日本腎臓学会誌
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
23 巻, 11 号
選択された号の論文の10件中1~10を表示しています
  • M. Hayakawa, H. Kinoshita, S. Jitsukawa, H. Ishikawa, M. Mukai, H. Taz ...
    1981 年 23 巻 11 号 p. 1427-1435
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
  • 喜馬 秀樹
    1981 年 23 巻 11 号 p. 1437-1461
    発行日: 1981/11/25
    公開日: 2011/07/04
    ジャーナル フリー
    In order to investigate the behavior of the urinary tubule and its surrounding interstitial tissue belonging to a glomerulus with reduced or abolished function, light and electron microscopic as well as microdissection and microangiographic studies of nephrons deprived both of glomerulic and beginning parts of proximal convolted tubules (aglomerular nephrons) were carried out. Those aglomerular nephrons were induced in rabbits by burn of the superficial layer of renal cortex according to the method of Fu jimoto et al. (1978). The results obtained were as follows: 1. In the aglomerular nephron induced in this way, there developed disuse atrophy and sclerosis of the proximal part of the nephron ultimately absorbed by surrounding tissue, dilatation of the lumen of Henle's loop, especially of its ascending limb, and following transformation of distal convoluted tubule into solid cell masses. Development of foci of massive coagulation necrosis in the superficial layer of renal cortex brought about stenosis or occlusion of arterioles supplying these areas, inducing secondary anemic atrophy and sclerosis of the aglomerular nephrons as well as the adjacent well preserved renal tissue. 2. An observation by microdissection and other means revealed the process of regeneration and covering by tubular epithelium at the proximal end of aglomerular nephron, along with cystic dilatation of the ascending limb of the Henle's loop and stagnation of some precipitates in the lumens. 3. About 2 months after burn injury a solid mass of cells with clear cytoplasms associated with development of capillaries appeared in the terminal portion of aglomerular nephron. Electron microscopy demonstrated that these cells contained a decreased number of organelles with no distinct microvilli or basal infolding, suggesting no active secretion or reabsorption. 4. Microangiography and other examinations showed that arterioles draining the injured area became heavily constricted without thickening of the intima about 1 month after injury, followed by marked constriction due to thickening of the intima, which led to anemic atrophy and sclerosis of the tissue drained thereby.
  • 大倉 誉暢, 松尾 清一, 日比 育夫, 公文 進一, 玉木 伸一郎, 渡辺 有三, 木下 裕子
    1981 年 23 巻 11 号 p. 1463-1471
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
    The evaluations of cyclophosphamide (CY) in the treatment of adults patients with primary nephrotic syndrome are obscure, except minimal change nephrotic syndrome (MCNS). The present trial has been designed to evaluate the effects of CY combined with prednisolone in conventional dosage. Now, we investigate the effects, side effects and influence of CY on lymphocyte during treatment. Material: Ninty-eight patients with primary nephrotic syndrome in Nagoya University Hospital from 1975 to 1979 were examined. Twenty-five of them were resistent or relapse to steroid. We medicated CY to these 25 patients. The hi stological diagnosis consisted of 8 MCNS, 7 memranous nephropathy (MN), 9 diffuse proliferative glomerulonephritis (DPGN), 1 focal glomerulonephrits (FGS). Method: CY 2-3 mg per kg per day plus maintenance prednisolone 20 mg per day was given. Routine examination including renal function, skin reaction and lymphocyte function were carried out after and defore treatment. Results: all patients in MCNS, 3/6 patients in MN, 1/8 patients in DPGN and 0/1 FGS were CY effective in patients with duration of CY administration more than 8 weeks. DNCB and PHA-P skin reaction are significantly low, comparing with controls. On the contrary suppressor cell activity (Show's method) has significantly incresad. (P<0.05) Immunoglobulin-prodution activity in patient's lymphocyte decreased. Discussion and Conclusion: It is sure that the mechanism of chronicity in glomerulonephritis has correration closely with immune mechanism. CY suppresses immune responce for along time, after and before antigen stimulation. From the point of view, CY is on important medicine that would be expected to be effective in steroid resistent nephrotic syndrome or frequently relapsing neqhrotic syndrome. The responce to treatment has been assessed not only by reference to clinical state and urinary protein, but also lymphocyte function in nephrotic patients. Eleven patients responded but the remainders were unsatisfactory. These data show that CY is effective in some cases. Several parameters we measured were not available for the evaluation of the effects of CY. That is, there is no difference between CY plus prednisolone and prednisolone, especially, in skin reaction and suppressor cell activity. CY has the side effects of dose-related hematopoietic-cell depression, alopecia, nausea, interstitial hemorrhagic cystitis, and so on. These results suggest careful f ollowup observation of patients. Cyclophosphamide therapy is an effective alternative for nephrotic patients with MCNS who develop steroid dependence or resistence, and for some nephrotic patients with membranous glomerulonephritis.
  • ―初発例を中心として―
    都築 一夫, 田辺 穰, 佐藤 千寿子, 野口 弘道, 上田 典司, 美濃 和茂, 伊東 重光, 矢崎 雄彦, 岩山 精三
    1981 年 23 巻 11 号 p. 1473-1481
    発行日: 1981/11/25
    公開日: 2011/07/04
    ジャーナル フリー
    The 26 children with idiopathic nephrotic syndrome, included 8 fresh cases, were treated by 2-3 hours intravenous infusion of betamethasone 2mg/kg or methylprednisolone 20mg/kg in 5% glucose solution 100-200ml for 3 consecutive days, as one course of therapy. Sixty-five courses of “pulse” therapy were performed, of which betamethasone was used in 48 cases and methylprednisolone was in 17 cases. The age of patients distributed form three to fifteen years. Renal biopsies were performed in 20 cases, which included minor glomerular abnormalities, mild diffuse proliferative mesangial glomerulonephritis (GN), moderate diffuse proliferative mesangial GN, focal glomerular sclerosis, comprising eight, eight, one and three cases, respectively. The results are as follows : 1) There was no difference between betamethasone and methylprednisolone, in effects and adverse reactions. 2) In the fresh cases or the exacerbated cases after discontinuation of corticosteroids, 1 to 3 courses of the “pulse” therapy remitted 78% of the cases, of which in some cases three courses of “pulse” therapy was followed by oral prednisolone 0.5-1.0 mg/kg/day. 3) In the exacerbated cases under corticosteroid administration, one course of “pulse” therapy induced remission in about a half of the cases. 4) The duration of remitted period induced by “pulse” therapy is not correlated with the change of peripheral lymphocyte count, the selectivity of proteinuria, or the interval required for remission. 5) One patient had become hypovolemic shock because of massive diuresis after “pulse” therapy, then plasma derivatives was used prophylactically. Other serious adverse reactions were not seen. 6) They are further problems that the optimal method of corticosteroids therapy in each nephrotic child is decided by the reactivity to “pulse” therapy, and that the prognosis is evaluated by the reactivity.
  • 水村 泰治, 飯田 博行, 高田 正信, 杉本 恒明, 高桜 英輔
    1981 年 23 巻 11 号 p. 1483-1487
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
    Renal tubular sodium and water excretion were evaluated in 5 patients in the recovery stage of acute tubular necrosis (ATN) by means of clearance technique. During the period of maximal hydration, urine osmolality in these patients remained high compared to control group despite same level of plasma osmolality in both groups. The values of maximal urine flow rate (V/Ccr), free water excretion rate (CHH2OO/Ccr) and (CNa+CH2O)/Ccr in patients with ATN were not significantly different from those in control group, indicating that proximal tubules in patients with ATN had already recovered function in terms of sodium and water excretion. However, CH2O/(CNa+CH2O), an index of sodium reabsorption rate in distal tubule, was significantly lower in patients with ATN than in control group. These results suggest that proximal tubules can recover function earlier than distal tubules in terms of sodium and water excretion in ATN.
  • 瀬崎 良三, 新里 徹, 前田 憲志, 浅田 博章, 川口 俊介, 臼田 正恒, 大林 祥悟
    1981 年 23 巻 11 号 p. 1489-1493
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
    In a mixed solution with several electrolytes, the apparent diffusion coefficient of the respective ions —especially that of bivalent ions—varies in terms of the partial equivalent ratios of ions. When a high sodium dialysate is used for dialysis, the same kind of variation in the apparent permeability of the respective ions is found. Thus, calcium transfer to the body is much less with a high sodium dialysate, compared to a low one. In dialysis with 12 patients using dialysate Na, Cl and Ca levels at 132, 101.5 and 3.0mEq/l, respectively, dialysate was changed after 1 hour for 5 min, to one with Na and Cl levels of 160 and 129.5 mEq/l, respectively, keeping other ion levels the same. After measuring calcium transfer to the body for 5min., dialysate was replaced by the initial one, and measurements repeated. Results showed mean calcium transfer of 0.38mEq/5min. with the low sodium dialysate against a significantly lower 0.11mEq/5min. with the high one. This finding indicates a need to elevate calcium level in higher sodium dialysate to prevent the accompanying side effects of reduced calcium transfer.
  • 藤田 嘉一, 井上 聖士, 佐藤 英一, 高瀬 重暉, 井上 秀昭, 駒場 啓太郎, 後藤 武男, 三木 章三, 島崎 孝一, 金津 和郎, ...
    1981 年 23 巻 11 号 p. 1495-1509
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
    To elucidate the immune-behaviour and susceptibility to infections in haemodialyzed patients, we performed various immune-serological examinations in 371 dialyzed patients caused by chronic nephritis. The results revealed significant reductions in the peripheral leukocyte count, lymphocyte count, T cell count, B cell count and IgG-FcR+T cell count and a significant increase in the serum-IgG level in these patients compared with normal levels. The CH 50 and C 3 levels were significantly lowered. PPD and PHA Skin reaction were negative in 59.3% and 54.0% of the patients, respectively. In dialyzed patients, both cellular and humoral immunity is very likely to be suppressed. As the involvement of many factors other than those determined this report is suspected, furthermore it's necessary for us to make investigation into other factors. Then we studied immune-supplemental therapy for the treatment of infections in the dialyzed patients. 32 patients who had not responded to 3-day administration of antibiotics were treated with the intravenous immunoglobulin preparation (Gamma-Venin (R)) in addition to the antibiotics. This combination normalized the peripheral leukocyte count, elevated the serum-IgA and-IgG levels and improved the CRP. The antipyretic activity of this treatment was noticeable. Therefore, concomitant use of the intravenous immunoglobulin preparation with antibiotics appears to be effective against infections in the dialysed patients.
  • 三上 洋, 荻原 俊男, 森川 忠則, 榊原 俊平, 熊原 雄一
    1981 年 23 巻 11 号 p. 1511-1516
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
    Two phosphoryl derivatives, phosphoryl-alanyl-proline (P-AP) and dibenzylphosphoryl-alanyl-proline (DBP-AP) were synthesized and the inhibitory activities of converting enzyme of these derivatives were evaluated and were compared with captopril by assessing the percent inhibition of the pressor responses to angiotensin I (300 ng/kg i.v.) following intravenus administration of these derivatives and captopril in bilaterally nephrectomized and urethane anesthetized rats. P-AP was shown to be a potent converting enzyme inhibitor, about one tenth as potent as captopril in weight basis while its duration of action was the shortest of them all. DBP-AP had the slowest onset of the action and the duration of the action was much longer than captopril suggesting that this derivative exerts its inhibitory action after being metabolized into yet unidentified form.
  • ―高血圧自然発症ラットならびに脳卒中易発症ラットにおける検討―
    水野 兼志, 後藤 光弘, 横川 俊博, 福地 総逸
    1981 年 23 巻 11 号 p. 1517-1523
    発行日: 1981/11/25
    公開日: 2011/07/04
    ジャーナル フリー
    The efiect of sodium intake on angiotensin-converting enzyme activity was studied in five areas of the brain (the cerebral cortex, midbrain, striatum, thalamus and hypothalamus) and in subcellular fractions of the aorta (homogenate, mitochondria, microsomes and supernatant) in normotensive, spontaneously hypertensive and stroke-prone spontaneously hypertensive rats. Angiotensin-converting enzyme activity was signiffcantly higher in the hypothalamus than in the other areas of the brain in spontaneously hypertensive rat. The enzyme activity of subcellular fractions of the aorta showed an extremely high value in the supernatant in normotensive, spontaneously hypertensive and stroke-prone spontaneously hypertensive rats. Sodium intake resulted in a marked decrease in the aortic converting enzyme activity from each fraction in each rat, while it did in a significant rise of the enzyme activity in the midbrain of spontaneously hypertensive rat, and also in the midbrain and the striatum of stroke-prone spontaneously hypertensive rat. It is likely therefore that sodium intake lowers the converting enzyme activity or content of the aorta. Increased activity of the converting enzyme of the brain of spontaneously hypertensive and stroke-prone spontaneously hypertensive rats may play a possible role in hypertension induced by a high circulating sodium level through much more convertion of angiotensin I into angiotensin II in the brain.
  • 上原 誉志夫, 堀江 直哉, 高橋 芳洋, 五味 明子, 湯原 幹男, 池田 隆夫, 池上 文詔
    1981 年 23 巻 11 号 p. 1525-1532
    発行日: 1981/11/25
    公開日: 2010/07/05
    ジャーナル フリー
    A thirty five year old unmarried man had a chance of venereal exposure on July in 1978. Three months later, right inguinal lymphadenopathy and low grade fever developed and the Wasserman reaction was positive. Six months later, he noticed decreased urine volume, facial edema, general malaise and roseola. He was admitted to the hospital on March in 1979. On physical examinations, he was found to have typical roseola and mild anemia, but no jaundice. T. protein and albumin levels were 5.5 and 2.3g/dl, respectively. There existed moderate renal dysfunction (BUN 36.8, creatinine 3.0mg/dl and Ccr. 39ml/ min). T, chol. level was within normal range. Urinary excretion of protein was amounted up to 5 g/day. Alkaline phosphatase was elevated markedly (more than 88 K. A.U.). G.0.T. was 88 I.U. and B.S.P. was 13.5%. The Wasserman reaction was positive (×320), TPHA 2+, FTA positive (×1280). HbsAg, ASK and ASLO were all within normal range. Skin biopsy disclosed pericapillary infiltration of plasma cells consistent with syphilitic roseola. On renal biopsy minimal change was shown in LM, bease-like staining of anti-IgG along the glomerular capillary wall in IF, and subepithelial dense deposits and foot process fusion in EM. The liver biopsy showed nonspecific pericholangitis without spirochete. On the basis of these findings, he was diagnosed as having secondary syphilis associated with nephrotic syndrome and acute hepatitis. All abnormal findings were normalized after Penicillin-G treatment (1.2million units/day, i.m.).
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