日本腎臓学会誌
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
35 巻, 9 号
選択された号の論文の14件中1~14を表示しています
  • ―初期抗ラットThy1腎炎における観察―
    大江 健二
    1993 年 35 巻 9 号 p. 1007-1014
    発行日: 1993/09/25
    公開日: 2011/07/04
    ジャーナル フリー
    To clarify whether heparan sulfate proteoglycans (HSPG) on glomerular basement membrane (GBM) are produced by mesangial cell in vivo, the number of anionic sites (AS) on lamina rara externa of GBM and the changes in urinary albumin excretion rate (UAE) were observed on mesangiolysis in rats induced by monoclonal anti-rat Thy1 antibody. Mesangiolysis was remarkable at day 3 after the administration of anti-rat Thyl antibody, whereas GBM as well as epithelial cell remained well preserved, and detached endothelial cell was observed. The number of AS on GBM was significantly (p<0.001) decreased in anti-rat Thy1 antibody treated rats (18.6±0.4/l000nm), when compared with that of normal control rats (22.8±0.4/l000nm). Furthermore, UAE was markedly (p<0.05) increased at day 3 (1692.6±627.5.μg/24h) compared with the value before (188.2±30.6μg/24h) administration of anti-rat Thyl antibody. From these results, it can be concluded that some part of AS on GBM may be produced by the mesangial cell.
  • 飯塚 一秀
    1993 年 35 巻 9 号 p. 1015-1021
    発行日: 1993/09/25
    公開日: 2011/07/04
    ジャーナル フリー
    Increasing evidence supports the hypothesis that epidermal growth factor (EGF) may have a role in the repair of tubular injury on acute renal failure (ARF). On the other hand, platelet-depletion reduces the renal damage in experimental ARF rats. We investigated the expression of EGF in the renal tissues of mercuric-choloride (HgCl2, 2mg/kg)-induced ARF rats with (group-1) or without (group-2) platelet depletion for clarification of the role of EGF in the recovery of the renal tubules after ARF. Platelet-depletion was accomplished by the injection of anti-rat platelet serum (APS) 24 hours prior to the induction of ARF. The tubular necrosis and deterioration of renal function were significantly suppressed in group-1 compared with group-2 24 hours after HgCl2 injection (S-Cr 0.60±0.17 mg/dl, Ccr0.58±0.11 ml/min in group-1 and 1.45±0.10 mg/dl, 0.20±0.02 ml/min in group-2, p<0.05) but were in the same range between both groups 12 hours after (S-Cr 0.75±0.03 mg/dl, Ccr 0.49±0.02 ml/min in group-1 and 0.60±0.05 mg/dl, 0.67±0.08 ml/min in group -2). By immunohistochemistry, EGF was localized in the ascending limbs of Henle and distal convoluted tubules in normal rats. However, in both ARF rats, EGF was stained on the proximal tubules, including the necrotic area as well as the ascending limbs of Henle and distal convoluted tubules, both 12 and 24 hours after ARF induction. Furthermore, in comparison with two ARF rat groups, the staining intensity of EGF was more prominent in group-1 than group-2 at both the 12- and 24-hour periods. These results indicate that EGF is a potent mediator in the repair of tubular injury on ARF.
  • ―チオアセタマイド誘発肝硬変ラットにおいて―
    大山 哲
    1993 年 35 巻 9 号 p. 1023-1032
    発行日: 1993/09/25
    公開日: 2011/07/04
    ジャーナル フリー
    In our previous papers, we reported change in the systemic hemodynamics in rats with glycerol-induced acute renal failure, as estimated by the microsphere method. It was found that the develop-ment of acute renal failure related not only to renal blood flow, but also to the hepatic blood flow. In view of the liver playing an important role in the metabolism of substances, such as drugs, and in blood circulation, we examined changes in the systemic circulation and blood chemistry in rats with thioacetamide-induced liver cirrhotic, and those rats injected with glycerol. The result indicated that liver cirrhotic rats showed hypertension, higher levels of atrial natriuretic peptide (ANP) and lower levels of renal blood flow relative to the control rats. However, after glycerol injection, the development of acute renal failure was suppressed in liver cirrhotic rats. These results suggest that liver cirrhotic rats were in a hyperdynamic state and that this condition would be beneficial in the prevention of glycerol induced development of acute renal failure.
  • 佐々木 隆
    1993 年 35 巻 9 号 p. 1033-1041
    発行日: 1993/09/25
    公開日: 2011/07/04
    ジャーナル フリー
    To elucidate the morphological basis of glomerular hematuria in IgA nephropathy, morphometric analysis of GBM alterations was performed by electron microscopy in 73 cases of IgA nephropathy. These cases were divided into 2 groups by the degree of hematuria. The IgA (1) group (52 cases) showed 1-30 Red Blood Cells (RBC)/hpf in urinary sediment and the IgA (2) group (21 cases) showed 30 or more RBC/hpf. The GBM alterations were observed in 67% of IgA nephropathy patients. Splitting and focal thinning of GBM were more frequent in the IgA (2) group than in the IgA (1) group. The gap was not associated with the degree of hematuria, but when accompanying splitting, it was with the degree of hematuria. It was concluded that most IgA nephropathy patients had GBM alterations, and splitting of the lamina densa, focal thinning of GBM, and a gap with splitting, which was associated with the degree of hematuria.
  • 庄野 義幸, 下釜 達朗, 酒見 隆信, 原田 篤実, 渡辺 照男
    1993 年 35 巻 9 号 p. 1043-1050
    発行日: 1993/09/25
    公開日: 2010/07/05
    ジャーナル フリー
    Using 100 serial sections for light microscopy, we studied the clinicopathologic character istics of IgA nephropathy with severe proteinuria. Eight out of 128 cases with IgA nephrop athy exhibited severe proteinuria of 3.0g/day or more. These cases consisted of 5 males and 3 females with an age range from 15 to 73 years. Daily proteinuria ranged from 3.3 to 7.1 g. At the time of biopsy, the serum creatinine level was 1.2 mg/dl or more in 6 cases; two of these developed end-stage renal failure during the follow-up period. In most of the cases, routine sections for light microscopy revealed moderate to severe mesangial proliferation and tubulointerstitial damage. In 7 cases, variable percentages of glomeruli, ranging from 20% to 95%, were involved by chronic lesion represented by sclerosis and fibrous crescents/adhesion, while only 2 cases exhibited active lesion characterized by segmental glomerular necrosis and/or cellular/fibrocellular crescents. In contrast, thorough observation of 100 additional serial sections disclosed the focal presence of active lesion in all except one case with features of endstage kidney. In addition, the highest precentage of glomeruli with active lesion in the serial sections correlated well with the severity of proteinuria. The results suggested that severe proteinuria in IgA nephropathy depends on, at least in part, focal outbreak of active lesion characterized by segmental glomerular necrosis and cellular/ fibrocellular crescents.
  • 宮田 真理子
    1993 年 35 巻 9 号 p. 1051-1058
    発行日: 1993/09/25
    公開日: 2010/07/05
    ジャーナル フリー
    To analyze the clinical and pathological changes in systemic lupus erythematosus (SLE) patients without clinical renal abnormalities, I performed histopathological examinations of renal biopsy specimens from 40 SLE patients, who were divided into two groups. Group A consisting of 16 patients had almost no clinical evidence of renal involvement. Group B consisting of 24 patients had clinical renal manifestations, proteinuria, hematuria or both due to lupus nephritis. Light microscopy showed minor to moderate proliferative changes in the patients of Group A, and severer changes in the patients of Group B. Immunofluorescent study revealed depositions of immunoglobulins and complement in varying degrees in all the patients of Groups A and B. By electron microscopic study, electron-dense deposits and mesangial deposits were found in all patients of Group A. However, subendothelial, subepithelial and intramembranous deposits were seen in less than one-half of the patients of Group A. The amounts of the deposits were small. By contrast, a large amount of electron dense deposits existed in the patients of Group B. The prognosis was better for patients of Group A than those of Group B. I concluded that various abnormalities of the renal glomeruli exist in SLE patients even without urinary abnormalities.
  • 柳沢 孝嘉, 山田 明, 西森 茂樹, 黒岡 雄二, 葛原 敬八郎, 小椋 陽介, 大坪 修
    1993 年 35 巻 9 号 p. 1059-1063
    発行日: 1993/09/25
    公開日: 2011/03/01
    ジャーナル フリー
    Urinary excretion of albumin was measured after renal transplantation in 37 patients who received cyclosporine quadrotherapy (cyclosporine A, azathioprine, prednisolone and antilymphocytoglobulin). In 26 patients with a favorable clinical course, daily urinary albumin level increased significantly on the first operative day. Subsequently, it decreased gradually, and remained at about 40mg/day after 3 weeks. In these patients, the urinarty albumin level did not correlate with blood pressure, whole blood cyclosporine level, serum creatinine level nor urinary enzyme level, i.e.β2-microglobulin, NAG, γγ-GTP. As for correlation between the urinary albumin level and biopsy findings in 21 patients who underwent renal graft biopsy, the urinary albumin level was siginificantly increased in 5 patients with high degree of lymphocyte infiltration in the renal graft as compared with 16 patients with low degree of infiltration. However, there was no significant correlation between the urinary albumin level and the degree of tubular damage. In 4 patients of allograft rejection, a clinical course was reflected better in the albumin level than in the urinary enzyme level, these results show that the measurement of urinary albumin is a useful clinical examination to evaluate the allograft rejection of renal transplantation in cyclosporine era.
  • 大津 稔彦, 伊藤 達雄, 稲垣 豊, 天野 泉, 政本 進午, 丹羽 正武
    1993 年 35 巻 9 号 p. 1065-1071
    発行日: 1993/09/25
    公開日: 2011/07/04
    ジャーナル フリー
    Twenty-nine cases of hypoglycemia induced by disopyramide (DP) have been reported in the literature to date. Twenty of the reported cases showed hypo-renal function and a high concentration was rare. DP is metabolized to mono-N-dealkyldisopyramide (MND) in the liver and accumulation of MND is to be expected in renal failure. Both DP and MND bind mainly to alpha-l-acid glycoprotein (AAG) in the plasma. In 10 hemodialysis (HD) patients with normal liver function receiving DP therapy in the steady state. DP, MND and AAG were measured pre- and post-HD. Ten patients with normal renal and liver function were selected as the controls. The DP concentration was 2.08±0.39μg/ml (mean±SD) in the control group, and the pre-and post-HD levels were 2.40±1.08μg/ml and 1.73±0.87μg/ml, respectively, in the HD group. The MND concentration was 0.42±0.23μEg/ml in the controls, 1.53μ 0.52μg/ml in pre-HD and 1.08±0.32μg/ml in post-HD. Although DP and MND are both classified as substances of small molecular weight, the average decrease in plasma concentration from pre- to post-HD was under 30% with both agents. The MND/DP ratio in the HD group was higher than in the controls, but there was no significant difference between pre and post-HD. The AAG level was 75±5mg/dl in the controls and 109±11mg/dl before HD in the HD group (P<0.001). In conclusion, MND accumulation was observed in the HD patients receiving DP therapy. Since the anticholinergic effect of MND is 24 times that of DP, MND is thought to contribute in some way to the hypoglycemia induced by DP in renal failure.
  • 小川 秀彌, 矢島 勇臣, 堀 夏樹, 石井 洋二, 五味 朋子
    1993 年 35 巻 9 号 p. 1073-1079
    発行日: 1993/09/25
    公開日: 2011/03/01
    ジャーナル フリー
    The authors performed Transcatheter Arterial Embolization (TAE) with pure ethanol in five cases of severely dysfunctioning kidneys, for which conventional surgical nephrectomy had been conducted. In 3 out of 5 cases, the dysfunctioning kidneys were complicated by renal hypertension, while the other two had the complication of refractory urinary fistula. 1. Single TAE trials in 4 out of 5 patients, and a secondary TAE trial in the remaining patient resulted in successful complete embolization of the kidneys. 2. The size of the kidney in the bidirectional measurement by CT after TAE was reduced markedly in all the five cases and the reduction rate of the kidney was from 89.29 to 62.84%, and 72.61% on the average. 3. Both the blood pressure (BP) and plasma renin activity (PRA) in the three patients with compli cated renal hypertension were all normalized two weeks after the TAE. Twenty six months, 48 and 60 months have elapsed in these three cases and blood pressure has remained normal without antihypertensive agents . From this result it is considered that TAE will induce the reduction of juxtaglomerular cell functions. 4. Two patients with urinary fistula were healed. 5. TAE has a number of advantages over surgical nephrectomy in that it is bloodless and noninvasive. Further, the techniques of TAE are easier than nephrectomy and TAE is applicable to almost all poor risk patients.
  • ―多施設共同研究―
    窪田 実, 川口 良人, 野本 保夫, 土田 弘基, 二瓶 宏, 久保 和雄, 大森 安恵, 馬場園 哲也, 小椋 陽介, 原 茂子, 多川 ...
    1993 年 35 巻 9 号 p. 1081-1090
    発行日: 1993/09/25
    公開日: 2011/07/04
    ジャーナル フリー
    Eighty-seven CAPD patients whose hematocrit (Ht) level was maintained by recombi nant human erythropoietin (rHuEPO) were enrolled in this trial for a new formulation of rHuEPO suitable for subcutaneous injection. 6000IU rHuEPO was administered every 2 weeks for 12 weeks. Fortnightly doses were increased to 9000IU or 12000IU at 4 or 6 weeks if the Ht level decreased by 2%or more. During the study period, Ht values were maintained at the appropriate level in 88%of patients. 6000IU or lower was selected as a maintenance dose given every 2 weeks in 57 (76.0%) patients, 9000IU was selected in 8 patients and 12000IU was chosen in one patient. In 9 patients, the Ht could not be maintained during the study and the appropriate dose, therefore, remained unclear. Hypertension was observed in 2 patients as a side effect, and headache occurred in 2 other patients during the trial. Cutaneous abnormalities were not observed in the course of the subcutaneous injections. We conclude that anemia in most CAPD patients could be controlled with fortnightly injections in the dose range of 6000 to 12000IU rHuEPO given subcutaneously.
  • 杉本 光, 槇野 博史, 和田 淳, 四方 賢一, 池田 修二, 太田 善介
    1993 年 35 巻 9 号 p. 1091-1095
    発行日: 1993/09/25
    公開日: 2011/03/01
    ジャーナル フリー
    A 16-year-old female was admitted to our hospital because of chance proteinuria. On admission, mild proteinuria (0.6g/day) was observed, but microhematuria was not detected during the observation period. All the values of the renal function tests were within the normal range. Her renal biopsy demonstrated a prominent increase in the mesangial area by light microscopy and showed marked paramesangial hemispherical deposits by electron microscopy. Though IgM, IgG, Clq, C3, and fibrinogen were localized in the mesangial region, IgA was not detected by immunofluorescence study. It has been reported that paramesangial hemispherical deposits are strongly indicative of IgA glomerulonephritis. We conclude that this patient is a rare case of non-IgA glomerulonephritis with huge paramesangial hemispher ical deposits.
  • 木村 徹, 鈴木 祐介, 五十嵐 浩一, 吉本 恵子, 斉間 恵樹, 中村 雄二
    1993 年 35 巻 9 号 p. 1097-1102
    発行日: 1993/09/25
    公開日: 2011/03/01
    ジャーナル フリー
    A 47 year-old patient with an 8-year history of proteinuria was admitted to our hospital in 1989. His laboratory data were compatible with nephrotic syndrome: total serum protein 5.9g/dl (albumin 3.Og/dl), total serum cholesterol 280mg/dl and total urinary protein excre tion 5.Og/day. Renal biopsy specimens contained 27 glomeruli associated with sclerosis and collaps of loops under light microscopical examination. In addition, mesangial proliferation and thickening of the basement membrane were visualized. With immunofluorescent study granular IgG deposits were detected in the peripheral region of the glomeruli. Staining for IgA, IgM, C3, Clq, light chain and Congo-red were all negative. On electron microscopy, microtubules apparently resembling cellular projections appeared to thicken the basement membrane. We are tempted to conclude that the current case is an atypical glomerulopathy accompanied by a glomerular microtubular-like structure.
  • 小西 憲子, 武下 清隆, 安井 浩, 八田 一郎
    1993 年 35 巻 9 号 p. 1103-1106
    発行日: 1993/09/25
    公開日: 2010/07/05
    ジャーナル フリー
    A 42-year-old female was admitted to a hospital, because of acute hepatitis A. Laboratory data were GOT 8210mU/ml, GPT 4650mU/ml, LDH 11860mU/ml, total bilirubin 4.7mg/dl. BUN 19.5mg/dl and creatinine 1.9mg/dl. Urinalysis showed proteinuria 3+ and occult blood 1+. Soon after admission, she suffered from anuric acute renal failure and was transferred to our hospital for hemodialysis. Her urine-volume was under 20 ml per day . Urinalysis showed proteinuria 4+, occult blood 1+ and casts. Laboratory data showed BUN 58.2mg/dl and creatinine 8.5mg/dl. She was treated by hemodialysis for 35 days, before recovering from renal failure. However, her renal function did not recover perfectly and her 24-hour creatinine clearance remained at 50m1/min after 6 months . Renal biopsy was performed on the 17th day after admission. Examination by light microscopy revealed the findings of acute tubular necrosis and examination by immunofluorescence antibody method was negative . Urinalysis of 8 patients with acute hepatitis A showed that all patients had proteinuria at the onset. Patients with acute hepatitis A have symptoms of appetite-loss, nausea, vomiting and/or diarrhea. These symptoms cause hypovolemia, and hepatic dysfunction causes discontrol of vasoactive hormones, which gives rise to disturbance of renal circulation . Subsequently, acute tubular necrosis and acute renal failureoccur.
  • 金田 浩, 旭 浩一, 佐野 久美子, 蔀 幸三, 村田 豊明, 中山 昌明
    1993 年 35 巻 9 号 p. 1107-1113
    発行日: 1993/09/25
    公開日: 2011/03/01
    ジャーナル フリー
    A 46-year-old male patient underwent long-term hemodialysis treatment had suffered from calciphylaxis (defined by Selye), such symptoms as advanced systemic vascular calcification, rapid progression of gangrene on both fingers and toes, disturbance of conscios ness, and sclerosis and obstruction of the superficial vein after venipuncture during 11.5 years of dialysis. Furthermore, he had a long history (30 years) of heavy smoking . He died as a result of sepsis due to pneumonia after 12.5 years of dialysis. He had received dialysis treatment using a small amount of dialysate (50 liters on a recirculating system) for 8.5 years and had been dialysed 2 and 2 or 3 times a week for 10 years . As a result of this insufficient dialysis treatment, his characteristic laboratory data showed hypocalcemia, hyperphosphatemia, elevated calcium-phosphorus product, advanced metabolic acidosis, hyperalkaliphosph atemia and elevated serum parathyroid hormone . Autopsy revealed the following; 1) enlarge ment parathyroid gland enlarged in two (4.0 g and 2.0 g, respectively) showing adenomatous hyperplasia presenting cord-like arrangement of chief cells and water -clear cells, 2) systemic medial calcification in radial, ulnar, renal, mesenteric and brain arteries, and 3) Berline-blue positive iron deposit in calcified arteries in mesenteric and parathyroid tissue . From these results, we concluded that factors (challengers) related to the appearance of calciphylaxis might be as follows: l) advanced secondary hyperparathyroidism, 2) long-term uremic state, 3) administration of VD2 and VD3, 4) iron salt injection, and 5) a long history of heavy smoking. We speculated that these challengers might act synergistically to cause calciphylaxis.
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