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Yoshimura Y, Suwabe T, Fujiki A, Kaji D, Asano-Mori Y, Oba Y, Mizuno H, Yamanouchi M, Tanaka K, Hasegawa E, Miki K, Yokoyama T, Namamura Y, Ishii Y, Yamashita S, Kono K, Kinowaki K, Takazawa Y, Sawa N, Ubara Y. Gastric Burkitt's monomorphic post-transplant lymphoproliferative disorder after kidney transplantation: A case report. Clin Nephrol 2024; 101:250-256. [PMID: 38329919 DOI: 10.5414/cn111321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 02/10/2024] Open
Abstract
We report on a 53-year-old Japanese man diagnosed with gastric Burkitt's monomorphic post-transplant lymphoproliferative disorder (B-PTLD) after endoscopy for gastric discomfort 28 months after the patient underwent renal transplantation in Ethiopia. Serum Epstein-Barr virus (EBV) tests were negative before transplantation, but the tumor cells collected from a gastric biopsy showed positive EBV-encoded small RNAs (EBER) at B-PTLD onset. Intensive treatment started with R(rituximab)-CHOP therapy and continued with DA-EPOCH-R therapy has been effective, and relapse has not yet occurred. Burkitt lymphoma has a poor prognosis, but B-PTLD may be effectively treated with high-dose chemotherapy. This is a rare case of gastric B-PTLD in a Japanese patient.
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Okubo N, Suwabe T, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Miki K, Yokoyama T, Ishii Y, Sawa N, Nakamura Y, Takaya H, Ubara Y. Early diagnosis of tuberculous peritonitis in peritoneal dialysis patients using the T-SPOT test. CEN Case Rep 2024:10.1007/s13730-024-00882-2. [PMID: 38643328 DOI: 10.1007/s13730-024-00882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
A 49-year-old man was admitted with peritonitis nine months after starting continuous ambulatory peritoneal dialysis (CAPD) for kidney failure. Ceftazidime and cefazolin were started. Peritoneal dialysate culture was negative for bacteria, but antibiotic treatment was continued because peritonitis improved. Twenty days later, the patient was discharged with no signs of peritonitis. However, 40-day culture of the original peritoneal dialysate detected Mycobacterium tuberculosis, and peritonitis recurred, leading to readmission. A T-SPOT test was performed and was positive in 4 days. Anti-tuberculosis therapy was started, which cured the peritonitis. The T-SPOT test may enable early diagnosis of tuberculosis.
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Affiliation(s)
- Naoto Okubo
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Katsuyuki Miki
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Takayoshi Yokoyama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yasuo Ishii
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Nakamura
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hisashi Takaya
- Department of Respiratory Medicine, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
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Ishiguro H, Ushiki T, Honda A, Yoshimatsu Y, Ohashi R, Okuda S, Kawasaki A, Cho K, Tamura S, Suwabe T, Katagiri T, Ling Y, Iijima A, Mikami T, Kitagawa H, Uemura A, Sango K, Masuko M, Igarashi M, Sone H. Reduced chondroitin sulfate content prevents diabetic neuropathy through transforming growth factor-β signaling suppression. iScience 2024; 27:109528. [PMID: 38595797 PMCID: PMC11002665 DOI: 10.1016/j.isci.2024.109528] [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: 07/31/2023] [Revised: 11/08/2023] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Diabetic neuropathy (DN) is a major complication of diabetes mellitus. Chondroitin sulfate (CS) is one of the most important extracellular matrix components and is known to interact with various diffusible factors; however, its role in DN pathology has not been examined. Therefore, we generated CSGalNAc-T1 knockout (T1KO) mice, in which CS levels were reduced. We demonstrated that diabetic T1KO mice were much more resistant to DN than diabetic wild-type (WT) mice. We also found that interactions between pericytes and vascular endothelial cells were more stable in T1KO mice. Among the RNA-seq results, we focused on the transforming growth factor β signaling pathway and found that the phosphorylation of Smad2/3 was less upregulated in T1KO mice than in WT mice under hyperglycemic conditions. Taken together, a reduction in CS level attenuates DN progression, indicating that CS is an important factor in DN pathogenesis.
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Affiliation(s)
- Hajime Ishiguro
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
| | - Takashi Ushiki
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan
- Departments of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Medical and Dental Hospital, Niigata University, Niigata, Japan
| | - Atsuko Honda
- Department of Neurochemistry and Molecular Cell Biology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Center for Research Promotion, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yasuhiro Yoshimatsu
- Division of Pharmacology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Riuko Ohashi
- Divisions of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shujiro Okuda
- Division of Bioinformatics, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Asami Kawasaki
- Department of Neurochemistry and Molecular Cell Biology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kaori Cho
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
| | - Suguru Tamura
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
| | - Tatsuya Suwabe
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
| | - Takayuki Katagiri
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
| | - Yiwei Ling
- Division of Bioinformatics, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Atsuhiko Iijima
- Neurophysiology & Biomedical Engineering Lab, Interdisciplinary Program of Biomedical Engineering, Assistive Technology and Art and Sports Sciences, Faculty of Engineering, Niigata University Niigata, Niigata, Japan
| | - Tadahisa Mikami
- Laboratory of Biochemistry, Kobe Pharmaceutical University, Kobe, Japan
| | - Hiroshi Kitagawa
- Laboratory of Biochemistry, Kobe Pharmaceutical University, Kobe, Japan
| | - Akiyoshi Uemura
- Department of Retinal Vascular Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazunori Sango
- Diabetic Neuropathy Project, Department of Diseases and Infection, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masayoshi Masuko
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
- Hematopoietic Cell Transplantation Niigata University Medical and Dental Hospital, , Niigata University, Niigata, Japan
| | - Michihiro Igarashi
- Department of Neurochemistry and Molecular Cell Biology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hirohito Sone
- Departments of Hematology, Endocrinology, and Metabolism, Graduate School of Medical and Dental Sciences, Niigata university, Niigata, Japan
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Oba Y, Mizuno H, Taneda S, Sawai T, Oda T, Ikuma D, Yamanouchi M, Suwabe T, Kono K, Kinowaki K, Ohashi K, Sawa N, Ubara Y. Anti-factor H antibody-positive C3 glomerulonephritis secondary to poststreptococcal acute glomerulonephritis with diabetic nephropathy. CEN Case Rep 2024; 13:110-116. [PMID: 37452997 PMCID: PMC10982226 DOI: 10.1007/s13730-023-00809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
Poststreptococcal acute kidney glomerulonephritis (PSAGN) has been seen in adults in recent years, especially in patients with type 2 diabetes mellitus, and the renal prognosis has not always been good. There have been cases of PSAGN in which complete remission was not achieved and hematuria and proteinuria persisted, leading to end-stage renal disease. Previous reports showed that the patients subjected to PSAGN have an underlying defect in regulating the alternative pathway of complement, and they identified that antibodies to the C3 convertase, C3 nephritic factors (C3NeF), are involved. C3NeF stabilizes C3 convertase, sustains C3 activation, and causes C3 glomerulonephritis (C3GN). On the other hand, factor H is a glycoprotein that suppresses the overactivation of the alternative pathway by decaying the C3 convertase. Anti-factor H (aFH) antibodies interfere with factor H and cause the same activation of the alternative pathway as C3NeF. However, a limited number of reports describe the clinical course of C3GN with aFH antibodies. We encountered a 49-year-old Japanese man with type 2 diabetes mellitus. He was referred to our hospital because of his elevated serum creatinine, proteinuria, hematuria, and developed edema on both legs. He was diagnosed as PSAGN at the first kidney biopsy, and his renal function improved and edema and hematuria disappeared, but proteinuria persisted after 5 months. He was diagnosed as C3GN at the second kidney biopsy. In our case, no C3NeF was detected. However, a high titer of aFH antibodies was detected in stored serum from the initial presentation, providing a unified diagnosis of aFH antibody-positive C3GN secondary to PSAGN. He progressed to end-stage renal disease (ESRD) and hemodialysis was started. The persistence of high levels of aFH autoantibodies may have caused C3GN secondary to PSAGN due to activating the alternative complement pathway, which eventually worsened the nephropathy and led to ESRD.
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Affiliation(s)
- Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan
| | - Sekiko Taneda
- Department of Pathology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Toshihiro Sawai
- Department of Pediatrics, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Takashi Oda
- Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Keiichi Kinowaki
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
- Department of Human Pathology, Tokyo Medical Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan
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Suwabe T, Shibasaki Y, Tamura S, Katagiri T, Fuse K, Ida-Kurasaki T, Ushiki T, Sone H, Narita M, Masuko M. Decade-long WT1-specific CTLs induced by WT1 peptide vaccination. Int J Hematol 2024; 119:399-406. [PMID: 38427208 DOI: 10.1007/s12185-024-03723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The peptide-based cancer vaccine targeting Wilms' tumor 1 (WT1) is a promising immunotherapeutic strategy for hematological malignancies. It remains unclear how long and to what extent the WT1-specific CD8 + cytotoxic T cell (CTL) persist after WT1 peptide vaccination. METHODS The WT1 peptide vaccine was administered with written consent to a patient with CML in the chronic phase who did not respond well to imatinib, and the patient was followed for 12 years after vaccination. Immune monitoring was performed by specific amplification of WT1-specific CTLs using a mixed lymphocyte peptide culture. T-cell receptors (TCRs) of amplified WT1-specific CTLs were analyzed using next-generation sequencing. This study was approved by the Institutional Review Board of our institution. RESULT WT1-specific CTLs, which were initially detected during WT1 peptide vaccination, persisted at a frequency of less than 5 cells per 1,000,000 CD8 + T cells for more than 10 years. TCR repertoire analysis confirmed the diversity of WT1-specific CTLs 11 years after vaccination. CTLs exhibited WT1 peptide-specific cytotoxicity in vitro. CONCLUSION The WT1 peptide vaccine induced an immune response that persists for more than 10 years, even after cessation of vaccination in the CML patient.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Hematopoietic Stem Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiko Shibasaki
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
| | - Suguru Tamura
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
| | - Takayuki Katagiri
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
| | - Kyoko Fuse
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
| | - Tori Ida-Kurasaki
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
| | - Takashi Ushiki
- Laboratory of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
| | - Miwako Narita
- Laboratory of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Masayoshi Masuko
- Department of Hematopoietic Stem Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan.
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Ikuma D, Sawa N, Yamanouchi M, Oba Y, Mizuno H, Suwabe T, Hoshino J, Ubara Y. Diagnostic value of 18F-fluorodeoxyglucose positron emission tomography and computed tomography for differentiating polymyalgia rheumatica and rheumatoid arthritis: Using classification and regression tree analysis. Mod Rheumatol 2024; 34:474-478. [PMID: 37279960 DOI: 10.1093/mr/road051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/19/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Determining which sites were important to differentiate polymyalgia rheumatica (PMR) from rheumatoid arthritis (RA) using 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET-CT) is challenging. METHODS Patients with PMR or RA who were undergoing PET-CT were recruited at two mutual-aid hospitals in Japan between 2009 and 2018. Classification and regression tree (CART) analyses were performed to identify FDG uptake patterns that differentiated PMR from RA. RESULTS We enrolled 35 patients with PMR and 46 patients with RA. Univariate CART analysis showed that FDG uptake in the shoulder joints, spinous processes of the lumbar vertebrae, pubic symphysis, sternoclavicular joints, ischial tuberosities, greater trochanters, and hip joints differentiated PMR from RA. Multivariate CART analysis revealed that FDG uptake by at least one of the ischial tuberosities had the highest diagnostic value for distinguishing PMR from RA (sensitivity, 77.1%; specificity, 82.6%). We performed the same CART analysis to patients who had not undergone treatment (PMR, n = 28; RA, n = 9). Similar results were obtained, and sensitivity and specificity were increased (sensitivity, 89.3%; specificity, 88.8%). CONCLUSIONS In PET-CT, FDG uptake by at least one of the ischial tuberosities best discriminates between PMR and RA.
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Affiliation(s)
- Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
| | | | - Yuki Oba
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Branch, Kawasaki, Kanagawa, Japan
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Fukuda M, Yokoyama T, Miki K, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Inoue N, Sekine A, Tanaka K, Hasegawa E, Suwabe T, Wada T, Kono K, Kinowaki K, Ohashi K, Yamaguchi Y, Nakamura Y, Ishii Y, Sawa N, Ubara Y. De novo posttransplant membranous nephropathy after COVID-19 vaccination 9 years after renal transplantation in a patient with polycystic kidney disease. CEN Case Rep 2024:10.1007/s13730-024-00864-4. [PMID: 38520631 DOI: 10.1007/s13730-024-00864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
A 63-year-old man with polycystic kidney disease underwent kidney transplantation from his wife. Nine years later, after the first and second doses of the COVID-19 vaccination, he developed proteinuria, hematuria, and elevated C-reactive protein. Kidney biopsy 7 months after the initial appearance of proteinuria showed immunoglobulin (Ig)-G granular stain, predominantly IgG1, and spike formation in the glomerular basement membrane. Electron microscopy revealed mainly subepithelial deposits, which corresponds to membranous nephropathy (MN) stage 3 of the Ehrenreich-Churg classification indicating chronic disease, but it also showed electron-dense deposits and endothelial damage. Because a kidney biopsy was performed 1 h after renal transplantation and a biopsy of the patient's native kidney showed intact glomeruli, atypical de novo posttransplant membranous nephropathy (MN) was diagnosed, and a close relationship with COVID-19 vaccination was assumed. Clinicians should consider the involvement of COVID-19 vaccination in de novo posttransplant MN with unclear pathogenesis.
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Affiliation(s)
- Miruzato Fukuda
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
| | - Takayoshi Yokoyama
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Katsuyuki Miki
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Noriko Inoue
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kiho Tanaka
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Takehiko Wada
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Yuki Nakamura
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yasuo Ishii
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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8
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Nakayama Y, Sawa N, Suwabe T, Yamanouchi M, Ikuma D, Mizuno H, Hasegawa E, Sekine A, Oba Y, Ishiwata K, Wake A, Hatano M, Kitajima I, Kono K, Kinowaki K, Takazawa Y, Takemura T, Ubara Y. Histologically Proven Recurrent Synovitis after Nivolumab Treatment. Intern Med 2024; 63:867-871. [PMID: 37495530 PMCID: PMC11009007 DOI: 10.2169/internalmedicine.2221-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
A 58-year-old woman with rheumatoid arthritis was diagnosed with methotrexate-associated Hodgkin lymphoma. After receiving several chemotherapy regimens, she started nivolumab treatment. Two weeks later, she was hospitalized with worsening finger, wrist, and elbow joint pain. A synovial biopsy of the wrist joint showed villous synovial proliferation and linear infiltration of CD68-/CD3-positive T cells (with more CD8 than CD4 T cells) but no CD20-positive B cells or CD138-positive macrophages. These findings corresponded to synovitis associated with immune-related adverse events, which are induced mainly by T cells and are different from typical rheumatoid arthritis (RA), in which B cells play a central role.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital Kajigaya, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Japan
| | - Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital Kajigaya, Japan
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
| | | | | | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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9
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Suenaga A, Sawa N, Oba Y, Ikuma D, Sekine A, Yamanouchi M, Hasegawa E, Mizuno H, Suwabe T, Kono K, Kinowaki K, Ohashi K, Miyazono M, Yamaguchi Y, Uesugi N, Ubara Y. Is Podocytopathy Associated with Gross Hematuria after COVID-19 Vaccination in Patients with Immunoglobulin A Nephropathy? Intern Med 2024:3247-23. [PMID: 38403757 DOI: 10.2169/internalmedicine.3247-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
We experienced three cases of a fever and subsequent severe, prolonged gross hematuria after COVID-19 vaccination. A kidney biopsy revealed immunoglobulin A (IgA) nephropathy, and electron microscopy showed two types of podocytopathy (podocyte damage): loss of foot processes from the glomerular basement membrane and foot process effacement. Mesangial interposition was also present in cases 1 and 3 but not in case 2. Podocytopathy is known to be a cause of proteinuria; however, the reactions to COVID-19 vaccination described here suggest that it may also be related to hematuria in IgA nephropathy.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Yamaguchi's Pathology Laboratory, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Japan
| | | | - Noriko Uesugi
- Department of Pathology, Faculty of Medicine, Fukuoka University, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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10
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Nitta K, Oba Y, Ikuma D, Mizuno H, Sekine A, Hasegawa E, Yamanouchi M, Suwabe T, Tokue M, Shiba M, Sawa N, Ubara Y. A Case of Autosomal Dominant Polycystic Kidney Disease With Resolution of Massive Pericardial Effusion After Renal Transcatheter Artery Embolization. Am J Kidney Dis 2024; 83:260-263. [PMID: 37734686 DOI: 10.1053/j.ajkd.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 09/23/2023]
Abstract
A 68-year-old woman being treated with hemodialysis for autosomal dominant polycystic kidney disease was admitted for progressive dyspnea over 6 months. On chest radiography, her cardiothoracic ratio had increased from 52.2% 6 months prior, to 71%, and echocardiography revealed diffuse pericardial effusion and right ventricular diastolic insufficiency. A resultant pericardial tamponade was thought to be the cause of the patient's dyspnea, and therefore a pericardiocentesis was performed, with a total of 2,000mL of fluid removed. However, 21 days later the same amount of pericardial fluid had reaccumulated. The second pericardiocentesis was performed, followed by transcatheter renal artery embolization (TAE). The kidneys, which were hard on palpation before TAE, softened immediately after TAE. After resolution of the pericardial effusion was confirmed, the patient was discharged after 24 days in hospital. Twelve months later, the patient was asymptomatic, the cardiothoracic ratio decreased to 48% on chest radiography and computed tomography revealed no reaccumulation of pericardial effusion. This case illustrates a potential relationship between enlarged kidneys in autosomal dominant polycystic kidney disease and pericardial effusion.
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Affiliation(s)
- Kumi Nitta
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan.
| | - Yuki Oba
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Daisuke Ikuma
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Akinari Sekine
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Eiko Hasegawa
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masayuki Yamanouchi
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masahide Tokue
- Cardiology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masanori Shiba
- Cardiology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan.
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11
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Suenaga A, Sawa N, Oba Y, Ikuma D, Sekine A, Yamanouchi M, Hasegawa E, Mizuno H, Suwabe T, Tsuji H, Kono K, Kinowaki K, Miyazono M, Yamaguchi Y, Ubara Y. Immunoglobulin G4-related Dacryoadenitis Successfully Treated with Baricitinib. Intern Med 2024; 63:461-464. [PMID: 38296523 PMCID: PMC10901715 DOI: 10.2169/internalmedicine.1862-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
A 48-year-old woman visited our hospital because of bilateral lacrimal gland enlargement. Her serum immunoglobulin G4 (IgG4) level was high, and positron emission tomography-computed tomography showed significant positive findings in the bilateral lacrimal gland. A biopsy revealed a considerable increase in IgG4/CD138, leading to a diagnosis of IgG4-related dacryoadenitis. The disease did not respond to steroid therapy, so treatment was started with baricitinib because of exacerbation of the original atopic dermatitis and dacryoadenitis after the second dose of the coronavirus disease 2019 (COVID-19) vaccine. Baricitinib was effective for resolving both dermatitis and dacryoadenitis, and steroids were able to be discontinued. The IgG4 level also improved.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Saga University Internal Medicine, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Hideki Tsuji
- Department of Ophthalmology, the Cancer Institute Hospital of JFCR, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Japan
| | | | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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12
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Yoshimura Y, Ikuma D, Mizuno H, Kono K, Kinowaki K, Sugimoto H, Kamido H, Sawada Y, Mizuta M, Kurihara S, Oba Y, Yamanouchi M, Suwabe T, Ohashi K, Ubara Y, Sawa N. Efficacy of SGLT2 inhibitors in IgA nephropathy associated with alcoholic liver cirrhosis accompanied by nephrotic syndrome: a case report. Front Nephrol 2024; 3:1331757. [PMID: 38318200 PMCID: PMC10839058 DOI: 10.3389/fneph.2023.1331757] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
We present a 51-year-old male patient with a history of Child-Pugh Grade B alcoholic liver cirrhosis (ALC) who developed renal impairment (serum creatinine of 2.00 mg/dL) and nephrotic syndrome (a urinary protein level of 4.35 g/gCr). The patient was diagnosed with immunoglobulin A nephropathy (IgAN) associated with ALC based on findings from comprehensive evaluations, including markedly elevated serum IgA levels (883.7 mg/dL), a kidney biopsy revealing significant IgA deposition in the para-mesangial area, and a liver diagnosis showing long-standing advanced ALC. Our treatment approach involved initiating dapagliflozin therapy, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, alongside strict alcohol abstinence. Remarkably, the patient demonstrated a dramatic reduction in proteinuria within one week of dapagliflozin administration. No hypoglycemic events were observed. This case adds valuable clinical insights into the potential therapeutic role of SGLT2 inhibitors in IgAN associated with ALC. Specifically, in cases where conventional steroid therapies may be contraindicated due to coexisting comorbidities such as diabetes or obesity, dapagliflozin emerges as a potentially efficacious alternative. Further investigations are warranted to validate these preliminary observations.
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Affiliation(s)
- Yusuke Yoshimura
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Keiichi Kinowaki
- Department of Pathology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Hisashi Sugimoto
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Hisashi Kamido
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yuichiro Sawada
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Masato Mizuta
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Shigekazu Kurihara
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | | | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
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13
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Oba Y, Koizumi R, Kageyama K, Yoshimoto M, Kurihara S, Ikuma D, Yamaguchi K, Yamanouchi M, Suwabe T, Ishiwata K, Wake A, Ubara Y, Sawa N. Percutaneous Perirenal Mass Biopsy in a Sitting Position Revealed Extramedullary Relapse of Acute Lymphoblastic Leukemia. Cancer Diagn Progn 2024; 4:66-70. [PMID: 38173667 PMCID: PMC10758842 DOI: 10.21873/cdp.10287] [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] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
Background/Aim Acute lymphoblastic leukemia (ALL) is a blood malignancy characterized by a rapid proliferation of lymphoid progenitor cells. Extramedullary relapse (EMR) is the recurrence of leukemia that occurs outside the bone marrow. The central nervous system is the most prevalent site of EMR in ALL, whereas other organs, particularly the renal organs, are less commonly involved. Case Report A 49-year-old man diagnosed with Philadelphia chromosome-negative ALL (Ph-negative ALL) received a second umbilical cord blood transplant (uCBT) and was confirmed to be in his third hematological complete remission. However, the perirenal mass lesion emerged after two weeks, and was difficult to detect on echography in the prone position. We successfully performed a percutaneous biopsy of the mass in a sitting position and pathologically identified it as EMR. After the diagnosis, chemotherapy was restarted, and the patient was scheduled to receive a third uCBT. Conclusion This is the first report of EMR in a perirenal lesion of ALL and shows that this novel biopsy can be performed as a renal biopsy, even in a sitting position. This case is the first to describe a biopsy technique in detail and demonstrates the value of collaboration between hematologists and nephrologists in diagnosing EMR of the kidneys.
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Affiliation(s)
- Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Ryo Koizumi
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kosei Kageyama
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | | | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kyosuke Yamaguchi
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Atsushi Wake
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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14
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Kataoka H, Shimada Y, Kimura T, Nishio S, Nakatani S, Mochizuki T, Tsuchiya K, Hoshino J, Hattanda F, Kawano H, Hanaoka K, Hidaka S, Ichikawa D, Ishikawa E, Uchiyama K, Hayashi H, Makabe S, Manabe S, Mitobe M, Sekine A, Suwabe T, Kai H, Kurashige M, Seta K, Shimazu K, Moriyama T, Sato M, Otsuka T, Katayama K, Shimabukuro W, Fujimaru T, Miura K, Nakanishi K, Horie S, Furuichi K, Okada H, Narita I, Muto S. Correction to: Public support for patients with intractable diseases in Japan: impact on clinical indicators from nationwide registries in patients with autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2024; 28:82-83. [PMID: 37924433 DOI: 10.1007/s10157-023-02426-x] [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: 11/06/2023]
Affiliation(s)
- Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Shimada
- Intelligent Systems Laboratory, SECOM CO., LTD. Mitaka, Tokyo, Japan
- Department of Medical Eleactronic Intelligence Management, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomonori Kimura
- Reverse Translational Research Project, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Osaka, Japan
| | - Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
- PKD Nephrology Clinic, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Fumihiko Hattanda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Haruna Kawano
- Department of Urology, Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, The Jikei University, Tokyo, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Daisuke Ichikawa
- Department of Nephrology and Hypertension, St Marianna University School of Medicine, Kanagawa, Japan
| | - Eiji Ishikawa
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital, Mie, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michihiro Mitobe
- Department of Nephrology, Takeda General Hospital, Fukushima, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Hirayasu Kai
- Pathophysiology of Renal Diseases, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mahiro Kurashige
- Nephrology and Hypertension, Department of Internal Medicine, The Jikei University, Tokyo, Japan
| | - Koichi Seta
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Keiji Shimazu
- Department of Nephrology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuya Fujimaru
- Department of Nephrology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shigeo Horie
- Department of Urology, Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University, Ishikawa, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan.
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15
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Oba Y, Sawa N, Ikuma D, Mizuno H, Inoue N, Sekine A, Hasegawa E, Yamanouchi M, Suwabe T, Yamaguchi Y, Takasawa Y, Ubara Y. Successful peficitinib monotherapy for the new-onset skin manifestations of rheumatoid vasculitis after long-term treatment with tocilizumab for rheumatoid arthritis. Mod Rheumatol Case Rep 2023; 8:5-10. [PMID: 37210210 DOI: 10.1093/mrcr/rxad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
Rheumatoid vasculitis (RV) is a severe extra-articular systemic manifestation of rheumatoid arthritis (RA). Its prevalence has been decreasing for decades because of improved early diagnosis of RA and advances in RA treatment, but it remains a life-threatening disease. The standard treatment for RV has been a glucocorticoid and disease-modifying antirheumatic drugs. Biological agents, including antitumour necrosis factor inhibitors, are also recommended for refractory cases. However, there are no reports of Janus kinase (JAK) inhibitor use in RV. We experienced a case of an 85-year-old woman with a 57-year history of RA who had been treated with tocilizumab for 9 years after receiving three different biological agents over 2 years. Her RA seemed to be in remission in her joints, and her serum C-reactive protein had decreased to 0.0 mg/dL, but she developed multiple cutaneous leg ulcers associated with RV. Because of her advanced age, we changed her RA treatment from tocilizumab to the JAK inhibitor peficitinib in monotherapy, after which the ulcers improved within 6 months. This is the first report to indicate that peficitinib is a potential treatment option for RV that can be used in monotherapy without glucocorticoids or other immunosuppressants.
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Affiliation(s)
- Yuki Oba
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Noriko Inoue
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yuko Yamaguchi
- Department of Dermatology, Toranomon Hospital, Tokyo, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
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16
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Mochizuki T, Ushiki T, Suzuki K, Sato M, Ishiguro H, Suwabe T, Watanabe S, Edama M, Omori G, Yamamoto N, Kawase T. Elevated IL-1β and Comparable IL-1 Receptor Antagonist Levels Are Characteristic Features of L-PRP in Female College Athletes Compared to Male Professional Soccer Players. Int J Mol Sci 2023; 24:17487. [PMID: 38139317 PMCID: PMC10743764 DOI: 10.3390/ijms242417487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Autologous platelet-rich plasma (PRP) therapy has been becoming popular for the treatment of musculotendinous injuries among athletes. However, for individual and practical variations, clinical success is hardly predictable. To overcome this difficulty, we have been exploring possible criterion candidates for monitoring its clinical effectiveness. In this study, we focused on sex-based differences in young elite athletes and compared the biochemical compositions of their PRP. Leukocyte-rich PRP (L-PRP) was manually prepared from blood samples collected from male professional soccer players (mPSPs) (n = 25) and female college athletes (fCAs) (n = 36). Platelet-derived growth factor-BB (PDGF-BB), transforming-growth factor-β1 (TGFβ1), platelet factor-4 (PF4), interleukin-1β (IL-1β), and IL-1 receptor antagonist (IL-1RA) were quantified using an enzyme-linked immunosorbent assay. The levels of PDGF-BB, TGFβ1, and PF4 in L-PRP were significantly higher in mPSPs than in fCAs. Conversely, IL-1β and IL-1RA were detected at significantly and slightly higher levels, respectively, in fCAs than in mPSPs. Our findings suggest that, even though L-PRP from fCAs may have lower potential to induce cell growth and differentiation than that of mPSPs, due to the latter's higher capacity to control inflammation, it does not necessarily imply that PRP treatment in fCAs is less effective. Thus, these cytokine levels should be checked before PRP therapy.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan;
| | - Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata 951-8518, Japan;
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; (K.S.); (M.S.)
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan; (H.I.); (T.S.)
| | - Katsuya Suzuki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; (K.S.); (M.S.)
| | - Misato Sato
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; (K.S.); (M.S.)
| | - Hajime Ishiguro
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan; (H.I.); (T.S.)
| | - Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan; (H.I.); (T.S.)
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata 950-2022, Japan;
| | - Mutsuaki Edama
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata 950-3102, Japan; (M.E.); (G.O.)
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata 950-3102, Japan; (M.E.); (G.O.)
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata 950-3304, Japan;
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan
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17
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Suenaga A, Sawa N, Oba Y, Ikuma D, Sekine A, Yamanouchi M, Hasegawa E, Mizuno H, Suwabe T, Hayashi N, Kono K, Kinowaki K, Ohashi K, Miyazono M, Yamaguchi Y, Ubara Y. A case of bullous pemphigoid and renal disease after dipeptidyl peptidase 4 inhibitor administration. CEN Case Rep 2023:10.1007/s13730-023-00835-1. [PMID: 38055184 DOI: 10.1007/s13730-023-00835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023] Open
Abstract
A 62-year-old man with type 2 diabetes was admitted because of a decrease in estimated glomerular filtration rate from 72 to 17.5 mL/min/1.73 m2 in 10 years and development of widespread bullous skin lesions. His hemoglobin A1c level had been maintained at 6.0-7.0% for 10 years with a dipeptidyl peptidase (DPP)-4 inhibitor. Skin biopsy showed typical bullous pemphigoid, and kidney biopsy showed tubulointerstitial nephritis with eosinophilic infiltration and glomerular endothelial cell proliferation. After discontinuing the DPP-4 inhibitor, skin lesions improved, and renal decline slowed. This case indicates that DPP-4 inhibitors can cause not only skin lesions but also renal disease.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
- Department of Nephrology, Saga University Internal Medicine, Saga, Japan.
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | | | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Saga, Japan
| | | | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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18
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Katayama Y, Sawa N, Kurihara S, Ikuma D, Oba Y, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Wada T, Kono K, Kinowaki K, Ohashi K, Tsuchiya Y, Ubara Y. A Case of Glomerular Microangiopathy-like Nephropathy Caused by Hyperthyroidism. Intern Med 2023:2436-23. [PMID: 37926548 DOI: 10.2169/internalmedicine.2436-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
A 49-year-old Japanese woman was admitted to our hospital with weight loss of 15 kg, nephrotic-range proteinuria (4.5 g/g.Cre), and hematuria over a 6-month period. She had received two doses of the COVID-19 vaccine one year before the onset of the disease, after which the estimated glomerular filtration rate increased. Laboratory tests and other tests led to a diagnosis of hyperthyroidism, and a kidney biopsy showed thrombotic microangiopathy-like glomerular microangiopathy comprising mainly glomerular endothelial cell damage. Thiamazole (30 mg) was started for the hyperthyroidism. Three months later, the thyroid function normalized, and two months later, the proteinuria and hematuria disappeared, suggesting that COVID-19 vaccination and these events were related.
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Affiliation(s)
- Yuri Katayama
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Shigekazu Kurihara
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Takehiko Wada
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | | | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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Iijima T, Sawa N, Oba Y, Ikuma D, Mizuno H, Yamanouchi M, Suwabe T, Wake A, Kono K, Ubara Y, Ohashi K. Cardiac and renal AL amyloidosis controlled by autologous stem cell transplantation for 17 years accompanying late onset atrial fibrillation and complete atrioventricular block. CEN Case Rep 2023; 12:362-367. [PMID: 36795309 PMCID: PMC10620357 DOI: 10.1007/s13730-023-00777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Amyloid light chain (AL) amyloidosis is a rare hematologic disease that may involve multiple organs. Amongst the organs, cardiac involvement causes the greatest concern as its treatment is challenging. Diastolic dysfunction rapidly progresses to decompensated heart failure, pulseless electrical activity, and atrial standstill due to electro-mechanical dissociation resulting in death. High-dose melphalan plus autologous stem cell transplantation (HDM-ASCT) is the most radical treatment but its risk is very high and thus only less than 20% of patients can receive this therapy under criteria that can suppress treatment-related mortality. In substantial proportion of patients, levels of M protein remain elevated, and organ response cannot be achieved. Moreover, relapse may occur, making prediction of treatment response and judgement of disease eradication very difficult. Herein we report a case of AL amyloidosis who was treated with HDM-ASCT, resulting in preserved cardiac function and resolution of proteinuria for more than 17 years after HDM-ASCT ensuing atrial fibrillation and complete atrioventricular block required management by catheter ablation and pacemaker implantation 10 years and 12 years after transplantation, respectively.
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Affiliation(s)
- Takashi Iijima
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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20
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Nakayama Y, Yamanouchi M, Mizuno H, Suwabe T, Sekine A, Ikuma D, Hasegawa E, Oba Y, Kono K, Kinowaki K, Ohashi K, Wada T, Sawa N, Ubara Y. Syphilis-related Membranous Nephropathy in a 35-year-old Woman. Intern Med 2023:2380-23. [PMID: 37839882 DOI: 10.2169/internalmedicine.2380-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
A 35-year-old woman was admitted for the examination of lower leg edema and proteinuria. A kidney biopsy showed membranous nephropathy (MN) with fine granular deposits of IgG along the glomerular capillary and poor spike formation, differing from primary MN in the presence of positive IgG3 and C1q. Lupus nephritis was excluded because serum complement and anti-dsDNA antibody, anti-Smith antibody, and anti-cardiolipin antibody tests were negative. The serological test for syphilis was positive, as was the Treponema pallidum hemagglutination test. The patient was diagnosed with syphilis, and the proteinuria disappeared with antibiotic treatment. In MN with positive IgG3 and C1q, syphilis nephropathy may be a differential diagnosis.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Takehiko Wada
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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21
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Suenaga A, Sawa N, Oba Y, Ikuma D, Sekine A, Hasegawa E, Mizuno H, Suwabe T, Ikeda S, Tsujimoto T, Kono K, Shintani-Domoto Y, Kinowaki K, Ohashi K, Miyazono M, Yamaguchi Y, Ubara Y. Dipeptidyl peptidase-4 inhibitor-related renal disease. J Diabetes Complications 2023; 37:108590. [PMID: 37678056 DOI: 10.1016/j.jdiacomp.2023.108590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/29/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used to treat type 2 diabetes (T2D). Lowering blood glucose is expected also to reduce the progression of diabetic nephropathy. We experienced a patient with T2D who achieved good glycemic control with a DPP-4 inhibitor but experienced rapid deterioration of renal function. Therefore, we performed a retrospective study of similar patients treated at our hospital. METHODS Out of 56 patients with biopsy-proven diabetic nephropathy who underwent native kidney biopsy at Toranomon Hospital from January 2018 through December 2022, we selected 22 patients who had been receiving DPP-4 inhibitors for at least 9 months at the time of kidney biopsy. Of these patients, we evaluated 16 diagnosed with class IIa diabetic nephropathy according to Tervaert's pathologic classification. The yearly estimated glomerular filtration rate (eGFR) slope in the 16 patients was arranged from the highest to the lowest slope. Ten patients with a large eGFR slope had thrombotic microangiopathy (TMA)-like lesions characterized by glomerular endothelial cell proliferation and GBM duplication on kidney biopsy (group A), whereas the remaining 6 patients did not have TMA-like lesions (group B). RESULTS Group A had a median (interquartile range [IQR]) eGFR of 18.2 (16.2, 26.2) and a yearly median (IQR) eGFR slope of -11.2 (-17.6, -9.2) mL/min/1.73 m2 after of DPP-4 administration, whereas group B had a median (IQR) eGFR of 31.5 (21.9, 34.8) mL/min/1.73 m2 and a yearly median (IQR) eGFR slope of -1.6 (-3.1, -0.3). Renal function declined significantly more rapidly in group A than in group B, and proteinuria was higher in group A than in group B (median [IQR], 3.4 [2.6, 4.4] g/day vs 0.8 [0.4, 1.3] g/day, respectively). Five patients in group A progressed to dialysis during follow-up, but none of the patients in group B did. Median (IQR) hemoglobin A1c was 6.2 % (6.0 %, 6.6 %) in group A and 5.8 % (5.7 %, 6.6 %) in group B. CONCLUSION DPP-4 inhibitors promote vascular endothelial regeneration, but when this effect occurs in the glomerulus, glomerular endothelial cell proliferation leads to TMA-like lesions, which may cause an increase in proteinuria and rapid decline in renal function.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan; Department of Nephrology, Saga University School of Medicine, Saga, Japan.
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Sara Ikeda
- Department of Diabetes and Endocrinology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tetsuro Tsujimoto
- Department of Diabetes and Endocrinology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan; Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University School of Medicine, Saga, Japan
| | | | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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22
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Kataoka H, Shimada Y, Kimura T, Nishio S, Nakatani S, Mochizuki T, Tsuchiya K, Hoshino J, Hattanda F, Kawano H, Hanaoka K, Hidaka S, Ichikawa D, Ishikawa E, Uchiyama K, Hayashi H, Makabe S, Manabe S, Mitobe M, Sekine A, Suwabe T, Kai H, Kurashige M, Seta K, Shimazu K, Moriyama T, Sato M, Otsuka T, Katayama K, Shimabukuro W, Fujimaru T, Miura K, Nakanishi K, Horie S, Furuichi K, Okada H, Narita I, Muto S. Public support for patients with intractable diseases in Japan: impact on clinical indicators from nationwide registries in patients with autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2023; 27:809-818. [PMID: 37368094 DOI: 10.1007/s10157-023-02372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Clinical practice guidelines recommend antihypertensive and tolvaptan therapies for patients with autosomal dominant polycystic kidney disease (ADPKD) in Japan. However, tolvaptan therapy may pose an economic burden. The Japanese Ministry of Health, Labour and Welfare supports patients with intractable diseases. This study aimed to confirm the impact of the intractable disease system in Japan on the clinical treatment of ADPKD. METHODS We analyzed the data of 3768 patients with ADPKD having a medical subsidy certificate from the Japanese Ministry of Health, Labour and Welfare in 2015-2016. The following quality indicators were use: the adherence rate to the 2014 clinical practice guideline for polycystic kidney disease (prescription rates of antihypertensive agents and tolvaptan in this cohort) and the number of Japanese patients with ADPKD nationwide started on renal replacement therapy in 2014 and 2020. RESULTS Compared with new applications from 2015 to 2016, the prescription rates of antihypertensives and tolvaptan for the indicated patients at the 2017 renewal application increased by 2.0% (odds ratio = 1.41, p = 0.008) and 47.4% (odds ratio = 10.1, p > 0.001), respectively. These quality indicators improved with antihypertensive treatment, especially in patients with chronic kidney disease stages 1-2 (odds ratio = 1.79, p = 0.013) and in those aged < 50 years (odds ratio = 1.70, p = 0.003). The number of patients with ADPKD who were started on renal replacement therapy in Japan decreased from 999 in 2014 to 884 in 2020 in the nationwide database (odds ratio = 0.83, p < 0.001). CONCLUSIONS The Japanese public intractable disease support system contributes to improvement of ADPKD treatment.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Shimada
- Intelligent Systems Laboratory, SECOM CO., LTD. Mitaka, Tokyo, Japan
- Department of Medical Eleactronic Intelligence Management, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomonori Kimura
- Reverse Translational Research Project, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Osaka, Japan
| | - Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
- PKD Nephrology Clinic, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Fumihiko Hattanda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Haruna Kawano
- Department of Urology, Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, The Jikei University, Tokyo, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Daisuke Ichikawa
- Department of Nephrology and Hypertension, St Marianna University School of Medicine, Kanagawa, Japan
| | - Eiji Ishikawa
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital, Mie, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michihiro Mitobe
- Department of Nephrology, Takeda General Hospital, Fukushima, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Hirayasu Kai
- Pathophysiology of Renal Diseases, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mahiro Kurashige
- Nephrology and Hypertension, Department of Internal Medicine, The Jikei University, Tokyo, Japan
| | - Koichi Seta
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Keiji Shimazu
- Department of Nephrology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuya Fujimaru
- Department of Nephrology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shigeo Horie
- Department of Urology, Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University, Ishikawa, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan.
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23
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Suenaga A, Sawa N, Ikuma D, Oba Y, Sekine A, Yamanouchi M, Hasegawa E, Mizuno H, Suwabe T, Kono K, Shintani-Domoto Y, Kinowaki K, Ohashi K, Suzuki Y, Miyazono M, Takemura T, Yamaguchi Y, Ubara Y. Immunoglobulin G4-related Tubulointerstitial Nephritis with Simultaneous Resolution of Plasma Cell Infiltration and Fibrosis after Steroid Treatment. Intern Med 2023; 62:2699-2706. [PMID: 36725037 PMCID: PMC10569928 DOI: 10.2169/internalmedicine.1121-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
We performed 3 kidney biopsies in a 71-year-old man. At the first biopsy, we made the diagnosis of immunoglobulin G4 (IgG4)-related interstitial nephritis characterized by the simultaneous presence of IgG4-positive plasma cells and characteristic fibrosis with a bird's-eye pattern. At the second biopsy, rather than finding fibrosis as a post-inflammatory scar, we noted that steroid treatment had caused the simultaneous disappearance of IgG4-positive plasma cells and fibrosis and had restored the normal tubular structure. The third biopsy showed the recurrence of the disease with inflammatory cells accompanied by fibrosis. These findings suggest that IgG4-positive plasma cells and fibrosis occur simultaneously.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Saga University School of Medicine, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical and Dental University, Japan
| | | | - Motoaki Miyazono
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | | | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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24
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Suenaga A, Sawa N, Miki K, Yokoyama T, Ishii Y, Mizuno H, Ikuma D, Oba Y, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Honda K, Miyazono M, Nakamura Y, Ubara Y. Antiphospholipid Syndrome Nephropathy with Acute Thrombotic Microangiopathy after Renal Transplantation. Intern Med 2023; 62:2707-2713. [PMID: 36725047 PMCID: PMC10569915 DOI: 10.2169/internalmedicine.0813-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
We experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Katsuyuki Miki
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Takayoshi Yokoyama
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yasuo Ishii
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Yuki Nakamura
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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25
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Mochizuki T, Ushiki T, Suzuki K, Sato M, Ishiguro H, Suwabe T, Edama M, Omori G, Yamamoto N, Kawase T. Characterization of Leukocyte- and Platelet-Rich Plasma Derived from Female Collage Athletes: A Cross-Sectional Cohort Study Focusing on Growth Factor, Inflammatory Cytokines, and Anti-Inflammatory Cytokine Levels. Int J Mol Sci 2023; 24:13592. [PMID: 37686398 PMCID: PMC10488049 DOI: 10.3390/ijms241713592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Platelet-rich plasma (PRP) has been increasingly used in sports medicine owing to its various advantages. The purpose of our project was to standardize the parameters before performing large-scale clinical trials in the near future to precisely evaluate individual PRP quality. To examine the effects of regular exercise on PRP quality, this study focused on young female athletes, who have been relatively less studied. Blood samples were obtained from female college athletes (n = 35) and ordinary healthy adults (n = 30), which were considered as controls, and leukocyte-rich PRP (L-PRP) was prepared manually. Body composition indices were determined using a bathroom weight scale equipped with an impedance meter. Growth factors and cytokines were quantified using ELISA kits. Platelet-derived growth factor-BB (PDGF-BB) and Transforming-growth factors β1 (TGFβ1) levels (per platelet) in L-PRP were significantly lower in female athletes than in controls. In contrast, Interleukin-1β and Interleukin 1 receptor antagonist (IL-1RA) levels (per platelet and L-PRP) in L-PRP were significantly higher in athletes, and this difference was more prominent in IL-1RA. These findings suggest that L-PRP from athletes may facilitate the inflammatory phase of the healing process by regulating the pro-inflammatory and anti-inflammatory balance. These chemical compositions can be adopted as "must-check" parameters to characterize individual PRP preparations prior to clinical trials.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan;
| | - Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata 951-9518, Japan;
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; (K.S.)
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan; (H.I.); (T.S.)
| | - Katsuya Suzuki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; (K.S.)
| | - Misato Sato
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; (K.S.)
| | - Hajime Ishiguro
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan; (H.I.); (T.S.)
| | - Tatsuya Suwabe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata 951-8510, Japan; (H.I.); (T.S.)
| | - Mutsuaki Edama
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata 950-3102, Japan; (M.E.); (G.O.)
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata 950-3102, Japan; (M.E.); (G.O.)
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata 950-3304, Japan;
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan
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26
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Ushiki T, Mochizuki T, Suzuki K, Kamimura M, Ishiguro H, Suwabe T, Watanabe S, Omori G, Yamamoto N, Kawase T. Strategic analysis of body composition indices and resting platelet ATP levels in professional soccer players for better platelet-rich plasma therapy. Front Bioeng Biotechnol 2023; 11:1255860. [PMID: 37711445 PMCID: PMC10499317 DOI: 10.3389/fbioe.2023.1255860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
Background: Autologous platelet-rich plasma (PRP) therapy is ambiguously thought to be more effective in elite athletes than in sedentary patients, although the possible importance of recipient responsiveness remains poorly understood. To address this issue, along with the well-known PRP quality, in this initial study, we evaluated two candidate biomarkers: body composition indices (BCIs), which reflect systemic physical conditions, and resting platelet ATP levels, which reflect platelet energy expenditure and the mass of energy generation units. Methods: In this cross-sectional cohort study, blood samples were collected from male professional soccer players (PSPs) on a local professional team during the off-season and platelet ATP levels were quantified using an ATP luminescence assay kit. BCIs were measured using the body mass impedance method. Age-matched male sedentary participants were used as the controls. Results: Among the BCIs, the body mass index, basal metabolic rate (BMR), and skeletal muscle weight levels were higher in the PSPs than in the controls. The platelet ATP levels in the PSPs group were significantly lower than those in the control group. The correlation between BMR and platelet ATP levels was moderately negative in the control group, but weakly positive in the PSPs group. Conclusion: Owing to regular physical exercise, PSPs had higher BMR levels and lower platelet ATP levels without a significant mutual correlation compared to sedentary controls. This study did not indicate the influence of these biomarkers on the success of PRP therapy but provided evidence for a better understanding of PRP therapy, particularly for elite athletes.
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Affiliation(s)
- Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Katsuya Suzuki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masami Kamimura
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Hajime Ishiguro
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tatsuya Suwabe
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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27
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Tamura S, Ishiguro H, Suwabe T, Katagiri T, Cho K, Fuse K, Shibasaki Y, Mikami T, Shindo T, Kitagawa H, Igarashi M, Sone H, Masuko M, Ushiki T. Genetic manipulation resulting in decreased donor chondroitin sulfate synthesis mitigates hepatic GVHD via suppression of T cell activity. Sci Rep 2023; 13:13098. [PMID: 37567982 PMCID: PMC10421903 DOI: 10.1038/s41598-023-40367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/09/2023] [Indexed: 08/13/2023] Open
Abstract
Donor T cell activation, proliferation, differentiation, and migration are the major steps involved in graft-versus-host disease (GVHD) development following bone marrow transplantation. Chondroitin sulfate (CS) proteoglycan is a major component of the extracellular matrix and causes immune modulation by interacting with cell growth factors and inducing cell adhesion. However, its precise effects on immune function are unclear than those of other proteoglycan families. Thus, we investigated the significance of CS within donor cells in acute GVHD development utilizing CSGalNAc T1-knockout (T1KO) mice. To determine the effects of T1KO, the mice underwent allogenic bone marrow transplantation from major histocompatibility complex-mismatched donors. While transplantation resulted in hepatic GVHD with inflammatory cell infiltration of both CD4+ and CD8+ effector memory T cells, transplantation in T1KO-donors showed milder cell infiltration and improved survival with fewer splenic effector T cells. In vitro T-cell analyses showed that the ratio of effector memory T cells was significantly lower via phorbol myristate acetate/ionomycin stimulation. Moreover, quantitative PCR analyses showed significantly less production of inflammatory cytokines, such as IFN-γ and CCL-2, in splenocytes of T1KO mice. These results suggest that reduction of CS in donor blood cells may suppress the severity of acute GVHD after hematopoietic stem cell transplantation.
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Affiliation(s)
- Suguru Tamura
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hajime Ishiguro
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tatsuya Suwabe
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takayuki Katagiri
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Kaori Cho
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Kyoko Fuse
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yasuhiko Shibasaki
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tadahisa Mikami
- Laboratory of Biochemistry, Kobe Pharmaceutical University, Kobe, Japan
| | - Takero Shindo
- Department of Hematology/Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Kitagawa
- Laboratory of Biochemistry, Kobe Pharmaceutical University, Kobe, Japan
| | - Michihiro Igarashi
- Department of Neurochemistry and Molecular Cell Biology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hirohito Sone
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masayoshi Masuko
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takashi Ushiki
- Department of Hematology, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan.
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28
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Nakayama Y, Mizuno H, Sawa N, Suwabe T, Yamanouchi M, Ikuma D, Hasegawa E, Hoshino J, Sekine A, Oba Y, Kono K, Kinowaki K, Ohashi K, Suzuki K, Sato Y, Shimizu A, Yamaguchi Y, Ubara Y. Adolescent-onset TAFRO Syndrome with Malignant Nephrosclerosis-like Lesions. Intern Med 2023; 62:2223-2229. [PMID: 36517029 PMCID: PMC10465276 DOI: 10.2169/internalmedicine.0529-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/30/2022] [Indexed: 12/15/2022] Open
Abstract
A 16-year-old Japanese girl developed a fever, thrombocytopenia, and renal dysfunction. Treatment was started with steroids, but cervical lymphadenopathy and ascites developed. A lymph node biopsy indicated TAFRO syndrome. The patient's renal function deteriorated, and dialysis was started. Refractory hypertension and subsequent encephalopathy developed. Treatment was started with an anti-IL-6 receptor antibody and an anti-CD20 monoclonal antibody. A kidney biopsy showed malignant nephrosclerosis-like microangiopathy and glomerular collapse due to narrowing of the small arteries. The majority of TAFRO syndrome cases are adult-onset, with glomerular microangiopathy. To our knowledge, this is the first report of adolescent-onset TAFRO syndrome presenting with malignant nephrosclerosis-like lesions associated with hypertension.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Junichi Hoshino
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Kodai Suzuki
- Department of General Internal Medicine, Saitama Medical University, Japan
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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29
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Sawamura M, Sawa N, Mizuno H, Oba Y, Ikuma D, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Suzuki M, Kono K, Kinowaki K, Ohashi K, Ehara T, Ikeda Y, Sawai T, Ubara Y. Immunoelectron microscopy findings in a patient with C3 glomerulonephritis. Clin Nephrol Case Stud 2023; 11:87-94. [PMID: 37363300 PMCID: PMC10286732 DOI: 10.5414/cncs111091] [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: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 06/28/2023] Open
Abstract
We performed a kidney biopsy in a 36-year-old man to evaluate microscopic hematuria and proteinuria. Light microscopy showed increased mesangial matrix and partial swelling of the glomerular basement membrane (GBM), and immunofluorescence showed positive staining only for C3. Immunoelectron microscopy showed that gold particle-labeled C3 was localized in the electron-dense and moderately electron-dense deposits shown by electron microscopy in the mesangium, the thickened GBM near the paramesangium, and the thickened distal portion of the GBM but was not localized in the non-thickened GBM. Gold-labeled immunoglobulin G, κ, and λ were not seen. C3 glomerulonephritis was more evident in gold-labeled electron microscopy, which further clarified the localization of C3 deposition.
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Affiliation(s)
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital
| | | | - Yuki Oba
- Nephrology Center and Department of Rheumatology
| | | | | | | | | | | | | | | | | | - Kenichi Ohashi
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo
| | - Takashi Ehara
- Department of Histopathology, Shinshu University School of Medicine, Matsumoto
| | - Yoichiro Ikeda
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Tokyo, and
| | - Toshihiro Sawai
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital
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30
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Terakawa K, Sekine A, Inoue N, Oba Y, Mizuno H, Ikuma D, Tanaka K, Yamanouchi M, Hasegawa E, Suwabe T, Urakami S, Sawa N, Ubara Y, Hoshino J. Can Takayasu Arteritis Cause Hydronephrosis? Intern Med 2023; 62:1625-1629. [PMID: 37258208 DOI: 10.2169/internalmedicine.0305-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
A 74-year-old woman was admitted because of malaise and a low-grade fever. Her C-reactive protein level was 0.96 mg/dL. Computed tomography (CT) revealed diffuse uniform thickening of the arterial wall from the abdominal aorta to the common iliac artery and right hydronephrosis. 18F-fluordesoxyglucose positron emission tomography-CT showed an accumulation in the same area. These findings suggested Takayasu arteritis and retroperitoneal fibrosis as differential diagnoses. Takayasu arteritis is characterized by thickening of the arterial walls, and retroperitoneal fibrosis is characterized by membranous lesions covering the outer surface of the arterial walls. Thus, Takayasu arteritis was deemed the most likely diagnosis. Steroid treatment was effective.
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Affiliation(s)
- Kanako Terakawa
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Noriko Inoue
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kiho Tanaka
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | | | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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31
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Hara R, Hasegawa E, Inoue N, Sekine A, Tanaka K, Ikuma D, Mizuno H, Oba Y, Yamanouchi M, Suwabe T, Sawa N, Kono K, Kinowaki K, Ohashi K, Ubara Y, Hoshino J. Crescentic Glomerulonephritis with Fibrinoid Vasculitis after Administration of Influenza Vaccine. Intern Med 2023; 62:1077-1080. [PMID: 36070955 PMCID: PMC10125826 DOI: 10.2169/internalmedicine.9410-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old man was admitted to our hospital because of a low-grade fever and arthralgia. The symptoms started on the third day after influenza vaccine administration and persisted for two months. Serum creatinine was 1.0 mg/dL; C-reactive protein, 16.1 mg/dL; and myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA), 4,170 IU/mL. A kidney biopsy showed crescentic glomerulonephritis with fibrinoid necrosis of small arteries. Microscopic polyangiitis was diagnosed. After five months of steroid pulse therapy and rituximab administration, the patient entered remission. There have been very few reports of this condition after influenza vaccine administration.
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Affiliation(s)
- Risa Hara
- Nephrology Center, Toranomon Hospital, Japan
| | | | | | | | - Kiho Tanaka
- Nephrology Center, Toranomon Hospital, Japan
| | | | | | - Yuki Oba
- Nephrology Center, Toranomon Hospital, Japan
| | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical and Dental University, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Human Pathology, Tokyo Medical and Dental University, Japan
- Department of Pathology, Toranomon Hospital, Japan
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32
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Sawamura M, Sawa N, Ikuma D, Oba Y, Yamanouchi M, Sekine A, Mizuno H, Hasegawa E, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Ubara Y. Successful Discontinuation of Glucocorticoid Treatment after Administration of a Calcineurin Inhibitor for Nephrotic Syndrome in a Patient with Lupus Nephritis. Intern Med 2023; 62:1037-1041. [PMID: 36070938 PMCID: PMC10125829 DOI: 10.2169/internalmedicine.0160-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Systemic lupus erythematosus was diagnosed in a patient at 43 years old. When proteinuria recurred at 57 years old, the first kidney biopsy was performed, and class IV-G (A) +V lupus nephritis was diagnosed. The prednisolone dose was increased to 40 mg/day, and cyclosporine A was introduced. After 1 year, proteinuria had decreased to 0.1 g/day. Prednisolone was discontinued three years later, and cyclosporine A was continued. Thereafter, proteinuria did not reoccur. At 67 years old, a second kidney biopsy showed complete remission of lupus nephritis. Cyclosporine A enabled permanent discontinuation of glucocorticoids in a patient with lupus nephritis.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Yuki Oba
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | | | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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33
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Okubo N, Suwabe T, Oba Y, Ikuma D, Mizuno H, Sekine A, Hasegawa E, Yamanouchi M, Hoshino J, Kitajima I, Shiba M, Uruga K, Takeshi F, Ohashi K, Sawa N, Ubara Y. A Half-Century Dialysis Survivor: Clinical and Autopsy Findings. Kidney Med 2023; 5:100612. [PMID: 36915367 PMCID: PMC10006697 DOI: 10.1016/j.xkme.2023.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
A man in his 20s initiated intermittent peritoneal dialysis in the late 1960s. He subsequently transitioned to hemodialysis and survived for more than 50 years, spanning low-flux and high-flux hemodialysis eras. He underwent surgery for cervical and lumbar spinal canal stenosis after 30 and 35 years, respectively, and both surgeries revealed similar degrees of severe amyloid deposition. At autopsy, significant improvement was seen in lumbar amyloid deposition. During the previous 25 years, serum β2 microglobulin levels had decreased from 40 mg/L and been maintained at 20 mg/L. This case indicates that advances in dialysis therapy aimed at lowering β2 microglobulin concentrations have reduced highly deposited amyloid.
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Affiliation(s)
- Noto Okubo
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Junichi Hoshino
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Izuru Kitajima
- Department of Orthopedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masanori Shiba
- Department of Cardiovascular Medicine, Toranomon Hospital, Tokyo, Japan
| | - Koki Uruga
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Fuji Takeshi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.,Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan
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34
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Kuno M, Sawa N, Mizuno H, Oba Y, Ikuma D, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Saito S, Kono K, Kinowaki K, Notohara K, Ubara Y. Immunoglobulin G4-related Hepatopathy after COVID-19 Vaccination. Intern Med 2023. [PMID: 37005259 PMCID: PMC10400404 DOI: 10.2169/internalmedicine.1634-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
An 84-year-old woman with immunoglobulin G4 (IgG4)-related disease presented with jaundice and liver dysfunction after COVID-19 vaccination. Serum IgG4 levels were elevated. Diagnostic imaging showed no stenotic lesions in the bile ducts. A liver biopsy was performed because of the enlarged liver. Infiltration of IgG4-positive plasma cells, which accounted for approximately 74% of total plasma cells, was found in the portal area, but there was no evidence of periportal hepatitis, and inflammatory cell infiltration into the lobular space was minimal. IgG4-related hepatopathy was diagnosed. The patient achieved spontaneous remission with no treatment and only follow-up and remains under observation at the time of writing.
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Affiliation(s)
- Masahiro Kuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | | | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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35
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Suenaga A, Sawa N, Oshima Y, Ikuma D, Oba Y, Yamanouchi M, Hasegawa E, Mizuno H, Sekine A, Suwabe T, Kono K, Kinowaki K, Ohashi K, Takemura T, Yamaguchi Y, Miyazono M, Atsumi T, Ubara Y. Antiphospholipid Syndrome Nephropathy Related Disease Diagnosed by Assessing Phosphatidylserine-dependent Antiprothrombin Antibodies. Intern Med 2023; 62:757-761. [PMID: 35908966 PMCID: PMC10037018 DOI: 10.2169/internalmedicine.0302-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 42-year-old Japanese woman was admitted for the evaluation of proteinuria. She had a history of four habitual abortions and valvular heart disease, including severe mitral regurgitation and moderate tricuspid regurgitation. A kidney biopsy showed fibrointimal thickening of interlobular arteries, fibrin thrombosis, and associated focal segmental sclerosis. Although the standard test for antiphospholipid (aPL) antibodies was negative, the patient was diagnosed with antiphospholipid syndrome (APS)-related disease by testing for phosphatidylserine dependent anti-prothrombin anticardiolipin antibody, a non-criterial aPL antibody. A kidney biopsy may lead to a diagnosis of APS in patients with negative laboratory test findings for APS.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yoichi Oshima
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | | | - Motoaki Miyazono
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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36
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Suwabe T, Ubara Y, Oba Y, Mizuno H, Ikuma D, Yamanouchi M, Sekine A, Tanaka K, Hasegawa E, Hoshino J, Sawa N. Acute renal intracystic hemorrhage in patients with autosomal dominant polycystic kidney disease. J Nephrol 2023; 36:999-1010. [PMID: 36753000 DOI: 10.1007/s40620-022-01562-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Renal cyst bleeding is a frequent problem in patients with autosomal dominant polycystic kidney disease (ADPKD). However, information is still limited on its frequency, causative factors, and effects on enlargement of polycystic kidneys in ADPKD. METHODS We investigated the total volume of acute renal intracystic hemorrhage and its association with total kidney volume (TKV) in a large series of patients with ADPKD on dialysis, referred for renal transcatheter arterial embolization. All patients had undergone CT scan and MRI scan before the procedure. We evaluated factors potentially associated with acute renal intracystic hemorrhage. The association between the volume of acute renal intracystic hemorrhage and the potential predisposing and associated factors was analysed by univariable and multivariable regressions. RESULTS: We enrolled 199 patients who underwent renal transcatheter arterial embolization from 2014 to 2018 (107 men, 92 women; mean age 59.1 ± 8.6 years). The median volume of acute renal intracystic hemorrhage was 97.3 ml (interquartile range 36.6-261.7 ml). Multivariable analysis revealed that body weight, kidney stones, systolic blood pressure, and total volume of acute renal intracystic hemorrhage were significantly associated with TKV; age, body mass index, smoking, renal cyst infection, serum alkaline phosphatase, and TKV were significantly associated with the volume of acute renal intracystic hemorrhage ; and sex, age, dialysis vintage, TKV, and total volume of acute renal intracystic hemorrhage were significantly associated with the number of microcoils required to achieve renal transcatheter arterial embolization. Total volume of acute renal intracystic hemorrhage was significantly associated with TKV (r = 0.15, p = 0.0325) and was greater in younger patients (r= - 0.32, p < 0.0001). Total volume of acute renal intracystic hemorrhage was also correlated with the number of microcoils required for renal transcatheter arterial embolization (r = 0.23, p = 0.0012). CONCLUSION Acute renal intracystic hemorrhage is frequent among ADPKD patients on dialysis, and total volume of acute renal intracystic hemorrhage significantly associated with TKV. Total volume of acute renal intracystic hemorrhage was greater in younger patients with higher renal artery luminal size. These results suggest that renal cyst bleeding and renal artery blood flow may synergistically accelerate the enlargement of polycystic kidneys in ADPKD patients on dialysis.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kiho Tanaka
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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37
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Sawamura M, Sawa N, Oshima Y, Ikuma D, Yamanouchi M, Hayami N, Sekine A, Mizuno H, Hasegawa E, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Ubara Y. A case of malignant nephrosclerosis occurring with serum renin in the normal range. CEN Case Rep 2023; 12:116-121. [PMID: 36038752 PMCID: PMC9892380 DOI: 10.1007/s13730-022-00726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023] Open
Abstract
A 37-year-old Japanese man was admitted to our hospital for evaluation of severe hypertension and visual impairment. His serum creatinine was 4.16 mg/dL. Plasma renin activity was normal (2.7 ng/mL/h), but plasma aldosterone concentration was elevated (27.2 ng/dL). A kidney biopsy showed concentric subendothelial edematous thickening of the arterioles (onion skin pattern) with luminal narrowing or obstruction, and malignant nephrosclerosis was diagnosed. Antihypertensive therapies, including an angiotensin II receptor blocker and spironolactone, were administered and effectively preserved kidney function and normalized blood pressure. This case indicates that hyperaldosteronemia in the presence of normal renin levels might also cause malignant hypertension.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoichi Oshima
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Noriko Hayami
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Kajigaya, 1-3-1, Takatsu, Kawasaki, Tokyo, Kanagawa, 212-0015, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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Nakayama Y, Sawa N, Suwabe T, Sekine A, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Hasegawa E, Hoshino J, Matoba S, Ubara Y. Development of an enterocutaneous fistula from an intestinal perforation in a patient with autosomal dominant polycystic kidney disease. CEN Case Rep 2023; 12:45-49. [PMID: 35789990 PMCID: PMC9892373 DOI: 10.1007/s13730-022-00716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
We herein report a case of enterocutaneous fistula in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 37-year-old Japanese man was admitted to our hospital. Three months prior to transfer to our hospital, he developed intense flank pain with gross hematuria. His serum creatinine had decreased to 7.8 mg/dL and hemodialysis was started, but gross hematuria persisted and he developed hypotension. Upon admission, plain chest radiography did not reveal any free air, but computed tomography (CT) showed generalized ventral subcutaneous air from the head to the lower extremities and enlarged kidneys. Enterography showed leakage of contrast medium from the descending colon into the subcutaneous area. C-reactive protein was 23.1 mg/dL. A colostomy was placed in the transverse colon proximal to the perforation, and systemic subcutaneous drainage was performed. The fever subsequently resolved, and the C-reactive protein test became negative. Three months later, renal artery embolization was performed, and 12 months thereafter, CT showed a marked decrease in kidney size. We assume that a markedly enlarged kidney leaded to intestinal perforation, which developed into an enterocutaneous fistula. Consequently, intestinal fluid leaked into the subcutaneous cavity of the abdominal wall and spread systemically, resulting in extensive subcutaneous abscesses.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Shuichiro Matoba
- Department of Gastrointestinal Surgery, Toranomon Hosipital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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Nakayama Y, Sawa N, Suwabe T, Yamanouchi M, Ikuma D, Mizuno H, Hasegawa E, Hoshino J, Sekine A, Oba Y, Kono K, Kinowaki K, Ohashi K, Yamaguchi Y, Nozu K, Ubara Y. Kidney Histology Findings in a Patient with Autosomal Dominant Tubulointerstitial Kidney Disease Subtype Hepatocyte Nuclear Factor 1β. Intern Med 2023; 62:419-422. [PMID: 35831109 PMCID: PMC9970820 DOI: 10.2169/internalmedicine.9364-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We evaluated kidney histology in a 43-year-old woman with autosomal dominant tubulointerstitial kidney disease subtype hepatocyte nuclear factor 1β. Magnetic resonance imaging showed multiple cysts in the renal medullary area, and computed tomography showed hypoplasia of the pancreatic body and tail. A kidney biopsy showed thinning of the cortex, size reduction of glomerular tuft area, proximal tubule clustering, fibrosis around the tubules, loss of peritubular capillaries, and multilayered epithelial cells of cortical collecting ducts; this last finding was consistent with so-called medullary dysplasia specific to congenital disease, in which the renal pelvic epithelial cells enter the collecting duct.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Junichi Hoshino
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | | | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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Suwabe T, Ubara Y, Oba Y, Mizuno H, Ikuma D, Yamanouchi M, Sekine A, Tanaka K, Hasegawa E, Hoshino J, Sawa N. Changes in Kidney and Liver Volumes in Patients With Autosomal Dominant Polycystic Kidney Disease Before and After Dialysis Initiation. Mayo Clin Proc Innov Qual Outcomes 2023; 7:69-80. [PMID: 36712823 PMCID: PMC9873948 DOI: 10.1016/j.mayocpiqo.2022.12.005] [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] [Indexed: 01/22/2023] Open
Abstract
Objective To examine the changes in total kidney volume (TKV) and total liver volume (TLV) before and after dialysis initiation in patients with autosomal dominant polycystic kidney disease. Patients and Methods This was a retrospective, single-center cohort study to investigate the changes in TKV and TLV before and after dialysis initiation, along with influencing factors, using linear mixed models. We enrolled 95 patients with autosomal dominant polycystic kidney disease (85 receiving hemodialysis [HD] and 10 receiving peritoneal dialysis [PD]) who began receiving dialysis at Toranomon Hospital from January 1, 2008, to December 31, 2020. Results The least squares mean TKV ratio (TKV at each time point/TKV at dialysis initiation) was 63.8% (95% confidence interval [CI], 54.7%-72.9%) at 6 years before dialysis initiation and 95.5% (95% CI, 82.9%-108.2%) at 6 years after dialysis initiation (P<.001). A multivariate linear mixed model analysis revealed that dialysis style (HD or PD) had the strongest effect on changes in TKV (P=.002). The least squares mean TLV ratio was 98.2% (95% CI, 88.4%-108.0%) at 6 years before dialysis initiation and 95.7% (95% CI, 85.2%-106.2%) at 6 years after dialysis initiation (P=.01). Although PD did not have significant effects on changes in TLV (P=.27), the changes in TLV were greater in patients on PD than in those on HD. Conclusion The TKV increased until dialysis initiation and generally decreased after dialysis initiation. The TLV continued to increase even after dialysis initiation, however, changes in the TLV significantly decreased after dialysis initiation. The increases in TKV and TLV were greater in patients on PD than in those on HD.
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Key Words
- ACDK, acquired cystic disease of the kidney
- ADPKD, autosomal dominant polycystic kidney disease
- ALB, albumin
- BMI, body mass index
- BP, blood pressure
- CI, confidence interval
- CT, computed tomography
- ESKD, end-stage kidney disease
- HD, hemodialysis
- HR, heart rate
- MRI, magnetic resonance imaging
- PD, peritoneal dialysis
- PKD, polycystic kidney disease
- PLD, polycystic liver disease
- TAE, transcatheter arterial embolization
- TKV, total kidney volume
- TLV, total liver volume
- UN, urea nitrogen
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,Correspondence: Address to Tatsuya Suwabe, MD, MSc, PhD, Department of Nephrology, Toranomon Hospital, Kajigaya, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa 213-0015, Japan.
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Kiho Tanaka
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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Mizuno H, Sawa N, Sekine A, Inoue N, Oba Y, Ikuma D, Yamanouchi M, Hasegawa E, Suwabe T, Suzuki H, Hoshino J, Ubara Y. A Bone Histomorphometric Analysis of Hypophosphatasia-related Osteoporosis after Teriparatide Treatment. Intern Med 2023; 62:75-79. [PMID: 35650135 PMCID: PMC9876712 DOI: 10.2169/internalmedicine.9624-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 79-year-old man was admitted with a compression fracture of the first lumbar vertebra. His alkaline phosphatase (ALP) level was 35 IU/L, and his dual energy X-ray absorptiometry T score was -3.7 standard deviations, indicating osteoporosis. A genetic analysis showed a mutation of the alkaline phosphatase biomineralization-associated gene encoding tissue-nonspecific alkaline phosphatase. Hypophosphatasia-related osteoporosis was diagnosed. Alendronate, teriparatide, and minodronate were administered in that order. The ALP level increased during teriparatide use. A bone biopsy performed after three years of teriparatide treatment showed that cancellous bone was adynamic. In cortical bone, tetracycline double-labeling indicates enhanced bone formation. Teriparatide may thus be a viable treatment option even in patients with hypophosphatasia.
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Affiliation(s)
- Hiroki Mizuno
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Naoki Sawa
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Noriko Inoue
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hisanori Suzuki
- Department of Endocrinology and and Metabolism, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yoshifumi Ubara
- Nephrology Center + the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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42
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Teramoto-Shibuya A, Funamizu K, Sawa N, Suenaga A, Oba Y, Ikuma D, Yamanouchi M, Hasegawa E, Sekine A, Suwabe T, Kono K, Kinowaki K, Fujii T, Takemura T, Hayashi N, Nishida A, Mori Y, Wake A, Ubara Y. Severe Erythroderma Due to Adult-onset Still's Disease-like Disease Related to Graft-versus-host Disease after Allogeneic Hematopoietic Stem Cell Transplantation. Intern Med 2023; 62:1355-1359. [PMID: 37121719 DOI: 10.2169/internalmedicine.0316-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
A 35-year-old woman was treated with chemotherapy for leukemia. One year later, allogeneic hematopoietic stem cell transplantation (HSCT) was performed with umbilical cord blood. After nine months, she developed a spiking fever, sore throat, arthralgia, pleural effusion, hyperferritinemia, and persistent generalized pruritic erythema. A skin biopsy showed dyskeratotic cells in the epidermis, neutrophil infiltration in the epidermis and upper dermis, and neutrophils in the parakeratotic layer. Treatment with tocilizumab was effective. Adult-onset Still's disease (AOSD)-like disease related to graft versus-host disease (GVHD) after HSCT was suspected. Abnormal immune states related to GVHD may cause AOSD-like disease with more severe skin lesions than usual.
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Affiliation(s)
- Akiko Teramoto-Shibuya
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
- Department of Hematology, Toranomon Hospital, Japan
| | | | - Naoki Sawa
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Atsuhiko Suenaga
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | | | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | | | - Aya Nishida
- Department of Hematology, Toranomon Hospital, Japan
| | - Yuki Mori
- Department of Hematology, Toranomon Hospital, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital, Japan
| | - Yoshifumi Ubara
- Department of Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Fukuda M, Sawa N, Ikuma D, Oba Y, Mizuno H, Yamanouchi M, Sekine A, Hasegawa E, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Tamaki H, Miyazono M, Ubara Y. Endothelial Damage-dominant Nephritis Related to IgA Vasculitis after 11 Years' Use of Infliximab for Rheumatoid Arthritis. Intern Med 2023; 62:81-85. [PMID: 35650123 PMCID: PMC9876708 DOI: 10.2169/internalmedicine.9059-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 43-year-old Japanese woman with rheumatoid arthritis treated by infliximab and methotrexate for 11 years was admitted for proteinuria and purpura. A kidney biopsy revealed endothelial damage-dominant nephritis with IgA deposition. Infliximab and methotrexate were discontinued, and tocilizumab was started; however, proteinuria persisted. Therefore, tocilizumab was discontinued, and oral prednisolone and methylprednisolone pulse therapy were administered. After 6 months, urinary protein was less than 0.1 g/day, and purpura subsided. To our knowledge, this is the first case of endothelial damage-dominant nephritis related to IgA vasculitis involving the skin and kidney after long-term use of infliximab and methotrexate.
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Affiliation(s)
- Makoto Fukuda
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hiromichi Tamaki
- Immuno-Rheumatology Center, St. Luke's International Hospital, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Suwabe T, Morita H, Khasnobish A, Araoka H, Hoshino J. Microbiome of infected cysts, feces and saliva in patients with autosomal dominant polycystic kidney disease. CEN Case Rep 2022. [PMID: 36574197 PMCID: PMC10393913 DOI: 10.1007/s13730-022-00767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD). Hematogenous spread via bacterial translocation in the intestine is considered to be the main cause, so intestinal flora may be involved. However, the exact role of the intestinal flora in cyst infection in ADPKD is unknown. We report a 66-year-old woman and a 56-year-old man with ADPKD who had severe hepatic cyst infection. We analyzed the microbiome of infected cyst content, feces, and saliva in these two patients. The microbiome of patient 1 showed various bacteria in an infected cyst, whereas that of patient 2 showed only one bacterium. In both patients, the composition of the microbiome of the cyst content was quite different from those of feces and saliva, and the main bacteria in the infected cyst content represented a small proportion of those in feces and saliva. Lactobacilli were not almost detected in the infected cyst content though some lactobacilli are endemic in the gastrointestinal tract and the saliva. The association between bacteria in cysts and those in feces or saliva remains uncertain, and further research on this topic is needed.
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45
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Oba Y, Yamanouchi M, Ikuma D, Mizuno H, Inoue N, Sekine A, Hasegawa E, Suwabe T, Sawa N, Ubara Y. Successful peficitinib addition on anti-MDA5 antibody-positive dermatomyositis refractory to triple therapy and glucocorticoid reduction. SAGE Open Med Case Rep 2022; 10:2050313X221141277. [PMID: 36507062 PMCID: PMC9726841 DOI: 10.1177/2050313x221141277] [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: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis is the poorest prognosis of all dermatomyositis due to its associated rapidly progressive interstitial lung disease. Intensive treatment is required from the onset and triple therapy with prednisolone, calcineurin inhibitors, and intravenous cyclophosphamide is recommended. However, some patients are refractory or dependent on this treatment and additional immunosuppressive therapy is required. Recently, the efficacy of tofacitinib, a JAK inhibitor, has been reported. Here, we describe a case of a 50-year-old woman with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis who became refractory to triple therapy and prednisolone reduction, and achieved remission with the addition of peficitinib, a JAK inhibitor. This is the first report showing that peficitinib is effective for anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis and it may be a potential treatment option.
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Affiliation(s)
- Yuki Oba
- Yuki Oba, Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki 212-0015, Kanagawa, Japan.
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46
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Yoshimura Y, Sawa N, Matsuoka S, Ikuma D, Oba Y, Sekine A, Hasegawa E, Mizuno H, Yamanouchi M, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Toda S, Matoba S, Wakui H, Ubara Y. Glomerular Microangiopathy with Cellular Crescent-like Formation and Endotheliopathy Due to Ramucirumab Treatment for Metastatic Sigmoid Colon Cancer. Intern Med 2022; 61:3547-3552. [PMID: 35569979 PMCID: PMC9790787 DOI: 10.2169/internalmedicine.9185-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/14/2022] [Indexed: 01/07/2023] Open
Abstract
We encountered a 77-year-old Japanese man who presented with nephrotic-range proteinuria 20 days after receiving ramucirumab treatment for metastatic sigmoid colon cancer. A kidney biopsy showed two characteristic histological findings. The first finding was podocyte injury with cellular crescent-like formation, although focal segmental glomerulosclerosis (FSGS) (collapsing variant) according to the Columbia classification may have been a more appropriate name for this injury, as hypertrophy and hyperplasia of epithelial cells, presumably resulting from podocyte injury, were seen between Bowman's capsule and the glomerular basement membrane (GBM); these changes appeared to be due to the collapse of the GBM rather than to GBM destruction with fibrinoid necrosis. The second finding was endotheliopathy characterized by prominent mesangial interposition via enlargement of the mesangial matrix with mesangiolysis. Proteinuria and renal dysfunction subsided after discontinuation of ramucirumab. Bevacizumab has been reported to induce glomerular microangiopathy with endothelial damage and swelling six months after treatment, but in this case, ramucirumab may have induced focal segmental glomerulosclerosis (FSGS) collapsing variant and glomerular microangiopathy with endotheliopathy via mesangial damage within 1 month. We believe that the damage to the glomerular podocyte and endothelial cells via mesangial damage secondary to ramucirumab in our patient was a different type of glomerular microangiopathy than the endothelial cell damage with enlargement of the subendothelial space caused by bevacizumab.
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Affiliation(s)
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | | | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | | | | | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | | | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Shigeo Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery, Toranomon Hospital, Japan
| | - Hideki Wakui
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
- Department of Life Science, Graduate School of Engineering Science, Akita University, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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47
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Yoshimura Y, Watanabe S, Yamanouchi M, Ikuma D, Mizuno H, Sekine A, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Ubara Y, Sawa N. Tocilizumab Attenuates Anti-neutrophil Cytoplasmic Antibody-associated Nephritis Occurring During Abatacept and Adalimumab Therapy for Rheumatoid Arthritis: A Case Report. Intern Med 2022. [PMID: 36418100 PMCID: PMC10400383 DOI: 10.2169/internalmedicine.0858-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We encountered an 86-year-old Japanese woman who presented with proteinuria (0.4 g/day) and hematuria (red blood cell sediment >100/high-power field), a decreased renal function (serum creatinine, 1.51 mg/dL), and elevated myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (231 IU/mL) during treatment of rheumatoid arthritis with abatacept (a CTLA-4 agent) and adalimumab (a tumor necrosis factor-α agent). A kidney biopsy showed pauci-immune necrotizing glomerulonephritis, and ANCA-associated vasculitis was diagnosed. Treatment with tocilizumab (an interleukin 6 receptor antibody) monotherapy resulted in the improvement of renal findings and normalization of rheumatoid arthritis disease activity and serum ANCA levels. Tocilizumab can also suppress ANCA-associated vasculitis.
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Affiliation(s)
- Yusuke Yoshimura
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Shun Watanabe
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yoshifumi Ubara
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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48
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Sekine A, Hidaka S, Moriyama T, Shikida Y, Shimazu K, Ishikawa E, Uchiyama K, Kataoka H, Kawano H, Kurashige M, Sato M, Suwabe T, Nakatani S, Otsuka T, Kai H, Katayama K, Makabe S, Manabe S, Shimabukuro W, Nakanishi K, Nishio S, Hattanda F, Hanaoka K, Miura K, Hayashi H, Hoshino J, Tsuchiya K, Mochizuki T, Horie S, Narita I, Muto S. Cystic Kidney Diseases That Require a Differential Diagnosis from Autosomal Dominant Polycystic Kidney Disease (ADPKD). J Clin Med 2022; 11:6528. [PMID: 36362756 PMCID: PMC9657046 DOI: 10.3390/jcm11216528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 09/05/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cystic kidney disease, with patients often having a positive family history that is characterized by a similar phenotype. However, in atypical cases, particularly those in which family history is unclear, a differential diagnosis between ADPKD and other cystic kidney diseases is important. When diagnosing ADPKD, cystic kidney diseases that can easily be excluded using clinical information include: multiple simple renal cysts, acquired cystic kidney disease (ACKD), multilocular renal cyst/multilocular cystic nephroma/polycystic nephroma, multicystic kidney/multicystic dysplastic kidney (MCDK), and unilateral renal cystic disease (URCD). However, there are other cystic kidney diseases that usually require genetic testing, or another means of supplementing clinical information to enable a differential diagnosis of ADPKD. These include autosomal recessive polycystic kidney disease (ARPKD), autosomal dominant tubulointerstitial kidney disease (ADTKD), nephronophthisis (NPH), oral-facial-digital (OFD) syndrome type 1, and neoplastic cystic kidney disease, such as tuberous sclerosis (TSC) and Von Hippel-Lindau (VHL) syndrome. To help physicians evaluate cystic kidney diseases, this article provides a review of cystic kidney diseases for which a differential diagnosis is required for ADPKD.
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Affiliation(s)
- Akinari Sekine
- Nephrology Center, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Yasuto Shikida
- Department of Nephrology, Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Keiji Shimazu
- Department of Nephrology, Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Eiji Ishikawa
- Department of Nephrology, Saiseikai Matsusaka General Hospital, Mie 515-8557, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
- Department of Advanced Informatics for Genetic Disease, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Mahiro Kurashige
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hirayasu Kai
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Fumihiko Hattanda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, Daisan Hospital, Jikei University, School of Medicine, Tokyo 105-8471, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University, Aichi 470-1192, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | | | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
- Department of Advanced Informatics for Genetic Disease, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
- Department of Urology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
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49
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Sugimoto H, Oshima Y, Oba Y, Ikuma D, Sekine A, Mizuno H, Yamanouchi M, Hasegawa E, Suwabe T, Chu PS, Hasegawa Y, Obara H, Sawa N, Ubara Y. Successful Case of Deceased Donor Liver Transplant for Polycystic Liver Disease. Transplant Proc 2022; 54:2779-2783. [DOI: 10.1016/j.transproceed.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
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50
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Sugimoto H, Sawa N, Yamagiwa H, Kawada M, Ikuma D, Oba Y, Mizuno H, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Nishida A, Kono K, Kinowaki K, Ohashi K, Yamaguchi Y, Ubara Y. A Case of Focal Segmental Glomerulosclerosis Associated With Essential Thrombocythemia. Intern Med 2022. [PMID: 36288989 DOI: 10.2169/internalmedicine.0767-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
A 72-year-old man was admitted for examination of proteinuria (9.14 g/day) and leg edema. Essential thrombocythemia (ET) was diagnosed because of thrombocytosis (platelet count, 57.9×104/μL), elevated megakaryocytes in bone marrow biopsy, and JAK2 V617 mutation. Kidney biopsy led to a diagnosis of focal segmental glomerulosclerosis (FSGS) cellular variant (characterized by glomerular capillaries filled with swollen endothelial cells containing foam cells) in 6 glomeruli, FSGS tip variant in 5 glomeruli, and additional FSGS variants in other glomeruli. Affected glomeruli had anti-CD61 antibody staining-positive megakaryocyte infiltrations. ET mayinduce FSGS because megakaryocyte infiltration increases intraglomerular pressure, resulting in hypertension and proteinuria.
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Affiliation(s)
- Hisashi Sugimoto
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Naoki Sawa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hajime Yamagiwa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masahiro Kawada
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center and the Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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