tochigi, 329-0498, Japan
| | - Takahiro Shinzato
- Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-city, Tochigi, 329-0498, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke-city, Tochigi, Japan
| | - Takashi Yagisawa
- Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-city, Tochigi, 329-0498, Japan
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Kinoshita Y, Yagisawa T, Sugihara T, Hara K, Takeshima S, Kubo T, Shinzato T, Shimizu T, Suzuki M, Maeshima A, Kamei J, Fujisaki A, Ando S, Suzuki M, Kume H, Fujimura T. Clinical outcomes in donors and recipients of kidney transplantations involving medically complex living donors - a retrospective study. Transpl Int 2020; 33:1417-1423. [PMID: 32654198 DOI: 10.1111/tri.13699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
We retrospectively compared the post-transplantation graft survival and the donor's estimated glomerular filtration rates (eGFRs) following living donor kidney transplantations (LDKTs) involving medically complex living donors (MCLDs) (the elderly and patients with obesity, hypertension, diabetes mellitus, or reduced renal function) and standard living donors (SLDs). The clinical data on patients who underwent LDKTs at our institution from 2006-2019, including 192 SLDs and 99 MCLDs, were evaluated. Regarding recipients, the log-rank test and multivariable Cox proportional hazards analyses showed a higher incidence of overall and death-censored graft loss in the recipients who received kidneys from MCLDs (Hazard ratio = 2.16 and 3.25, P = 0.015 and 0.004, respectively), after adjusting for recipient-related variables including age, sex, duration of dialysis, ABO compatibility, and donor-specific antibody positivity. Regarding donors, a linear mixed model showed significantly lower postdonation eGFRs (-2.25 ml/min/1.73 m2 , P = 0.048) at baseline in MCLDs than SLDs, but comparable change (difference = 0.01 ml/min/1.73 m2 /year, P = 0.97). In conclusion, although kidneys from MCLDs are associated with impaired graft survival, the donation did not adversely affect the MCLDs' renal health in at least the short-term. LDKTs involving carefully selected MCLDs would be an acceptable alternative for recipients with no SLDs.
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Affiliation(s)
- Yoshitaka Kinoshita
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan.,Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Toru Sugihara
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Konan Hara
- Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Saki Takeshima
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Taro Kubo
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takahiro Shinzato
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Toshihiro Shimizu
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Michiko Suzuki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Jun Kamei
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Akira Fujisaki
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Satoshi Ando
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
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Shibata K, Nakai S, Masakane I, Ito T, Ozawa K, Maeda K, Matusuoka T, Shinzato T. P1088BRAND NEW METHOD TO CALCULATE THE VOLUME OF EXTRA CELLULAR FLUID IN HEMODIALYSIS PATIENT ONLY FROM REGULAR BLOOD TEST. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Uric acid is a small molecule with molecular weight 168, but has an electrical pole which enables pass through the phospholipid bilayers of cell membranes by simple diffusion. Urate transport proteins of cell membranes (URAT1, GLUT9, OAT, MRP4, MCT9, NPT4, ABCG2) are expressed only in uric acid-excreting tissues. These findings suggest that uric acid does not pass through the cell membrane, either by diffusion or active transport. Since uric acid does not pass through cell membranes, the uric acid distribution volume (UDiV) would reflect the extracellular volume (ECV). At ASN 2018, we reported that UDiV significantly correlated with ECV predicted by the bio-impedance method measured by InBody, S 20 (Biospace Co., Ltd, Korea). However, both data were correlated, there was a large fixed error. This time, we examined the correlation with the UDiV again using the Fresenius BCM (Fresenius Medical Care, Bad Homberg, Germany), which is trusted worldwide.
Method
We calculated UDiV from regular blood test results by uric acid kinetic modeling.
This study was performed in Yokohama Minami Clinic. One hundred nine patient under hemodialysis was consented and enrolled in this study. The HD patients were 59males and 50females. 68.0±10.9years old.
We performed UDiV calculation from blood samples obtained before and after hemodialysis. Then, after the hemodialysis session, 30minutes interval was made to measure the BIA-ECV using BCM. Then, we compared UDiV with BIA-ECV .
We used least squares regression analysis and Bland–Altman analysis to compare the UDiV method and the BIA-ECV method, and the Steel test for multiple comparisons of UDiV and symptoms. All analyses were performed using JMP 9.0.2 (SAS Institute, Inc., Cary, NC, USA).
Results
There was a significant correlation between UDiV(x) and BIA-ECFV (y): (y = 0.70x +3.02, r-square = 0.61, p < 0.0001, Figure 1a). The regression line closely coincided with the line of identity. Bland–Altman analysis showed a systematic error for UDiVvs. BIA-ECV (Figure 1b). There was a significant difference between UDiVand BIA-ECV (mean difference 1.32 L, 95% CI -2.6 to 5.2 L).
Conclusion
UdiV could be a viable alternative marker of BIA-ECV for the assessment of hydration status of patients with HD.
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Kinoshita Y, Yagisawa T, Sugihara T, Takeshima S, Kubo T, Shinzato T, Shimizu T, Kamei J, Akira F, Ando S, Suzuki M, Kume H, Fujimura T. P1648CLINICAL OUTCOMES OF LIVING DONOR KIDNEY TRANSPLANTATION FROM MARGINAL DONORS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Evidence demonstrating the outcomes of living donor kidney transplantation (LDKT) from marginal donors (MDs) is limited. We retrospectively investigated the clinical outcomes of LDKT from MDs in both recipients and donors.
Method
Clinical data on patients who received LDKT in Jichi Medical University Hospital between 2006 and 2019 were extracted from the medical records. Based on the Japanese guideline for preoperative conditions of donors, they were classified as standard donors (SDs) or MDs, the latter including the elderly and patients with obesity, hypertension, diabetes mellitus, and reduced renal function. Multivariate Cox proportional hazard regression analysis for graft survival was performed using explanatory variables of the donor conditions (MD vs SD) and recipient conditions, including age, gender, duration of dialysis, ABO compatibility, and presence of donor specific antibodies. The estimated glomerular filtration rates (eGFRs) of the donors were compared using an unpaired t-test.
Results
Of the 293 donors, 195 were SDs and 98 were MDs.
Demographics and baseline characteristics of recipients and donors
Recipients of kidney transplants from MDs were associated with a higher incidence of death-censored graft loss than recipients of kidney transplants from SDs.
Kaplan-Meier plots for overall and death-censored graft survival.
Multivariate Cox proportional hazard regression analyses for overall and death-censored graft survival
The eGFRs of MDs before transplantation were significantly lower than those of SDs, while no significant differences were observed between the two groups 3- and 5-years after transplantation.
Comparison of estimated glomerular filtration rates of donors
Conclusion
While the renal prognosis of recipients of kidneys from MDs is poorer than that of recipients from SDs, donating a kidney has no adverse effects on the renal health of MDs. The present study is the most comprehensive study that examined that the outcomes of LDKT from MDs according to the Japanese guideline.
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Affiliation(s)
- Yoshitaka Kinoshita
- Jichi Medical University Hospital, Surgical Branch, Institute of Kidney Diseases, Shimotsuke, Tochigi, Japan
| | - Takashi Yagisawa
- Jichi Medical University Hospital, Surgical Branch, Institute of Kidney Diseases, Shimotsuke, Tochigi, Japan
| | - Toru Sugihara
- Jichi Medical University Hospital, Department of Urology, Shimotsuke, Tochigi, Japan
| | - Saki Takeshima
- Jichi Medical University Hospital, Surgical Branch, Institute of Kidney Diseases, Shimotsuke, Tochigi, Japan
| | - Taro Kubo
- Jichi Medical University Hospital, Surgical Branch, Institute of Kidney Diseases, Shimotsuke, Tochigi, Japan
| | - Takahiro Shinzato
- Jichi Medical University Hospital, Surgical Branch, Institute of Kidney Diseases, Shimotsuke, Tochigi, Japan
| | - Toshihiro Shimizu
- Jichi Medical University Hospital, Surgical Branch, Institute of Kidney Diseases, Shimotsuke, Tochigi, Japan
| | - Jun Kamei
- Jichi Medical University Hospital, Department of Urology, Shimotsuke, Tochigi, Japan
| | - Fujisaki Akira
- Jichi Medical University Hospital, Department of Urology, Shimotsuke, Tochigi, Japan
- The University of Tokyo, Department of Urology, Tokyo, Japan
| | - Satoshi Ando
- Jichi Medical University Hospital, Department of Urology, Shimotsuke, Tochigi, Japan
| | - Motofumi Suzuki
- The University of Tokyo, Department of Urology, Tokyo, Japan
| | - Haruki Kume
- The University of Tokyo, Department of Urology, Tokyo, Japan
| | - Tetsuya Fujimura
- Jichi Medical University Hospital, Department of Urology, Shimotsuke, Tochigi, Japan
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Shinzato T, Ohara K, Kaminaga H, Sugase T, Masuda T, Nagata D, Saki K, Kinoshita Y, Kubo T, Shimizu T, Nanmoku K, Yagisawa T. Acute Interstitial Nephritis and Acute Tubular Injury Due to a Transdermal Loxoprofen Patch. Intern Med 2020; 59:2733-2736. [PMID: 33132307 PMCID: PMC7691042 DOI: 10.2169/internalmedicine.4945-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A transdermal patch formulation of a non-steroidal anti-inflammatory drug (NSAID) used by a 44-year-old man resulted in acute interstitial nephritis and acute tubular injury. This patient also had a history of mild kidney dysfunction and osteoporosis. The NSAID patch had been prescribed after a traffic accident. He was also receiving a vitamin D analog and taking over-the-counter calcium supplements. Two months later, renal dysfunction and hypercalcemia were discovered. A renal biopsy showed acute interstitial nephritis and acute tubular injury. Once these agents were withdrawn, the renal function recovered. This is the first reported occurrence of biopsy-proven acute interstitial nephritis attributable to NSAID patch usage.
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Affiliation(s)
- Takahiro Shinzato
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
| | - Ken Ohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University Hospital, Japan
| | - Hiroaki Kaminaga
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University Hospital, Japan
| | - Taro Sugase
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University Hospital, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University Hospital, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University Hospital, Japan
| | - Katano Saki
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
| | - Yoshitaka Kinoshita
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
| | - Taro Kubo
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
| | - Toshihiro Shimizu
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
| | - Koji Nanmoku
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
| | - Takashi Yagisawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Japan
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13
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Shinzato T, kinoshita Y, Kubo T, Shimizu T, Nanmoku K, Yagisawa T. Renal allograft survival in transplant recipients with focal segmental glomerulosclerosis. J Nephropathol 2019. [DOI: 10.34172/jnp.2020.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The frequency that idiopathic focal segmental glomerulosclerosis (FSGS) recurs in renal allografts is reportedly 20-50%, but the epidemiology of secondary FSGS in this setting has scarcely been addressed. Objectives: The aim of this study was to examine the incidence, etiology, and subtypes of FSGS in renal allograft recipients and allograft survival in recipients with FSGS. Patients and Methods: As a retrospective review, we examined medical records of 359 consecutive renal allograft recipients (living donors, 329; cadaveric donors, 30). In 121 of these patients, allograft dysfunction or proteinuria prompted biopsies. We compared allograft survival in recipients with and without FSGS. We then determined histologic subtypes of FSGS using the Columbia classification and categorized FSGS as recurrent or de novo, and idiopathic or secondary. Results: Of 121 subjects who were biopsied, six with inadequate specimens (<10 glomeruli) were excluded. Only 17 of those remaining (n=115) were diagnosed as secondary FSGS. Renal allograft survival did not differ significantly in patients with or without FSGS (P=0.953). Subtypes of FSGS were as follows; not otherwise specified (NOS; n=8), collapsing (n=5), cellular (n=2), and perihilar (n=2). Conclusion: Secondary FSGS was observed in 14.5% of biopsies of renal allograft recipients and seemed no significant impact on allograft survival.
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Affiliation(s)
- Takahiro Shinzato
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Yoshitaka kinoshita
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Taro Kubo
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Toshihiro Shimizu
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Koji Nanmoku
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takashi Yagisawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan
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14
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Fujiwara SI, Ikeda T, Morita K, Shinzato T, Ishikawa N, Nakamura N, Yagisawa T, Kanda Y. Multiple myeloma derived from a kidney transplant donor who also developed myeloma after kidney donation. Am J Transplant 2019; 19:2374-2377. [PMID: 30916888 DOI: 10.1111/ajt.15373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 01/25/2023]
Abstract
Patients who undergo kidney transplantation are at increased risk of cancer due to the long-term use of immunosuppressive treatment. Postrenal transplant cancers usually originate from recipient cells, but donor-related cancers have been rarely reported. We report the case of 49-year-old woman who developed multiple myeloma of donor origin 7 years after kidney transplantation. The donor was the mother of the recipient and also developed multiple myeloma 1 year after kidney donation. The diagnosis of multiple myeloma was based on IgG lambda monoclonal protein and the infiltration of plasma cells in bone marrow. The renal biopsy did not reveal plasmacytoma in the transplanted kidney. Epstein-Barr virus DNA load was negative in peripheral blood. The patient responded to lenalidomide and dexamethasone, and subsequently received autologous stem cell transplantation. Donor chimerism was detected in the recipient marrow by short tandem repeat analysis; however, studies of Ig gene rearrangement were inconclusive due to insufficient DNA quality. The chromosomal abnormalities in the two myelomas were different. This case suggests that donor cells with myeloma-initiating potential can be transferred to a recipient via a renal graft and can lead to the development of donor-derived multiple myeloma in the recipient under immunosuppression.
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Affiliation(s)
| | - Takashi Ikeda
- Division of Hematology, Jichi Medical University, Shimotuke, Japan
| | - Kaoru Morita
- Division of Hematology, Jichi Medical University, Shimotuke, Japan
| | - Takahiro Shinzato
- Division of Renal Surgery and Transplantation, Jichi Medical University, Shimotuke, Japan
| | - Nobuo Ishikawa
- Division of Renal Surgery and Transplantation, Jichi Medical University, Shimotuke, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Jichi Medical University, Shimotuke, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Shimotuke, Japan
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15
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Nanmoku K, Shinzato T, Kubo T, Shimizu T, Yagisawa T. Effect of Rabbit Antithymocyte Globulin on Acute and Chronic Active Antibody-Mediated Rejection After Kidney Transplantation. Transplant Proc 2019; 51:2602-2605. [PMID: 31324482 DOI: 10.1016/j.transproceed.2019.02.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/06/2019] [Accepted: 02/17/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Rabbit antithymocyte globulin (rATG) induction is associated with reduction in the occurrence of de novo donor-specific antibody (DSA) and antibody-mediated rejection (AMR). Therefore, rATG administration is considered as a treatment for AMR. However, only a few studies have investigated the treatment of AMR with rATG after kidney transplantation. METHODS Between April 2013 and March 2018, 162 consecutive de novo kidney transplantations were performed with induction immunosuppressive therapy comprising tacrolimus, mycophenolate mofetil, methylprednisolone, and basiliximab. AMR was diagnosed on the basis of the presence of DSA and episode biopsy findings. For DSA-positive recipients, plasmapheresis was performed to remove DSA before rATG administration (1.5 mg/kg for 5 days). Patients treated with rATG against active AMR were retrospectively analyzed for graft function. RESULTS A total of 13 kidney transplant recipients developed active AMR within 302 days after transplantation. After rATG administration, the mean serum creatinine and urine protein levels significantly declined from 3.03 mg/dL to 1.68 mg/dL (P = .002) within 46 days and from 3.01 g/gCr to 0.54 g/gCr (P = .006) within 106 days, respectively. The peripheral blood lymphocyte count rapidly decreased after rATG administration and remained low for 12 months. With regard to adverse events, fever (84.6%), cytomegaloviremia (84.6%), thrombocytopenia (61.5%), anemia (30.8%), and neutropenia (15.4%) occurred within 3 months after rATG administration. CONCLUSIONS rATG improved graft function by suppressing peripheral blood lymphocytes in kidney transplant recipients with active AMR. The rATG administration as a treatment for active AMR may contribute to positive graft outcomes after kidney transplantation.
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Affiliation(s)
- Koji Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - Takahiro Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Taro Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Toshihiro Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takashi Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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16
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shibata K, Nakai S, Ito T, Ookawara S, Masakane I, Yuzawa Y, Aoki T, Inaguma D, Hasegawa M, Shinzato T. SP396THE NEW METHOD TO DETERMINE INTRACELLULAR FLUID VOLUME BY KINETIC MODELING OF UREA AND URIC ACID. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp396] [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: 11/12/2022] Open
Affiliation(s)
| | | | | | - Susumu Ookawara
- Saitama Medical CenterJichi Medical University, Saitama, Japan
| | | | | | - Takeshi Aoki
- Nagoya Municipal Industrial Research Institute, Nagoya-shi, Japan
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17
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shibata K, Toma S, Osawa M, Kawata S, Nishihara M, Imoto K, Kuji T, Satta H, Koguchi N, Nakai S, Shinzato T. SP578THE EFFECT OF ELECTROLYTIC WATER ON THE INFECTION RATE OF BUTTONHOLE PUNCTURE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp578] [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: 11/14/2022] Open
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18
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Nanmoku K, Shinzato T, Kubo T, Shimizu T, Yagisawa T. Remission of Epstein-Barr virus-positive post-transplant lymphoproliferative disorder by conversion to everolimus in a kidney transplant recipient. Transpl Infect Dis 2019; 21:e13116. [PMID: 31102475 DOI: 10.1111/tid.13116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/26/2019] [Accepted: 05/12/2019] [Indexed: 12/12/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of transplantation. There is no clear consensus on the treatment of PTLD. In most cases, the pathogenetic mechanism of PTLD involves the Epstein-Barr virus (EBV). We report the case of an elderly kidney transplant recipient who developed EBV-positive monomorphic T-cell PTLD 14 years after transplantation. Conversion from conventional immunosuppressants to everolimus induced complete remission of PTLD accompanied by a decrease in blood EBV-DNA level without chemotherapy.
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Affiliation(s)
- Koji Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takahiro Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Taro Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Toshihiro Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takashi Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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19
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Nanmoku K, Shinzato T, Kubo T, Shimizu T, Yagisawa T. Conversion to Everolimus in Kidney Transplant Recipients With Calcineurin Inhibitor-Induced Nephropathy: 3 Case Reports. Transplant Proc 2019; 51:1424-1427. [PMID: 31060742 DOI: 10.1016/j.transproceed.2019.01.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/28/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Calcineurin inhibitors (CNIs), which remain the most important immunosuppressants in kidney transplant recipients, are a major cause of renal dysfunction due to CNI-induced nephropathy. However, a safe and effective CNI-sparing protocol is yet to be established. Herein, we report a case series of kidney transplant recipients experiencing CNI nephropathy, whose renal function is improved after conversion from CNIs to everolimus. CASES The 3 kidney transplant recipients included in this study were diagnosed with CNI arteriolopathy by episode biopsy between 9 months and 11 years after transplantation. All patients received triple immunosuppressive therapy consisting of CNI (tacrolimus or cyclosporine), mycophenolate mofetil, and methylprednisolone. All allografts were transplanted from elderly living donors to ABO-compatible and donor-specific antibody-negative recipients. All allograft biopsy specimens exhibited CNI arteriolopathy with alternative quantitative criteria for hyaline arteriolar thickening (aah score: 2 or 3), according to the Banff classification; however, histopathologic assessment did not show any evidence of allograft rejection. Conversely, total dose and blood concentrations of CNIs were within appropriate ranges. After conversion from CNIs to everolimus (1.5 mg/day, twice daily; trough level, 3-5 ng/mL), serum creatinine levels returned to baseline levels measured before the diagnosis of CNI arteriolopathy. In all patients, renal allograft function remained stable, with no evidence of donor-specific antibodies, 1 year after conversion from CNIs to everolimus. CONCLUSION Conversion from CNIs to everolimus can safely and effectively improve renal function in kidney transplant recipients experiencing CNI-induced nephropathy.
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Affiliation(s)
- Koji Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - Takahiro Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Taro Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Toshihiro Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takashi Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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20
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Nanmoku K, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Conversion From Steroid to Everolimus in Maintenance Kidney Transplant Recipients With Posttransplant Diabetes Mellitus. EXP CLIN TRANSPLANT 2019; 17:47-51. [DOI: 10.6002/ect.2017.0178] [Citation(s) in RCA: 3] [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] [Indexed: 01/08/2023]
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21
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Shinzato T, Kubo T, Shimizu T, Nanmoku K, Yagisawa T. Fibrosing cholestatic hepatitis in a kidney transplant recipient with hepatitis C virus. CEN Case Rep 2019; 8:101-105. [PMID: 30604247 DOI: 10.1007/s13730-018-0374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/17/2018] [Indexed: 01/13/2023] Open
Abstract
Fibrosing cholestatic hepatitis (FCH) is a fatal disorder that presents as a progressive deterioration of liver function over a period of several weeks to several months. It is caused by the direct cytotoxic effect of the over-expression of viral antigens on hepatocytes in immunosuppressed patients. Our patient was a 59-year-old man with hepatitis C virus (HCV) infection of genotype 2a who had suffered from end-stage renal disease due to diabetic nephropathy and underwent kidney transplantation. His serum total bilirubin levels gradually increased to 20 mg/dl and liver atrophy progressed during several weeks after kidney transplantation, which was initially difficult to distinguish from drug-induced liver injury. We diagnosed the condition as FCH on the basis of pathological findings and increased HCV viral load, and treated the patient with Glecaprevir/Pibrentasvir. However, the patient died of refractory hemorrhagic gastric ulcer and liver failure. Currently, it is possible to treat infections of all genotypes of HCV, even with end-stage renal disease, with direct acting antivirals. Furthermore, it is preferable to treat HCV before kidney transplantation considering the risk of FCH due to immunosuppressive therapy.
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Affiliation(s)
- Takahiro Shinzato
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan.
| | - Taro Kubo
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Toshihiro Shimizu
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Koji Nanmoku
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Takashi Yagisawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
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22
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Nanmoku K, Owada Y, Oshiro Y, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Sakuma Y, Ishikawa N, Ohkohchi N, Okamoto H, Yagisawa T. Prevalence and characteristics of hepatitis E virus infection in kidney transplant recipients: A single-center experience in Japan. Transpl Infect Dis 2018; 21:e13033. [PMID: 30481402 DOI: 10.1111/tid.13033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) infection can lead to chronic hepatitis in solid organ transplant recipients. To investigate whether HEV infection influences outcomes following kidney transplantation, we examined the prevalence of HEV infection and clinical characteristics of kidney transplant recipients in our hospital. METHODS Our cross-sectional study included 184 kidney transplant recipients. Blood samples were obtained from all patients to detect anti-HEV immunoglobulin (Ig)A, IgM, and IgG by enzyme-linked immunosorbent assay and HEV RNA by reverse transcription polymerase chain reaction. Clinical data were collected from medical charts for all patients. RESULTS The prevalence of anti-HEV IgG was 8/184 (4.3%). Anti-HEV IgA, anti-HEV IgM, and HEV RNA were not detected in any patients. Compared to their anti-HEV IgG-negative counterparts, anti-HEV IgG-positive patients were significantly older at the time of transplantation, and they were more likely to receive kidneys from deceased donors. No significant differences in other characteristics such as the prevalence of primary cause of end-stage renal disease, blood transfusion, and immunosuppressive therapy use; liver and renal function; and the frequencies of hepatitis B and hepatitis C virus infection were observed according to the patients' anti-HEV IgG status. CONCLUSION HEV infection had no significant influence on the outcomes of kidney transplantation at our institution. However, HEV infection should be recognized in kidney transplant recipients similarly as hepatitis B and hepatitis C virus infection in cases of liver dysfunction.
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Affiliation(s)
- Koji Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Yohei Owada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Oshiro
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center, Inashiki, Japan
| | - Akira Kurosawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Taro Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takahiro Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Toshihiro Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takaaki Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Yasunaru Sakuma
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Nobuo Ishikawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Nobuhiro Ohkohchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Takashi Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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23
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Nanmoku K, Shinzato T, Kubo T, Shimizu T, Yagisawa T. Prevalence and predictors of early hypercalcemia after kidney transplantation: a nested case-control study within a cohort of 100 patients. Clin Exp Nephrol 2018; 23:268-274. [PMID: 30121799 DOI: 10.1007/s10157-018-1627-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/05/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypercalcemia (HC) after kidney transplantation (KTx) can deteriorate both graft and patient survival. However, HC as a clinical condition and its clinical significance after KTx remain unknown. We evaluated the prevalence and risk factors of early HC after KTx. METHODS We performed a nested case-control study using a cohort of 100 KTx patients. KTx patients were divided into the HC and normocalcemia (NC) groups based on the baseline serum-corrected calcium (cCa) levels (≥ 10.5 and < 10.5 mg/dL) within 1 year after KTx. RESULTS Overall, the median value of maximum serum cCa level within 1 year after KTx was 10.1 (9.1-13.8) mg/dL. Of the 100 KTx patients within the cohort, 31 patients (31.0%) were classified as the HC group. The maximum serum cCa level was reached significantly earlier in the HC group compared with the NC group (2 vs. 4 months, p = 0.024). In univariate analysis, the risk factors of early HC after KTx were dialysis duration ≥ 10 years, serum cCa level the day before KTx, and cinacalcet administration before KTx. Among these risk factors, serum cCa level the day before KTx and cinacalcet administration before KTx were identified as significant independent risk factors of early HC after KTx in multivariate analysis. CONCLUSIONS One-third of the KTx patients presented early HC within 1 year after KTx. Early HC after KTx resulted from persistent hyperparathyroidism. Therapeutic strategies to manage HC after KTx must be established.
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Affiliation(s)
- Koji Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Takahiro Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Taro Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Toshihiro Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takashi Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Nanmoku K, Shinzato T, Kubo T, Shimizu T, Kimura T, Yagisawa T. Prevention of Late-Onset Cytomegalovirus Infection and Disease in Donor-Positive/Recipient-Negative Kidney Transplant Recipients Using Low-Dose Valganciclovir. Transplant Proc 2018; 50:124-129. [PMID: 29407294 DOI: 10.1016/j.transproceed.2017.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The main challenge with cytomegalovirus (CMV) prophylaxis in IgG donor-positive/recipient-negative (D+/R-) kidney transplant recipients is late-onset CMV disease. We evaluated a novel protocol for the prevention of late-onset CMV infection and disease in D+/R- organ recipients. METHODS Our prospective, observational, cohort study included 100 adult kidney transplant recipients. Prophylaxis with low-dose valganciclovir (450 mg/d, 3 times a week for 6 months) was administered to D+/R- recipients. Risk factors for CMV infection and disease were identified. Renal function and the outcomes of CMV infection and disease were compared between D+/R- (n = 15) and recipient-positive (R+; n = 81) organ recipients. RESULTS D+/R- recipients showed significant independent risk factors with high hazard ratios for CMV infection (2.04) and disease (10.3). The proportion of CMV infection in D+/R- and R+ recipients was 80% and 46% (P = .023), and that of CMV disease was 33% and 6.2% (P = .008), repectively. D+/R- recipients developed CMV infection and disease within 6 months after transplantation. However, both CMV infection- and disease-free survival rates beyond 1 year post-transplantation defined as late-onset were stable in D+/R- recipients. Moreover, serum creatinine levels at 1 year post-transplantation were comparable between D+/R- and R+ recipients (1.45 ± 0.71 vs 1.16 ± 0.35 mg/dL, P = .26). CONCLUSION Our novel protocol prevented late-onset CMV infection and disease beyond 1 year post-transplantation in D+/R- recipients.
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Affiliation(s)
- K Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - T Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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Kimura T, Shiizaki K, Akimoto T, Shinzato T, Shimizu T, Kurosawa A, Kubo T, Nanmoku K, Kuro-O M, Yagisawa T. The impact of preserved Klotho gene expression on antioxidative stress activity in healthy kidney. Am J Physiol Renal Physiol 2018; 315:F345-F352. [PMID: 29693450 DOI: 10.1152/ajprenal.00486.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Klotho, which was originally identified as an antiaging gene, forms a complex with fibroblast growth factor 23 receptor in the kidney, with subsequent signaling that regulates mineral metabolism. Other biological activities of Klotho, including antiaging effects such as protection from various types of cellular stress, have been shown; however, the precise mechanism of these effects of Klotho gene in the healthy human kidney is not well understood. In this study, we examined the relationships of Klotho and antioxidative stress gene expression levels in zero-hour biopsy specimens from 44 donors in kidney transplantation and verified them in animal models whose Klotho gene expression levels were varied. The nitrotyrosine expression level in the kidney was evaluated in these animal models. Expression levels of Klotho gene were positively correlated with the p53 gene and antioxidant enzyme genes such as catalase, superoxide dismutase 1 (SOD1), SOD2, peroxiredoxin 3 (PRDX3), and glutathione peroxidase 1 (GPX1) but not clinical parameters such as age and renal function or pathological features such as glomerulosclerosis and interstitial fibrosis tubular atrophy. The expression levels of all genes were significantly higher in mice with Klotho overexpression than in wild-type mice, and those except for catalase, PRDX3, and GPX1 were significantly lower in Klotho-deficient mice than in wild-type littermate mice. Nitrotyrosine-positive bands of various sizes were observed in kidney from Klotho-deficient mice only. The preservation of Klotho gene expression might induce the antioxidative stress mechanism for homeostasis of healthy human kidney independently of its general condition, including age, renal function, and histological findings.
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Affiliation(s)
- Takaaki Kimura
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Kazuhiro Shiizaki
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Takahiro Shinzato
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Toshihiro Shimizu
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Akira Kurosawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Taro Kubo
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Koji Nanmoku
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi , Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke, Tochigi , Japan
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Nanmoku K, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Effective and Safe Reduction of Conventional Immunosuppressants Using Everolimus in Maintenance Kidney Transplant Recipients. Transplant Proc 2018; 49:1724-1728. [PMID: 28923615 DOI: 10.1016/j.transproceed.2017.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/07/2017] [Accepted: 04/27/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Adverse events due to conventional immunosuppressive therapy decrease both graft and patient survival. We aimed to establish a new protocol using everolimus (EVR) to safely minimize conventional immunosuppressants in maintenance kidney transplant recipients. METHODS A total of 86 consecutive kidney transplant recipients with no complications were maintained with triple-drug combination therapy (conventional group). In case of complications, the administration of very low-dose tacrolimus (C0: 5.0 to <3.0 ng/mL), reduced mycophenolate mofetil (1000-1500 to 500-1000 mg), and EVR (C0: 3.0-5.0 ng/mL) and methylprednisolone withdrawal (2-4 to 0 mg) were simultaneously conducted (EVR group). Graft survival and acute rejection rate were compared between groups. Within the EVR group, the dose of conventional immunosuppressants was compared between pre- and post-EVR administration. Renal function was evaluated 1 year post-EVR administration. RESULTS All grafts survived in the conventional (n = 50) and EVR (n = 36) groups, and biopsy-proven acute rejection rate exhibited no significant difference between these groups (12% vs 17%; P = .55). Furthermore, no acute rejection occurred post-EVR administration. In the EVR group, all immunosuppressants significantly decreased post-EVR administration compared with those pre-EVR administration (P < .01), and serum creatinine significantly improved at postoperative year 1 (P = .031). CONCLUSIONS EVR administration enables very low-dose tacrolimus administration, helps reduce mycophenolate mofetil and steroid withdrawal, and ameliorates renal function in maintenance kidney transplant recipients experiencing complications associated with conventional immunosuppressive therapy.
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Affiliation(s)
- K Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - A Kurosawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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Nanmoku K, Shinzato T, Kubo T, Shimizu T, Kimura T, Yagisawa T. Steroid Withdrawal Using Everolimus in ABO-Incompatible Kidney Transplant Recipients With Post-Transplant Diabetes Mellitus. Transplant Proc 2018; 50:1050-1055. [PMID: 29631750 DOI: 10.1016/j.transproceed.2018.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/06/2018] [Accepted: 01/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effectiveness of everolimus (EVR) for ABO-incompatible (ABOi) kidney transplantation is unknown. We evaluated outcomes of conversion from steroid to EVR in ABOi kidney transplant recipients. METHODS We performed a retrospective observational cohort study of 33 de novo consecutive adult ABOi living donor kidney transplant recipients. Desensitization was performed using 0 to 4 sessions of plasmapheresis and 1 to 2 doses of 100 mg rituximab according to the anti-A/B antibody titer. ABOi recipients were administered a combination of tacrolimus, mycophenolate mofetil, and methylprednisolone. Diabetic patients were converted from methylprednisolone to EVR at 1 to 15 months post-transplantation to prevent diabetes progression. Graft outcomes, hemoglobin A1c (HbA1c) levels, and cytomegalovirus infection rates were compared between the EVR (n = 11) and steroid (n = 22) groups. RESULTS Mean postoperative duration was 814 and 727 days in the EVR and steroid groups, respectively (P = .65). Between the 2 groups, graft survival rate (100% vs 95.5%, P > .99), acute rejection rate (9.1% vs 18.2%, P = .64), and serum creatinine levels (1.46 mg/dL vs 1.68 mg/dL, P = .66) were comparable. Although HbA1c levels were elevated in the steroid group (5.47%, 5.87%; P = .003), no significant deterioration was observed in the EVR group without additional insulin administration (6.10%, 6.47%; P = .21). Cytomegalovirus infection rate was significantly lower in the EVR group than in the steroid group (18.2% vs 63.6%, P = .026). CONCLUSION Conversion from steroid to EVR in ABOi kidney transplant recipients maintained excellent graft outcomes and avoided diabetes progression and cytomegalovirus infection.
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Affiliation(s)
- K Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - T Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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Affiliation(s)
- T. Shinzato
- Nagoya University Daiko Medical Center, Nagoya - Japan
| | - S. Nakai
- Nagoya University Daiko Medical Center, Nagoya - Japan
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Shinzato T, Kurosawa A, Kubo T, Shimizu T, Kimura T, Nanmoku K, Yagisawa T. No significant differences in short-term renal prognosis between living kidney donors with and without diabetes. Clin Exp Nephrol 2017; 22:694-701. [PMID: 29027035 PMCID: PMC5956044 DOI: 10.1007/s10157-017-1487-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal prognosis in living kidney donors with diabetes is currently not known. In this study, we sought to investigate renal prognosis in living kidney donors with diabetes. METHODS We retrospectively investigated 241 living kidney donors who underwent nephrectomy at Jichi Medical University Hospital between January 2000 and December 2015. Donors with a follow-up period of less than 1 year were excluded. The remaining donors were divided into a diabetic group and a non-diabetic group. Their clinical parameters before donation and renal prognosis after donation were compared. RESULTS Of the 241 donors, 16 were excluded due to their follow-up period being less than 1 year. Of the remaining 225 donors, 14 were diabetic and 211 were non-diabetic. There were no significant differences in variables at pre-donation. The median follow-up period was 4.3 (1.5-10.7) and 4.6 (1.0-13.0) years in kidney donors with and without diabetes, respectively. At the end of follow-up, the estimated glomerular filtration rate was 51.7 ± 7.1 ml/min/1.73 m2 in the diabetic group and 52.1 ± 12.2 ml/min/1.73 m2 (p = 0.906) in the non-diabetic group; urine albumin excretion was 9.5 (2-251) mg/day (or mg/g creatinine) in the diabetic group and 6 (0-626) mg/day (or mg/g creatinine) in the non-diabetic group (p = 0.130); and urine protein excretion was 0.079 (0-0.41) g/day in the diabetic group and 0.051 (0-3.7) g/day in the non-diabetic group (p = 0.455). CONCLUSIONS There were no significant differences in short-term renal prognosis between kidney donors with and without diabetes.
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Affiliation(s)
- Takahiro Shinzato
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan.
| | - Akira Kurosawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Taro Kubo
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Toshihiro Shimizu
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Takaaki Kimura
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Koji Nanmoku
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Takashi Yagisawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
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Nanmoku K, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Selection Criteria for Kidney Laterality in Retroperitoneoscopic Living Donor Nephrectomy and the Usefulness of Pretransplant Intervention. Transplant Proc 2017; 49:924-929. [PMID: 28583560 DOI: 10.1016/j.transproceed.2017.03.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the selection criteria for kidney laterality and the usefulness of pretransplant intervention in living donor nephrectomy. METHODS We compared conventional and revised criteria. The conventional criteria were that left kidneys were chosen in preference and provided the kidney with the fewest structural abnormalities and lowest functional decline and that most renal arteries remained in the donor. From April 2013, we allowed the use of left kidneys with double renal arteries. Patient characteristics and surgical outcomes were retrospectively compared between right and left retroperitoneoscopic living donor nephrectomies. RESULTS We compared data for 30 right kidney and 222 left kidney nephrectomies. Right kidneys were selected because of multiple renal arteries (n = 18), structural abnormalities (n = 10) of the left kidney, or functional decline (n = 2) of the right kidney. Right retroperitoneoscopic nephrectomies were associated with significantly longer operating times (267 minutes vs 241 minutes), larger blood losses (240 g vs 55 g), and higher open conversion rates (10% vs 0.9%). Pretransplant intervention was necessary for structural abnormalities in right kidneys, but the amended selection criteria resulted in fewer right nephrectomies. Pretransplant intervention was still necessary by ex vivo arterial anastomosis for multiple left renal arteries, which increased the total ischemia time (94 minutes vs 64 minutes); however, post-transplantation renal function was not significantly different. CONCLUSIONS Pretransplant intervention was beneficial both for repairing structural abnormalities and for reducing the difficulties of retroperitoneoscopic living donor nephrectomy.
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Affiliation(s)
- K Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - A Kurosawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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Shibata K, Toma S, Satta H, Kuji T, Nishihara M, Imoto K, Kawata S, Koguchi N, Yasuda G, Shinzato T. SP581NEW METHOD TO DECREASE BUTTONHOLE LOCAL INFECTION RATE TO LESS THAN 1 IN 10,000. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx153.sp581] [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: 11/12/2022] Open
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Kimura T, Shiizaki K, Kurosawa A, Shimizu T, Shinzato T, Kubo T, Nanmoku K, Kuro-o M, Yagisawa T. SP370FGF23 MAINLY REGULATES PHOSPHATE HOMEOSTASIS IN STAGE 3 CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx147.sp370] [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: 11/12/2022] Open
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Nanmoku K, Kurosawa A, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Febuxostat for the Prevention of Recurrent 2,8-dihydroxyadenine Nephropathy due to Adenine Phosphoribosyltransferase Deficiency Following Kidney Transplantation. Intern Med 2017; 56:1387-1391. [PMID: 28566603 PMCID: PMC5498204 DOI: 10.2169/internalmedicine.56.8142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder that results in irreversible renal damage due to 2,8-dihydroxyadenine (DHA) nephropathy. A 28-year-old man underwent living-related kidney transplantation for chronic kidney disease of unknown etiology. Numerous spherical brownish crystals observed in his urinary sediment on postoperative day 3 and were observed within the tubular lumen of renal allograft biopsy specimens on postoperative day 7. After a genetic diagnosis, febuxostat treatment was started on postoperative day 7, with the dosage gradually increased to 80 mg/day until complete the disappearance of 2,8-DHA crystals. Febuxostat prevented secondary 2,8-DHA nephropathy after kidney transplantation.
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Affiliation(s)
- Koji Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Japan
| | - Akira Kurosawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Japan
| | - Takahiro Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Japan
| | - Toshihiro Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Japan
| | - Takaaki Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Japan
| | - Takashi Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Japan
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Abstract
Purpose: In this study, we discuss a mechanism of development of access-related Staphylococcus aureus infections in patients on buttonhole (BH) method and logically construct a measure to prevent such infections on the basis of the mechanism. Summary:S. aureus can colonize a BH track. Once S. aureus colonizes a BH track, access-related infections may develop when the equilibrium is upset between the factors of host resistance and a level of bacterial growth in a BH track. Thus, the logically constructed measure to prevent access-related infections are as follows: (1) decolonization of S. aureus from a BH track by applying mupirocin ointment to a BH entry site when a patient has been proven to be a carrier of S. aureus in the track, (2) prevention of bacterial invasion of the BH track by a new method to remove a scab completely, and (3) control of bacterial growth in the BH track by disinfecting the site with diluted povidone-iodine solution (0.1% povidone-iodine solution) before access vessel cannulation.
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Misra M, Toma S, Shinzato T. Buttonhole Cannulation: Current Prospects and Challenges. Preface. Contrib Nephrol 2015; 186:VII. [PMID: 26502481 DOI: 10.1159/isbn.978-3-318-05567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shinzato T, Sasaki M, Ota N, Shibata K, Fukui H, Toma S, Maeda K. A New Method That Enables Complete Removal of Scabs at Buttonhole Entry Sites. Contrib Nephrol 2015; 186:41-7. [PMID: 26283558 DOI: 10.1159/000431166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scab removal is a time-consuming process and often injures the skin at a buttonhole entry site. Incomplete removal of scabs may cause access-related infection. METHODS In a new procedure, buttonhole entry sites were treated with a moist healing step after hemodialysis, and then a formed scab was wiped off with a microfiber towel during bathing on the night prior to hemodialysis, which was performed on the following day. In the moist healing step, the entry site was disinfected with a diluted povidone-iodine solution (0.1% povidone-iodine solution). RESULTS When the buttonhole entry sites of the patients were treated with the new procedure, the scabs had already been removed at the buttonhole entry sites, and the sites were covered with a thin transparent membrane. Histological examination showed the thin membrane was stratum corneum, in which nuclei are still seen in keratinocytes. CONCLUSION By treating the buttonhole entry sites of patients with the wound moist healing method and then rubbing the sites with a microfiber towel during bathing, scabs can be removed without injuring the skin at the sites in advance.
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Sato S, Shinzato T, Sakai N, Ohkuri K, Sasaki M, Nakai S, Toma S. Deformity of Buttonhole Entry Site Causes Higher Frequency of Vascular Access-Related Infection. Contrib Nephrol 2015; 186:48-56. [PMID: 26283559 DOI: 10.1159/000431164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vascular access-related infection is more frequent in patients using the buttonhole method for cannulation of the arteriovenous access for hemodialysis. Deformity of buttonhole entry sites is frequently observed among patients on the buttonhole method for extended periods of time. With deformed buttonhole entry sites, moreover, scabs are often incompletely removed at the time of buttonhole cannulation. METHOD In 166 patients using the buttonhole method at Hino Clinic in Osaka, Japan as of June 30, 2014, the shapes of buttonhole entry sites were categorized into the following 3 types: flat, depressive deformity, and bulging deformity. A multivariate logistic regression method was used to analyze associations between various data including shapes of buttonhole entry sites and occurrence of access-related infection. We also examined microscopic features of the buttonhole entry site tissue that was removed from a patient who died after 3 years of buttonhole cannulation. RESULTS For the flat buttonhole entry sites, frequency of access-related infection was 0.12 events/1,000 arteriovenous fistulas as compared to 0.47 events/1,000 arteriovenous fistulas for the entry sites with bulging deformity. Such infection did not occur for the entry sites with depressive deformity. The multivariate logistic regression analysis revealed a significant association between an entry site with bulging deformity and occurrence of access-related infection (odds ratio = 5.369, p = 0.0085). Furthermore, the microscopic section showed granulations beneath the skin at the buttonhole entry site and around the buttonhole tract. CONCLUSION A significant association was shown between an entry site with bulging deformity and occurrence of access-related infection. The microscopic features of the buttonhole entry site of the patient on the buttonhole method for 3 years suggest that the entity of bulging deformity at the entry site is hypertrophic granulation.
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Shinzato T. SP594DEFORMITY OF BUTTONHOLE ENTRY SITE CAUSES HIGHER FREQUENCY OF VASCULAR ACCESS-RELATED INFECTION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.17] [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: 11/14/2022] Open
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Shibata K, Shinzato T, Satta H, Kuji T, Kawata S, Koguchi N, Nishihara M, Kaneda T, Toma S. SP623HEMODIALYSIS PUNCTURE STRESS RELIEF THROUGH BUTTONHOLE METHOD BY USING MOIST WOUND HEALING METHOD. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.46] [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: 11/12/2022] Open
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Shibata K, Shinzato T, Satta H, Kuji T, Kawata S, Kogutchi N, Nishihara M, Kaneda T, Toma S. SP585BUTTONHOLE NEEDLING COME TO BE AS SAFE AS ROPE-LADDER PUNCTURE METHOD BY USING MOIST WOUND HEALING METHOD. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.08] [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: 11/14/2022] Open
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Hayakawa K, Sugiyama D, Shinohara S, Muraoka A, Miwa M, Shinzato T. SP618BUTTONHOLE CANNULATION METHOD PREVENTS COMPLICATIONS OF SURGICALLY SUPERFICIALIZED ARTERY ACCESS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.41] [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: 11/12/2022] Open
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Kuji T, Fujikawa T, Shibata K, Satta H, Kawata SI, Kouguchi N, Shinzato T. FP681METHOD TO CALCULATE ESA DOSE TO ACHIEVE TARGET HAEMOGLOBIN LEVEL BY ANALYSING HAEMOGLOBIN KINETIC MODEL. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv182.29] [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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Shibata K, Shinzato T, Satta H, Koguchi N, Kawata S, Kuji T, Nishihara M, Kaneda T, Yasuda G. SP704THE EFFECT OF MIRTAZAPINE IN DIALYSIS PATIENT WITH APPETITE LOSS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv200.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morita H, Cai Z, Shinzato T, David G, Mizutani A, Itano N, Habuchi H, Yoneda M, Maeda K, Kimata K. Glycosaminoglycans in dialysis-related amyloidosis. Contrib Nephrol 2015; 112:83-9. [PMID: 7554996 DOI: 10.1159/000424095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- H Morita
- Department of Internal Medicine, Branch Hospital, Nagoya University School of Medicine, Japan
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Morita H, David G, Mizutani A, Shinzato T, Habuchi H, Maeda K, Kimata K. Heparan sulfate proteoglycans in the human sclerosing and scarring kidney. Changes in heparan sulfate moiety. Contrib Nephrol 2015; 107:174-9. [PMID: 8004965 DOI: 10.1159/000422977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- H Morita
- Branch Hospital, Nagoya University, School of Medicine, Japan
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Shinzato T, Fujisawa K, Nakai S, Miwa M, Kobayakawa H, Takai I, Morita H, Maeda K. Newly developed economical and efficient push/pull hemodiafiltration. Contrib Nephrol 2015; 108:79-86. [PMID: 8039400 DOI: 10.1159/000423360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Shinzato
- Department of Internal Medicine, Nagoya University School of Medicine, Japan
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Shinzato T, Miwa M, Kobayakawa H, Morita H, Nakai S, Miyata T, Maeda K. Effectiveness of new push/pull hemodiafiltration for arthralgia in long-term hemodialysis patients. Contrib Nephrol 2015; 112:111-8. [PMID: 7554982 DOI: 10.1159/000424099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- T Shinzato
- Department of Internal Medicine, Branch Hospital, Nagoya University School of Medicine, Japan
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Buiten MS, De Bie MK, Van Dam B, Bouma-De Krijger A, Dekker FW, Jukema JW, Rabelink TJ, Rotmans JI, Parfrey PS, Drueke T, Block GA, Kubo Y, Chertow GM, Kosmadakis G, Carceles O, Da Costa Correia E, Somda F, Aguilera D, Shibata K, Sohara H, Satta H, Nishihara M, Koguchi N, Kuji T, Kaneda T, Kawata S, Yasuda G, Shinzato T, Messa M, Tomei P, Motton M, Ortalda V, Gangemi C, Lupo A. DIALYSIS CARDIOVASCULAR COMPLICATIONS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu130] [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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Fontsere N, Mestres G, Burrel M, Barrufet M, Montana X, Arias M, Ojeda R, Maduell F, Campistol JM, Nagaraja P, Rees D, Husein T, Chess J, Lin CC, Yang WC, Khosravi M, Kandil H, Cross J, Hopkins S, Collier S, Lopes D, Pereira S, Gomes AM, Ventura A, Martins V, Seabra J, Rothuizen TC, Damanik F, Visser MJT, Lavrijsen T, Cox MAJ, Moroni L, Rabelink TJ, Rotmans JI, Fontsere N, Cardozo C, Donate J, Soriano A, Muros M, Pons M, Mensa J, Campistol JM, Navarro-Gonzalez JF, Maduell F, Wijewardane A, Murley A, Powers S, Allen C, Baharani J, Wilmink T, Esenturk M, Zengin M, Dal M, Tahtal N, Shibata K, Shinzato T, Satta H, Nishihara M, Koguchi N, Kuji T, Kawata S, Kaneda T, Yasuda G, Scrivano J, Pettorini L, Rutigliano T, Ciavarella GM, De Biase L, Punzo G, Mene P, Pirozzi N, El Haggan W, Belazrague K, Ehoussou S, Foucher V, El Salhy M, Ouellet G, Davis J, Caron P, Leblanc M, Pettorini L, Romitelli F, Fazzari L, Scrivano J, Ortu G, Di Stasio E, Punzo G, Mene P, Pirozzi N, Loizzo G, Vigano SM, Bacchini G, Rocchi E, Sala V, Pontoriero G, Letachowicz K, Go biowski T, Kusztal M, Letachowicz W, Weyde W, Klinger M, Murley A, Wijewardane A, Powers S, Allen C, Hollingsworth L, Wilmink T, Baharani J, Roca-Tey R, Samon R, Ibrik O, Roda A, Gonzalez-Oliva JC, Martinez-Cercos R, Viladoms J, Renaud CJ, Lim EK, Seow TY, Teh HS, Tosic J, Jankovic A, Djuric P, Radovic Maslarevic V, Popovic J, Dimkovic N, Kazantzi A, Trigka K, Buono F, Laurino S, Toriello G, Di Luccio R, Galise A, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Asano M, Oguchi K, Saito A, Onishi Y, Yamamoto Y, Fukuhara S, Akiba T, Akizawa T, Kurokawa K, Guedes Marques M, Ibeas J, Maia P, Ponce P, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Likaj E, Seferi S, Caco G, Petrela E, Barbullushi M, Idrizi A, Thereska N, Lomonte C, Casucci F, Libutti P, Lisi P, Basile C, Ancarani P, Valsuani G, Cavallo L, Parodi D, Lorusso C, Renaud C, Lai BC, Tho S, Yeoh L, Guedes Marques M, Botelho C, Maia P, Ponce P, Yankovoy A, Alexandr S, Smoliacov A, Stepanov V, Rees D, Parker C, Davies P, Taylor S, Mikhail A, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Gubensek J, Persic V, Vajdic B, Ponikvar R, Buturovic-Ponikvar J, Hadimeri U, Warme AV, Stegmayr B, Jankovic A, Suvakov S, Tosic J, Damjanovic T, Djuric P, Bajcetic S, Radovic-Maslarevic V, Popovic J, Simic T, Dimkovic N, Likaj E, Seferi S, Petrela E, Idrizi A, Rroji M, Barbullushi M, Thereska N, Chua HL, Kanda H, See SL, Liew NC, Tsuchida K, Tomo T, Fukasawa M, Kawashima S, Minakuchi J, Thanaraj V, Dhaygude A, Ikeda K, Forneris G, Cecere P, Pozzato M, Trogolo M, Vallero A, Mesiano P, Roccatello D, Esenturk M, Zengin M, Keskin L, Loizzo G, Vigano SM, Bacchini G, Rocchi E, Sala V, Pontoriero G, Casey JR, Hanson CS, Winkelmayer WC, Craig J, Palmer S, Strippoli G, Tong A, Ferrara D, Scamarda S, Bernardino L, Amico L, Lorito MC, Incalcaterra F, Visconti L, Visconti G, Valenza F, D'Amato F, Di Napoli A, Tazza L, Chicca S, Lapucci E, Silvestri P, Di Lallo D, Michelozzi P, Davoli M. DIALYSIS VASCULAR ACCESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McCullough KP, Lok CE, Fluck RJ, Spergel LM, Andreucci VE, Fort J, Krishnan M, Fissell RB, Kawanishi H, Saran R, Port FK, Robinson BM, Pisoni RL, Shinzato T, Shionoya Y, Fukui H, Sasaki M, Miwa M, Toma S, Lin CC, Yang WC, Simone S, Loverre A, Cariello M, Divella C, Castellano G, Gesualdo L, Grandaliano G, Pertosa G, Mattei S, Pignatelli G, Corradini M, Stefani A, Bovino A, Iannuzzella F, Vaglio A, Manari A, Pasquali S, Chan JS, Wu TC, Roy-Chaudhury P, Shih CC, Chen JW, Ponce P, Scholz C, Goncalves P, Grassmann A, Canaud B, Marcelli D, Suzuki S, Shibata K, Kuji T, Kawata S, Koguchi N, Nishihara M, Satta H, Toya Y, Umemura S, Corbett R, Demicheli N, Iori F, Grechy L, Khiroya R, Ellis D, Crane J, Hamady M, Gedroyc W, Duncan N, Vincent P, Caro C, Sarween N, Price A, Powers S, Allen C, Holland M, Gupta I, Baharani J, Parisotto MT, Schoder V, Kaufmann P, Miriunis C, Grassmann A, Marcelli D, Moura A, Madureira J, Alija P, Fernandes J, Oliveira JG, Lopez M, Felgueiras M, Amado L, Sameiro-Faria M, Miranda V, Vieira M, Santos-Silva A, Costa E, David P, Capurro F, Brustia M, De Mauri A, Ruva C, Chiarinotti D, Gravellone L, De Leo M, Turkvatan A, Kirkpantur A, Mandiroglu S, Afsar B, Seloglu B, Alkis M, Erkula S, GURBUZ HG, Serin M, CALIK Y, Mandiroglu F, Balci M, Rikker C, Juhasz E, Tornoci L, Tovarosi S, Greguschik J, Rosivall L, Ibeas J, Valeriano J, Vallespin J, Fortuno J, Rodriguez-Jornet A, Cabre C, Merino J, Vinuesa X, Bolos M, Branera J, Mateos A, Jimeno V, Grau C, Criado E, Moya C, Ramirez J, Gimenez A, Garcia M, Kirmizis D, Kougioumtzidou O, Vakianis P, Bandera A, Veniero P, Brunori G, Dimitrijevic Z, Cvetkovic T, Paunovic K, Stojanovic M, Ljubenovic S, Mitic B, Djordjevic V, Aicha Henriette S, Farideh A, Daniela B, Zafer T, Francois C, Ibeas J, Vallespin J, Fortuno J, Merino J, Vinuesa X, Branera J, Mateos A, Jimeno V, Bolos M, Rodriguez-Jornet A, Gimenez A, Garcia M, Donati G, Scrivo A, Cianciolo G, La Manna G, Panicali L, Rucci P, Marchetti A, Giampalma E, Galaverni M, Golfieri R, Stefoni S, Skornyakov I, Kiselev N, Rozhdestvenskaya A, Stolyar A, Ancarani PPA, Devoto E, Dardano GGD, Coskun yavuz Y, Selcuk NY, Guney I, Altintepe L, Gerasimovska V, Gerasimovska-Kitanovska B, Persic V, Buturovic-Ponikvar J, Arnol M, Ponikvar R, Brustia M, De Mauri A, Conti N, Chiarinotti D, De Leo M, Capurro F, David P, Scrivano J, Pettorini L, Giuliani A, Punzo G, Mene P, Pirozzi N, Balci M, Turkvatan A, Mandiroglu S, Afsar B, Mandiroglu F, Kirkpantur A, Kocyigit I, Unal A, Guney A, Mavili E, Deniz K, Sipahioglu M, Eroglu E, Tokgoz B, Oymak O, Gunal A, Boubaker K, Kaaroud H, Kheder A, Ibeas J, Vidal M, Vallespin J, Amengual MJ, Merino J, Orellana R, Sanfeliu I, Rodriguez-Jornet A, Vinuesa X, Marquina D, Xirinachs M, Sanchez E, Moya C, Ramirez J, Rey M, Gimenez A, Garcia M, Strozecki P, Flisinski M, Kapala A, Manitius J, Gerasimovska V, Gerasimovska-Kitanovska BD, Sikole A, Weber E, Adrych D, Wolyniec W, Liberek T, Rutkowski B, Afsar B, Oguchi K, Nakahara T, Okamoto M, Iwabuchi H, Asano M, Rap O, Ruiz-Valverde M, Rodriguez-Murillo JA, Mallafre-Anduig JM, Zeid MM, Deghady AA, Elshair HS, Elkholy NA, Panagoutsos S, Devetzis V, Roumeliotis A, Kantartzi K, Mourvati E, Vargemezis V, Passadakis P, Kang SH, Jung SY, Lee SH, Cho KH, Park JW, Yoon KW, Do JY. Vascular access. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft118] [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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