Proteinuria is quantified for diagnostic and prognostic purposes and to assess responses to therapy. Methods used to assess urinary protein include 24- hour urine collection (24-Up) and determination of the ratio of protein to creatinine concentration (Up/Ucr) in simple voided urine samples (Up/Ucr quantitative method). However, these methods are costly and time consuming. The Multistix PRO 11 (Bayer Medical Co., Ltd., Tokyo, Japan) is a new urine dipstick that allows rapid measurement of Up/Ucr. Results obtained with the Multistix PRO 11 coincided well with those obtained with the 24-Up method (κ=0.68) and the Up/Ucr quantitative method (κ=0.75). However, Multistix PRO 11 did not accurately measure moderate to severe proteinuria (≥500mg/g. Cr). Our findings suggest that Multistix PRO 11 is useful for the screening, assessment, and follow-up of mild proteinuria.

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Combined peritoneal dialysis and hemodialysis therapy (combined therapy) is recognized as an effective alternate in peritoneal dialysis patients with insufficient water and solute removal, but there is no appropriate index for dialysis dose, as two distinct dialysis procedures are utilized in the same patient. Among several candidate parameters, the dilution index proposed and defined by Yamada, et al as the solute generation rate divided by the distribution volume and time-averaged concentration of the solute might be applicable, because it is unrelated to the method of solute removal. Among 11 patients undergoing combined therapy at Toride Kyodo General Hospital, six patients who had transferred from peritoneal dialysis alone to combined therapy were recruited. All patients received peritoneal dialysis therapy for five consecutive days followed by one day off dialysis before a hemodialysis session on the seventh day every week. Total weekly creatinine and urea removal by residual renal function, peritoneal dialysis, and hemodialysis were measured, and their solute removal on the last (5th) day under peritoneal dialysis was ascertained and correlated with the averaged daily removal of solutes. Hence the value of solute removal obtained on the last day under peritoneal dialysis was multiplied seven times and defined as the weekly solute generation. The distribution volumes of creatinine and urea were defined as 58% of body weight. The time-averaged concentration was obtained from the mean level of a solute before and after a hemodialysis session. During the period followed solely by peritoneal dialysis, the dilution indices for creatinine and urea were 1.22±0.14 and 1.85±0.14, respectively. The dilution index after tranferring to combined therapy, calculated by the above-mentioned method was increased to 1.72±0.29 and 2.28±0.31, respectively. Hence the dilution index may be useful for reflecting dialysis doses even in combined therapy.

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We investigated the relationship between the levels of serum albumin (ALB), serum transthyretin (TTR) or retinol binding protein (RBP) and those of serum cystatin C or clinical gradings in patients with diabetic nephropathy. Serum samples were obtained from 85 patients with type 2 diabetic nephropathy in our hospital. The levels of serum ALB, TTR, RBP and cystatin C were measured by the Dade Behring assay system using the automated Dade Behring Nephelometer II (BN II). The grades of diabetic nephropathy were classified into five groups according to Report of the Ministry of Health and Welfare, Japan. The serum levels of RBP showed a significant correlation between the serum levels of cystatin C and the grades of diabetic nephropathy. However, the serum levels of TTR were not significantly correlated with those of serum cystatin C or the grades of diabetic nephropathy.
In this study, the serum levels of TTR were not influenced by renal function although those of RBP and ALB were influenced by renal function. In spite of clinical usefulness in the nutritional assessment of healthy controls and hemodialysis patients, RBP and ALB are not suitable nutrition marker in patients with chronic renal failure. However, TTR is suitable marker in patients with chronic renal failure.

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We report a case of anti-neutrophil cytoplasmic antibody (ANCA)-associated rapid progressive glomerulonephritis (RPGN) that was treated with intravenous immunoglobulin (IVIg) therapy.
A 37-year-old woman was admitted to our hospital because of a low-grade fever, general malaise, and a poor appetite. At the time of admission, her renal function had severely deteriorated (serum creatinine level 9.5mg/dl; mean Ccr 3.3ml/min) and she had severe anemia (Hb 6.6g/dl). An immunological examination revealed the presence of ANCA-associated RPGN. A biopsy confirmed adiagnosis of pauci-immune-type necrotizing crescentic glomerulonephritis. After initial treatment with steroid pulse therapy (methylprednisolone, 1, 000mg/day×3 days), her general condition deteriorated and two sessions of hemodialysis were required. On the 10th hospital day, a high dose of immunoglobulin was administered intravenously (IVIg 400mg/kg/day×5 days). This therapy immediately improved her general condition and lowered her serum titer of MPO-ANCA and her serum creatinine level. After two IVIg treatments, her MPO-ANCA titer returned to a normal level and her serum creatinine level improved from 9.5mg/dl to 3.3mg/dl. A second biopsy confirmed clinical improvement.
These findings suggest that IVIg therapy is effective for cases of ANCA-associated glomerulonephritis that are difficult to treat using conventional immunosuppressive therapy.

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