The Japanese Journal of Nephrology
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
Volume 34, Issue 11
Displaying 1-14 of 14 articles from this issue
  • HIROSHI KASAHARA
    1992 Volume 34 Issue 11 Pages 1117-1133
    Published: November 25, 1992
    Released on J-STAGE: March 01, 2011
    JOURNAL FREE ACCESS
    The reconstruction process of the glomerular capillary structure following mesangiolysis induced in rats by anti-thymocyte serum(ATS) was investigated for three months. Cystic ballooning change of the glomerular tufts was remarkable four days after the administration of ATS, which was followed by inflammatory cell infiltration, and hypercellularity in mesangial area was observed one week later. Glomerular tufts were gradually reconstructed thereafter, leaving focal and segmental sclerotic or adhesive lesions. In the periphery of the ballooning area, a large vascular lumen was subdivided into smaller capillary lumina by endothelial and mesangial bridging, which resembled to the process in the fetal glomerulogenesis. The endothelial cells in mesangiolysis connected one another by junctional complexes and formed new capillary structure. The mesangial cells got in touch with the endothelial cells by mesangial bridging. In the proliferative lesion, endothelium-like cells could be recognized by immunostaining and had fenestrae with diaphragmatoid structure without mature basement membrane in the initial stage on electron microscopic observation. Interstitial-typed collagen fibers were found in the proliferative lesion, and they still existed in the focal segmental sclerotic lesion in the late stage of the experiment. The glomerular basement membrane(GBM) was seen to be reformed by fusing the original GBM with the newly synthesized one covering subendothelial space, where mesangial cells were interposed. Endothelial cells, endothelial-mesangial interaction and extracellular matrix formation seemed to play an important role in reconstruction of the glomerular tufts after mesangiolysis induced by ATS.
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  • REIKO YOSHIDA
    1992 Volume 34 Issue 11 Pages 1135-1148
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Four boys and six girls with progressive hereditary nephritis were studied clinicopathol-ogically. Renal biopsy was performed 16 times in ten cases. Mean age at renal biopsy was 7.3 years old (range 2 to 14 years old). The obtained results were as follows: (1) Montages of electron micrographs were prepared to complete one whole glomerulus. The length of the glomerular basement membrane (GBM) with the characteristic splitting of the lamina densa (Reticulation) was measured and expressed as a percentage of the total length of the GBM. The range of the percentage of the GBM with Reticulation was from 2 to 43% (13.4±10.0%, mean±SD, n=16). In 4 cases of the 5 cases performed serial renal biopsy, the percentage of the GBM with Reticulation at the 2nd biopsy increased compared with the 1st one. (2) Protein excretion in the urine, serum albumin, α 2-globulin, fibrinogen and total cholesterol showed the correlation with the percentage of the GBM with Reticulation. (3) Incomplete ruptures (deep invasion of the epithelial cells into the thickened GBM with Reticulation) were obserbed. Those suggested that the GBM became fragile associated with the expansion of Reticulation and finally ruptured. Gaps of the GBM were obserbed 0 to 3 per in one glomerulus (0 to 1.87 per lmm GBM) and the serial biopsies showed an increase in the number of the gaps as time passed. (4) This study showed the increase in factors activating the blood coagulation such as total cholesterol and fibrinogen, with the expansion of the GBM with Reticulation. And in a nephrotic case, fibrin strands were observed in the glomerular capillary loops and in the GBM. These findings suggest that the activation of the blood coagulation plays a role for the damage of the glomeruli in progressive hereditary nephritis.
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  • —Relationship between IgA bearing cells and clinico-pathological findings or Tα4 cells—
    REIKO KUBOTA
    1992 Volume 34 Issue 11 Pages 1149-1159
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    It has been reported that patients with Henoch-Schonlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) showed an familial increase of IgA bearing peripheral blood lymphocyte. To elucidate the relationship between IgA bearing cells and clinico-pathological findings or T cell subsets, especially IgA specific helper T cells (Tα4 cells), 20 paients with HSPN and 33 patients with IgAN were studied. The results demonstrated as follows; 1) IgA bearing cells were significantly increased in patients with both HSPN and IgAN (p<0.001). 2) The increase of IgA bearing cells was well correlatd to the degree of patients'proteinuria and hematuria (p<0.05), and also correlated with the severity of patients'renal pathological findings in both diseases. 3) With relation to the T cell subsets in patients with both diseases, only the CD4+ Leu8- cells(helper T cells) and Tα4 cells were significantly increased, in addition, positive correlation between IgA bearing cells and CD4+ Leu8- cells or Tα4 cells was observed. 4) The increase of IgA bearing cells seemed to be transient in HSPN, but remained elevated in IgAN. In conclusion, it was indicated that patients with HSPN and IgAN could have IgA related immunological abnormalities, which may be reflected in the increase of IgA bearing cells and Tα4 cells. It was also suggested that determination of IgA bearing cells could be a useful paramater which may be reflected in the disease activity of HSPN and IgAN.
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  • SUMIKO IMAI, KIKUO IITAKA, SATOSHI HIRAISHI
    1992 Volume 34 Issue 11 Pages 1161-1165
    Published: November 25, 1992
    Released on J-STAGE: March 01, 2011
    JOURNAL FREE ACCESS
    Five chirdren (four boys and one girl) with chronic renal failure (CRF)developed congestive heart failure 0.5 to 11 years after the onset of the disease. Their ages were from 4 to 13 years old. They noticed tachypnea, tachycardia, cough, chest anxienty, general fatigue and their chestX-rays showed cardiomegaly with cardio-thoracic ratio (CTR) of from 55 to 63% and pulmonary congestion. Their echocardiograms showed no casrdiomuscular hypertrophy, but the dilatation of left ventricular diastolic diameter (LVDd), and the decreased ejection fraction (EF) were observed. They were treated with water restriction, antihypertensive agents, cardiotonics and dialysis. Their clinical symptoms improved promptly, but their cardiomegary and echocardiographic findings improved gradually, The causes of heart failure in these patients seemed to be due to uremia, fluid overload and hypertention. The echocardiographic examination was useful for the management of the children with CRF in heart failure.
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  • RYOICHI ANDO, SEINOSUKE NAKAGAWA, MITSUO OGURA, KEN GOTO, SHIGEO TOMUR ...
    1992 Volume 34 Issue 11 Pages 1167-1176
    Published: November 25, 1992
    Released on J-STAGE: March 01, 2011
    JOURNAL FREE ACCESS
    The clinical effects of six-month short time biofiltration (SBF) were evaluated using a B-A-B' study (B, B': conventional bicarbonate hemodialysis; CBHD, A:SBF) in ten patients maintained on CBHD three times a week. An F80 hemodiafilter (1.9 m2, polysulfone, Fresenius) was used. In addition to routine clinical parameters for a patient on regular dialysis treatment, plasma von Willebrand factor antigen (vWF) (an index of stimulation of vascular endothelium), and the methylguanidine / creatinine ratio (MG / Cr) and malondialdehide (MDA) (indices of the levels of oxygen radicals), were evaluated. Nine patients completed the study, one patient dropping out at the 12th week of A because of muscle cramps during SBF. The treatment time was 2 hours in six cases and 2.5 hours in three cases. The mean blood flow rate was 280±42 (SD) minutes. Using the urea kinetics model, the mean KT/V was 1.26±0.28, and the mean protein catabolic rate was 1.22±0.18 g/kg body weight/day at the end of A. No change in ultrafiltration, blood pressure, cardiac function (assessed by echocardiography), CTR, human atrial natriuretic peptide, total protein, albumin, uric acid, serum creatinine, sodium, calcium, inorganic phosphorus, vWF, or MDA was found between each period. Blood urea nitrogen, c-PTH, and MG/Cr increased during the A period. Serum magnesium and beta-2 microglobulin decreased during the A period. Blood gas results, on the whole, did not change. In a patients, however, acidosis gradually developed. An increase in substitution fluid from 5 L/session to 7.5 L/session improved the acid-base balance in that patient. In conclusion, SBF is as effective as CBHD in removing small molecules and maintaining cardiocirculatory status, and is superior to CBHD in removing beta 2-microglobulin and is less stimulative to the endothelium than CBHD.
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  • -Hyperinsulinemia and renal sodium retention-
    WATARU AOI, YASUO UEDA, MUNEO TANIGAWA
    1992 Volume 34 Issue 11 Pages 1177-1182
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    The role of insulin and dopamine on blood pressure and renal sodium excretion was evaluated in 10 obese hypertensive patients. Essential hypertensive subjects (age 49.7±7.7) with at least 26.0kg/m2 obesity were hospitalized and a 2000k cal diet for 7 days (control periods) followed by a 800 k cal for 21 days were given. Salt intake was maintained at 10 g/ day throughtout this study. Mean blood pressure (MBP), plasma insulin (IRI), urinary dopamine and fractional excretion of sodium (FENa) were measured in both diet periods. Body mass index significantly decreased from 31.6±4.6kg/m2 to 28.6±4.1kg/m2 after weight reduction (P<0.001). MBP significantly lowered from 112.8±14.1mmHg to 100.4±12.4 mmHg (P<0.01) and IRI from 9.11±5.0 μU/ml to 6.3±5.5 iU/ml (P<0.001) after weight loss. We observed a significant correlationship between ΔMBP and ΔIRI (r=0.754, P<0.01). Also, we observed a significant correlationship between ΔMBP and ΔFENa (r= -0.835, P<0.01). A significant relationship was observed between urinary excretion of sodium and urinary excretion of dopamine (r=0.507, P<0.05). We concluded that sodium retention and increase of sympathetic nervous activity by hyperinsulinemia might play an important role of hypertension, and blood pressure reduction by weight loss resulted from decreased insulin and increased excretion of sodium in obesity hypertension.
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  • KIMIAKI KADONO, TAKEKO YAMAGUCHI, TAMIKO TETSUTANI, KOJIRO YASUNAGA
    1992 Volume 34 Issue 11 Pages 1183-1187
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Since urinary guanidinoacetic acid (GAA) derives from the kidneys, its detection is suggested to be associated with renal disease . We have been making a practice of investigating renal GAA production in diabetic patients, using a citrulline/creatine loading test . We noted a marked in crease in urinary GAA excretion in 1 patient . Since GAA-synthesis is hormonally regulated, we made a through investigation of endocrine function in this patient . She was a 58-year -old woman with a 15-year history of diabetes mellitus, proliferative diabetic retinopathy, and negative microalbuminuria . There was a high plasma GH level and urinary 17-KS analysis revealed an increase in the adrenal androgen-derived fractions . Based on the X -ray finding of ballooning of the sella turcica and the MRI data, empty sella syndrome was diagnosed. It was suggested that stimulated anabolic horm one release had accelerated renal nitrogen metabolism and induced aggravation of he r retinopathy . The findings in this patient implied the involvement of hormones in the development of diabetic complications .
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  • KENKICHI MAJIMA, TAKASHI ISHIZAKI, TOURU INOUE, YOSHIHARU HORI, JUNICH ...
    1992 Volume 34 Issue 11 Pages 1189-1194
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    A 36-year-old woman was hospitalized because of nephrotic syndrome. On admission, laboratory studies revealed total protein 5.9g/dl, total cholesterol 381mg/dl, urine protein 2-4g/day, c3 68mg/dl(90-185mg/dl) and the immunological tests showed that antinuclear factor, anti-DNA antibodies and the LE cell phenomenon were positive. Renal function was within normal range. After admission, renal biopsy was done. Light micoscopic finding showed diffuse membranous glomerulonephritis, and vacuolization of epithelial cells. Immunofluorescent microscopic finding showed a granular specific staining for IgG, IgM, C3 and Clq along the capillary loops. Electron microscopic finding shwwed subepithelial and subendothelial dense doposits, and visceral epithelial cell cytoplasm containing osmiophilic multilamellar lipoid bodies. In the studies of the enzyme activities, the patient's fibloblast extract demonstrated a partial deficiency of α-galactosidase, and urine ceramide trihexoside was positive. But the patient's leukocyte extract did not demonstrate a deficiency of α-galactosidase. So Fabry's disease associated with lupus nephritis was diagnosed. It seems that the case of Fabry's disease which is an X-linked disorder caused by deficiency of the lysosomal enzyme a-galactosidase, associated with lupus nephritis, is extremely rare.
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  • —Adding to analysis of immune cells, cytokine—
    MITSURU OKADA, KAZUO YOSHIOKA, SADANORI ISOKAWA, TSUKASA TAKEMURA, TOM ...
    1992 Volume 34 Issue 11 Pages 1195-1199
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    This paper describes a case report of acute interstitial nephritis associated with Bufferin(R). A 15-year-old girl were referred to our hospital due to fever and renal dysfunction. Laboratory findings showed elevation of serum BUN and creatinine, and increased urinary β2-MG excreation. Light microscopic findings of her renal biopsy specimen revealed edema and numerous inflammatory cells in the interstitium, and minor alterations in glomeruli. The interstitial infiltrates consisted mainly of T cells and also monocytes/macrophages. Interstitial cells were labelled with antibodies to interleukin (IL)-1 and tumor necrose factor (TNF). Bufferin(R) was positive by lymphocyte stimulation test . Thus, we considered that this drug was causative in this case. This observation suggests the participation of cell -mediated immune injury in drug induced acute interstitial nephritis .
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  • ICHIRO IWAMOTO, AKIO IMADA
    1992 Volume 34 Issue 11 Pages 1201-1208
    Published: November 25, 1992
    Released on J-STAGE: March 01, 2011
    JOURNAL FREE ACCESS
    Loss of ultrafiltration during continuous ambulatory peritoneal dialysis (CAPD) is often caused by the structural peritoneal membrane alteration, namely the disappearance of mesothelial cells and the proliferation of peritoneal collagen fibers. The interleukin hypothesis has been proposed to explain the etiology of peritoneal fibrosis. The CAPD procedure has been shown to induce macrophages and lymphocytes in the peritoneum, resulting in the production of interleukin-1 (IL-1) and interferon-γ (IFN-γ), which may be promote to the development of pritoneal fibrosis. On the other hand, the mesothelial defect can be rapidly restored by proliferation of mesothelial cells implanted on the wound surface. In this study, we demonstrated that IL-1β, IFN-γ, epidermal growth factor (EGF) and platelet derived growth factor (PDGF) enhance to the growth of cultured human peritoneal mesothelial (CHPM) cells. The cell cultures were derived from surgically removed omentum using the enzymatic disaggregation method. CHPM cells were cultured with Ham's F-12 medium containing 10% FCS up to third generation. At a concentration of 1×104 cells/well were cultured with various concentrations of IL-1β, IFN-γ, EGF, PDGF and IL-6. [3H] TdR (37MBq/well) was added to the cultures during the last 12hr of the 48hr culture period and then radioactivity was measured to determine the uptake of [3H] TdR. It was shown that IL-1β, IFN-γ, EGF and PDGF induced the proliferation of CHPM cells in a dose dependent manner when cultured in medium containing 3%FCS. These results provide compelling evidence that the growth factors might be promote to the mesothelial cell proliferation in vivo and regulate to the mesothelial regeneration in the peritoneum of CAPD patients.
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  • HIDEO ARAI
    1992 Volume 34 Issue 11 Pages 1209-1218
    Published: November 25, 1992
    Released on J-STAGE: July 04, 2011
    JOURNAL FREE ACCESS
    In order to analyze urinary proteins from patients with various renal diseases, a reversed-phase high performance liquid chromatography (HPLC) with IPG PACK ODS column packed with polyporous glass was used. The reproducibility of standard proteins was good. The results by this method correlated well with those by radioimmunoassay or laser nephelometry. precolumn procedure needed the centrifugation only. The reversedphase HPLC was superior to the other HPLC methods in the analysis of urinary proteins for its simplicity and high sensitivity. The peaks of both α1-acid glycoprotein (α1-AGP) and human serum albumin (HSA) in the chromatogram was regarded as the marker of renal damage. Urinary α1-AGP/HSA ratio was calculated after measuring these two peak areas. As a result, it was significantly higher in the urine from patients with various glomerulonephritis (GN) than in those from healthy children. In the patients with postural proteinuria, it was the same level as that in healthy children. These date suggest that the urinary α1-AGP/HSA ratio would be a beneficial indicator to find out the patients with GN from among children with proteinuria. Furthermore, it seems that this method is suitable for use in routine screening of renal diseases for its simplicity and speed.
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  • ASAKO WATANABE
    1992 Volume 34 Issue 11 Pages 1219-1225
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    The production of hydrogen peroxide (H2O2) by neutrophilic polymorphonuclear leukocytes (PMN) after stimulation with PMA, FMLP, aggregated IgG and phagocytosis were determined in 36 patients with non-insulin dependent diabetes mellitus (NIDDM) . The H2O2 production of PMN after the stimulation was measured using by flow cytometry. The patients were divided into four stages as follows: (1) non-microalbuminuric stage, (2) microalbuminuric'stage, (3) proteinuric stage without impairment of renal function (less than 1.2 mg/dl of serum creatinine) and (4) proteinuric stage with impairment of renal function (more than 1.3mg/dl of serum creatinine). The H2O2 production after stimulation with PMA or phagocytosis was significantly higher in patients with NIDDM than normal controls. And also, there is the tendency of an increase in the H2O2 production after stimulation with FMLP or aggregated IgG. This increase of the H2O2 production was observed in all four stages of NIDDM patients after the stimulation, especially in patients with renal failure associated with diabetic nephropathy. These results suggest that reactive oxygen species produced by PMN after stimulation under various conditions may play an important role in the progression and exacerbation of diabetic nephropathy.
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  • SYUICHI KOARADA, YOSIROU NAGANO, TAKANOBU SAKEMI, YOSIYUKI SYOUNO, TER ...
    1992 Volume 34 Issue 11 Pages 1227-1232
    Published: November 25, 1992
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Cimetidine is a histamine H2-receptor antagonist. Widely it is prescribed, and then various side effects have been increasingly recognized. Acute renal failure as a result of acute interstitial nephritis is one of the most important adverse effect. We report a case of biopsy-proven acute interstitial nephritis following cimetidine therapy. Farther more, we review other reported casess of cimetidine-induced acute interstitial nephritis, , and discuss the clinical features and a role of immunological mechanisms of these cimetidine-induced disorders. A 52-year-old woman was admitted because of fever and protenuria. A month befor admission, she developed gastric ulcer and was given cimetidine 6OOmg orally a day by a near physician. Laboratory data on admission inculuded the following: white blood cell count, 14700/μl; eosinop.hils, 6%; BUN, 50 7mg/dl Cr, 7.6mg/dl; CRP, 34.0mg/dl. All drugs were discontinued because we suspected drug-induced acute renal failure, ispecially by cimetidine. Renal biopsy performed on day 3 showed interstitial nephritis with lymphocyte infiltration which was composed mainly of T cell. T4/T8 ratio was determined to be 1. There was neither predominance of helper nor cytotoxic cells in T cell subpopulation. We reviewed 22 cases reported and discussed the features of cimetidin.e-induced interstitial nephritis. The most important thing is to monitor renal function periodically with the suspicion of this disorder. On the detection of abnormality of laboratory data, cimetidine should be uncontined.
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  • YOSHIFUMI NAKAHARA, SHUJI KATOH, HIROYUKI YAMADA, YASUFUMI KANETAKE, S ...
    1992 Volume 34 Issue 11 Pages 1233-1236
    Published: November 25, 1992
    Released on J-STAGE: March 01, 2011
    JOURNAL FREE ACCESS
    A case of acute immune hemolytic anemia associated with non-traumatic rhabdomyolysis (NTR) induced by streptomycin (SM) reinjection, which developed acute renal failure, has been reported. A 70-year-old female was admitted to our hospital because of sudden macroscopic hematuria after reinjection of lg. SM. Laboratory findings on admission were as follows; hemoglobin and myoglobin were positive in urine. RBC 129×104/μl, Hb 4.9g/dl, Ht 11.1%, reticulocytes 52%, serum indirect billirubin 3.8g/dl. LDH 9, 230 WU, BUN 149mg/dl, Cr 7.9mg/dl, myoglobin 1, 400ng/ml and haptoglobin 10.6mg/dl. The drug lymphocyte stimulating test of SM was positive (215%). A direct antiglobulin test was also positive. An indirect antiglobulin test was negative, but became positive after incubation with SM. These observations made the diagnosis of SM-induced hemolytic anemia associated with NTR. On the second hospital day she developed anuria, and was put on hemodialysis treatment. Two months after the acute hemolytic episode and acute renal failure she recovered and is presently in good health without recurrence.
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