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Volume 37, Issue 1
Displaying 1-14 of 14 articles from this issue
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Fumitake GEJYO, Hiroki MARUYAMA, Masaaki ARAKAWA1995 Volume 37 Issue 1 Pages 1-6
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSDialysis amyloidosis is a frequent complication encountered in patients receiving long-term hemodialysis. These amyloid deposits are composed mainly of an insoluble fibrillar material that consists of β2-microglobulin (β2-m). While this fibrillar protein is a major component of these deposits, numerous other substances have been identified in the amyloid deposits; e. g., amyloid Pcomponent, calcium, glycosaminoglycans, chondroitin sulfate, hyaluronic acid, collagen, protease inhibitors, k-chain protein, ubiquitin, apolipoprotein E and macrophages. Hypotheses on the patho genesis of amyloidosis have suggested roles for each of these factors. The pathogenesis of β2-mrelated amyloidosis is probably multifactorial, with the retention of β2-m presumed to be the basic requirement for its initiation. It has been demonstrated in vivo that radiolabeled β2-m accumulates at the site of amyloid deposits. Our autoradiographic study of synovial tissue demonstrated that the cells had taken up radiolabeled β2-m, indicating that circulating radiolabeled-β2-m could be detected as an accumulation because it is taken up by the cells around the amyloid deposits. At present it can not besaid that any basic treatment for β2-m-related amyloidosis has been established. It has been reported that the administration of a low dose of a corticosteroid may be effective in treating β2-m amyloid related arthropathy. The articular symptoms resolved in most patients with corticosteroid. However, it should be borne in mind that corticosteroid may induce some adverse effects. Corticosteroid should be used only in patients with severe articular symptoms.View full abstractDownload PDF (1367K) -
Yoshiaki KUSUMI, Satoshi OSHIMA, Nobuyuki YOSHIZAWA1995 Volume 37 Issue 1 Pages 7-11
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSThe possible role of a streptococcal protein, preabsorbing antigen (PA-Ag), in human cellular immunity was examined by a lymphocyte stimulation test. Lymphocytes were obtained from 12 healthy adult donors who had no history of acute poststreptococcal glomerulonephritis nor of other renal diseases, and from the blood of 4 umbilical cords. In addition to PA-Ag, pre-purifed material from ruptured cell supernatant (RCS) was also tested for lymphocyte stimulation, and their time-response relationships were compared to those with stimulation by phytohemaggultinin (PHA), a nonspecific mitogen. Results showed that the lymphocytes of the 12 adult donors proliferated in a dose-dependent manner in response to PA-Ag or RCS stimulation. In the response to these proteins, the peak responsiveness of lymphocyte proliferation was characteristically seen between the 5th and 7th days of cultivation, while it was seen between the 3rd and 5th days in PHA stimulation. Surprisingly, lympyhocytes derived from umbilical cord bloods also significantly proliferated in the presence of PA-Ag. These results indicate that PA-Ag stimulates human lymphocytes to proliferate in a different manner than when stimulated by PHA, and the induction of the stimulatory effects is not dependent on antigen-specific response, since it does not require pre-sensitization of the host.View full abstractDownload PDF (849K) -
Naoko TAKEI, Shigeki TAKEI, Kazufumi SUZUKI, Eiji TOMOMATSU, Shigeru M ...1995 Volume 37 Issue 1 Pages 12-16
Published: 1995
Released on J-STAGE: March 01, 2011
JOURNAL FREE ACCESSThe present study was undertaken to examine the possible augmentation of clonidine on the control of renal sympathetic nerve activity by Bezolid-Jarisch reflex in anesthetized cats. Veratrine (3-20μg/kg) produced dose -dependent decreases in arterial blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RNA). Clonidine (3μg/kg) resulted in decreases in BP, HR and RNA. Clonidine significantly potentiated the influence of Bezold-Jarisch reflex on RNA, but did not potentiate the influence of Bezold-Jarisch reflex on BP and HR. Bezold-Jarisch reflex gain calculated as percent inhibition of renal sympathetic nerve activity divided by decreases in mean blood pressure was significantly higher after the administration of clonidine.View full abstractDownload PDF (798K) -
Issui UETA, Kazunaga TAKAMATSU, Kozo HASHIMOTO1995 Volume 37 Issue 1 Pages 17-23
Published: 1995
Released on J-STAGE: March 01, 2011
JOURNAL FREE ACCESSTo investigate the clinical significance of the urinary glycosaminoglycans excretion rate (GER) in patients with incipient diabetic nephropathy, GER was measured by the dye-binding method (Whiteman, 1972) in nocturnal urines of 30 normoalbuminuric (urinary albumin excretion rate (AER)<10μg/min) and 10 microalbuminuric (10≤ AER<200μg/min) diabetics without hypertension and 24 healthy control subjects. The mean GER in microalbuminuric diabetics was 56.5±15.0μg/min and was significantly higher than that in the healthy controls (41.1±12.9μg/min, p<0.01). There was no significant difference in GER between normoalbuminuric diabetics and the healthy controls (50.2±36.3μg/min, p<0.1). GER correlated positively with HbAlc levels in the diabetics (r=0.451, p<0.01). In diabetics with good glycemic control (HbA1c<8.0%). GER positively correlated with urinary transferrin and albumin excretion rates (r=0.593, 0.584, both p<0.01), whereas it did not correlate significantly with N-acetyl-β-D-glucosaminidase excretion rate (NAGER). In diabetics with poor glycemic control (HbA1c≥ 8.0%). GER correlated positively with NAGER (r=0.626, p<0.01), whereas it did not correlate significantly with urinary transferrin and AER. These results indicate that GER may be affected by glycemic control and is associated with the severity of the glomerular basement membrane lesion in well-controlled diabetics and with the severity of the tubulointerstitial lesion in poorly controlled diabetics. The measurement of GER is useful for determining the pathophys iological state in incipient diabetic neohrouathy.View full abstractDownload PDF (898K) -
Takuji UTSUNOMIYA, Kazuo KUMANO, Tadasu SAKAI, Akiyasu YAMASHITA1995 Volume 37 Issue 1 Pages 24-28
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESScontinuous vibration of the abdominal wall with a small electric vibrator was conducted to enhance peritoneal mass transport in rats with normal kidney function. Thirty ml of either 2.5% or 4.25% dextrose dialysate containing creatinine, urea and dextran 70 was infused intraperitoneally and was allowed to dwell for 30-240 min with or without abdominal wall vibration at the rate of 80 Hz. The mass transfer area coefficient (KA) of small molecular solutes and peritoneal lymphatic absorption were investigated. Peritoneal dialysis with vibration for 60 min increased the KA of urea, creatinine and glucose by 12%, 15%, 27%, respectively, without changes in ultrafiltration and lymphatic absorption. This effect may be attributed to enhanced mixing of dialysate in the peritoneal cavity and the increased peritoneal effective blood flow. This concept can be applied to short-term dwell dialysis, such as automated peritoneal dialysis.View full abstractDownload PDF (785K) -
Shigeo NEGI, Yuji KITA, Kazuhiro UCHITA, Tomiya ABE1995 Volume 37 Issue 1 Pages 29-34
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSDialysis-related amyloidosis (DRA) is a serious complication in patients receiving long-term hemodialysis. Intrigued by the fact that the shoulder joint is primarily favored by DRA, we measured the shoulder-capsular distance (SCD) by ultrasonography to investigate the relationship between SCD and the duration of hemodialysis, patient age and biochemistry findings. The SCD of patients receiving hemodialysis was significantly increased, and there was a positive correlation between SCD and the duration of hemodialysis. The SCD tended to show a significant increase in patients receiving long-term hemodialysis over 10 years. Although the SCD was not significantly correlated with serum levels of β2-microglobulin and C-PTH, there was a significant positive correlation between the SCD and the serum levels of Al. In patients receiving long-term hemodialysis for 10 years or more, the SCD was increased significantly in the groups patients with the complications of carpal tunnel syndrome (CTS), cystic radiolucencies (CRL) or destructive spondyl arthropathy (DSA) compared with the value in complication-free patients. The results of this study suggest that the majority of patients with SCD>8mm had the complication of DRA. Since ultrasonography is a non-invasive, east-to-perform procedure, ultrasono graphic measurement of the SCD seems to be useful in the diagnosis of DRA.View full abstractDownload PDF (1907K) -
Toru HYODO, Kazuo KUMANO, Makoto RAGA, Tadasu SAKAI1995 Volume 37 Issue 1 Pages 35-43
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSThere is increasing interest in the examination of urine sediment to differentiate between glomerular and non-glomerular hematuria. A newly developed automated urinary sediment analyzer was used for this purpose. It clearly recognized red blood cells, white blood cells, epithelial cells, bacteria and crystals by their cell size and fluorescent intensity. Ninety-eight urine samples from 31 glomerular and 67 non-glomerular lesions were analyzed by the analyzer and 69 samples, by light microscopy. Acoording to the analysis of their histograms, a forward scatter (FSC) intensity of less than 126, where 80% of the smaller red blood cells were observed, was diagnosed as glomerular hematuria. A FSC intensity of more than 84, where 80% of the large red blood cells were counted, was non-glomerular hematuria. An FSC intensity between 84 and 126 was considered to be the overlap zone of glomerular and non-glomerular hematuria. The sensitivity for glomerular red blood cells was found to be 100% and specificity, 92.54% by means of flow cytometric analysis. On the other hand, light microscopic analysis yielded 95.83% sensitivity and 93.33% specificity for glomerular lesions. Flow cytometric analysis of the urinary red blood cells was concluded to be a fast, simple and reliable method to differentiate glomerular and non-glomerular hematuria.View full abstractDownload PDF (3763K) -
Yutaka YAMAJI, Shunya UCHIDA, Yoshihiro MIYAJIMA, Shunya KAMANE, Etsur ...1995 Volume 37 Issue 1 Pages 44-48
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSA 55-year-old female with a long history of pure red cell aplasia temporarily manifested Fanconi syndrome with hypophosphatemia, hypouricemia, glycosuria, acidic amino aciduria, but not metabolic acidosis nor hypokalemia. These abnormalities completely resolved in 3-4 weeks after withdrawal of several drugs, suggesting that the cause of her Fanconi syndrome could be attributed to a drug or a combination of multiple drugs, though lymphocyte stimulating tests revealed negative results for all possible drugs. Postmortem specimen of her kidneys showed mild mesangial proliferation without significant changes in tubular and interstitial regions. Massive ferrous precipitations were found in the zona glomerulosa of the adrenal glands. The pathophysiology of Fanconi syndrome shown in the patient was likely to have been a drug-induced transient and mild dysfunction of the Na+/K+ pump of the renal proximal tubules, which might also explain the selective amino aciduria. The absence of hypokalemia corroborates well with both a lack of bicarbonaturia and hemochromatosis-induced adrenal insufficiency. Patients with a renal dysfunction associated with electrolyte derangements and without proteinuria or azotemia should be under vigilant observation when using many drugs.View full abstractDownload PDF (1412K) -
Fujiko IRIE, Hiroshi KIKUCHI, Toshiko HIBINO, Motohiro SATO, Naoto YAM ...1995 Volume 37 Issue 1 Pages 49-56
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSWe report a case of renal vein thrombosis (RVT) and pulmonary embolism associated with diffuse membranous glomerulonephritis. A 44-year-old Japanese male was referred to the Nephrology Department with heavy proteinuria. Renal biopsy revealed diffuse membranous glomerulonephritis and we administered PSL 30mg/day and dipyridamole 300mg/day. Three weeks later, he was admitted with severe chest pain, dyspnea and massive proteinuria. RVT and pulmonary embolism were detected on CT scan and perfusion lung scan. After a few days of continuous intravenous unfractionated heparin (UFH) therapy, we used 72 U (anti-FXa)/kg of intravenous low-molecularweight heparin (LMWH) every 12 hours for 10 days. He also received urokinase at the dose of 120, 000 U/day for 4 weeks and long-term therapy with warf grin potassium at the dose of 3 mg/day. One month later, the thrombi in the pulmonary arteries and inferior versa cava disappeared on CT scan and perfusion lung scan. LMWHs have a longer biological half-life and a lower bleeding tendency than UFH for an equivalent antithrombotic effect. This case indicates that intermittent intravenous LMWH administration combined with urokinase is effective against RVT and pulmonary embolism without any side effect.View full abstractDownload PDF (2744K) -
Hideto UYAMA, Hideo SHIIKI, Teruo WATANABE, Kazuhiro DOHI1995 Volume 37 Issue 1 Pages 57-61
Published: 1995
Released on J-STAGE: March 01, 2011
JOURNAL FREE ACCESSA twenty-one-year-old male was admitted to our hospital because of hypertension and proteinuria. He had felt general fatigue and low grade fever for one month. Blood pressure was 180/120 mmHg on admission. Laboratory findings showed 3+ proteinuria and 1+ occult blood in uninalysis; an accelerated erythrocyte sedimentation rate (ESR) of 39 mm/hr; elevation of LDH to 755 IU/1. Antinuclear antibody was positive with a titer of 1:160, with a speckled pattern. Plasma renin activity and serum aldosterone were markedly elevated to 25.8 ng/ml/hr and 585.3 pg/ml, respectively. Renal function had declined mildly; endogenous creatinine clearance was 60 ml/min. Renal arteriogram demonstrated multiple intrarenal aneurysms in the bilateral kidneys. Aneurysms, 5-8 mm in diameter were located in the arteries from the interlobar to interlobular region. He was diagnosed as having polyarteritis nodosa (PN) and was then treated with 20 mg/day of prednisolone and monthly pulse therapy of cyclophosphamide. After steroid, cyclophoshamide and anti-hypertensive therapy, he became well and had normal blood pressure. The patient was considered a rare case of PN with multiple intrarenal aneurysms and accelerated hypertension. We discuss aneurysms in PN and accelerated or malignant hypertension documented in the literature.View full abstractDownload PDF (1450K) -
Hideaki IYORI, Aijirou TOKUSHIGE, Naoko ISHITOYA, Kensuke JOH, Norimas ...1995 Volume 37 Issue 1 Pages 62-68
Published: 1995
Released on J-STAGE: March 01, 2011
JOURNAL FREE ACCESSEpstein's triad which is a syndrome with the combination of macrothrombocytopenia, deafness and nephritis, is similar to Alport's syndrome. We report on a case of Epstein syndrome and describe the results of morphological examination of a renal biopsy, specimen. The patient was a 14-year-old girl with the diagnosis of chronic idiopathic thrombocytopenic purpura that had preseated from the age of 3 years. She was referred to Daisan Hospital of the Jikei University School of Medicine on April 1, 1991 for refractory thrombocytopenia. She had shown sensorineural hearing loss since the age of 6 years and her peripheral blood smear revealed giant platelets on admission. She was treated with interferon, prednisolone, and high-dose γ-globulin (400 mg/day ×5 days). However, the platelet count did not increase, but hypermenorrhea continued. She subsequently showed proteinuria and hemat uria. She underwent splenectomy and renal biopsy on August 12, 1992. The glomeruli appeared to be almost normal under light microscopy. The interstitium showed regional fibrosis containing foam cells and the renal tubuli showed mild atrophy. Under electronmicroscopy, the basement membrane of the glomeruli was associated with mesangial interposition and the lamina densa was split into several layers. These ultrastructual findings were compatible with those of Alport's syndrome.View full abstractDownload PDF (2016K) -
Shigeru MORIOKA, Hirofumi MAKINO, Jun WADA, Kenichi SHIKATA, Yasushi Y ...1995 Volume 37 Issue 1 Pages 69-73
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSWe report here, a patient of systemic lupus erythematosus (SLE) with severe fibrinoid necrosis in the afferent arteriole of the glomerulus, in whom antiphospholipid antibody might have contributed to the pathogenesis. A 24-year-old female who was suffering from severe anemia with fragmented red blood cells, acute renal failure and thrombocytopenia, was admitted to our hospital. Further examinations revealed findings compatible with active lupus nephritis. Moreover, she was found to be positive for antiphospholipid antibody, and anticardiolipin antibody, as well as for lupus anticoagulant and syphilis test. Intensive treatment by methylprednisolone pulse therapy, hemodialysis, and double filtration plasmapheresis were performed. However, 13 days after admission she died suddenly because of intracranial hemorrhage. Pathological investigation of renal tissue revealed severe fibrinoid necrosis of the arterioles mainly in the glomerular afferent arteriole associated with diffuse proliferative lupus nephritis. In this case, hemolytic uremic syndrome (HUS) was associated with SLE. Antiphospholipid antibody was considered to be not only an accelerator in the arterial lesions of HUS, but also an initiator of HUS itself.View full abstractDownload PDF (1563K) -
Takashi ARAI, Tatsuya INUMARU, Takashi MOMOSE, Kazuaki MORIO, Kenzo MA ...1995 Volume 37 Issue 1 Pages 74-80
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSIn recent years, it has been revealed that verocytotoxin-producing E. coli (VTEC) infection is one of the leading causes of HUS and the molecular aspects of its pathophysiology have also been studied extensively. We report a case of a 56-year-old man who developed BUS after E. coli (0 26 strain) infection with diarrhea. The characteristic laboratory findings in this case included hypergammaglo bulinemia, hypocomplementemia and a high level of immune complex in addition to the common findings of HUS. The light microscopic findings of the first renal biopsy performed before treatment revealed extensive interstitial changes with remarkable mononuclear cell infiltrations as well as mild mesangial proliferation with crescent formation. Subendothelial electron-dense deposits within the glomerular capillary walls and mesangial area were also detected by electron microscopic examination. The diagnostic possibilities of infectious endocarditis and collagen diseases, such as Sjogren syndrome, were reasonably ruled out by the appropriate examinations. After 2-month prednisolone therapy, proteinuria and deteriorated renal functions as well as the abnormal immunological param eters described above were remarkably improved. The second renal biopsy after treatments showed clearly diminished subendothelial deposits and interstitial mononuclear cell infiltrations. This case report might provide information on the unique features of renal interstitial damage and immunolog ical abnormalities in VTEC-induced adult HUS.View full abstractDownload PDF (2019K) -
Akinori SOEJIMA, Shynji ISHIZUKA, Michihiko SUZUKI, Shinobu MINOSHIMA, ...1995 Volume 37 Issue 1 Pages 81-85
Published: 1995
Released on J-STAGE: July 05, 2010
JOURNAL FREE ACCESSIn recent years, several laboratories have suggested that serum levels of antioxidant activity and redox balance are reduced in patients with chronic renal failure. Some clinical reports have also proposed that defective serum antioxidative enzymes may contribute to a certain uremic toxicity through peroxidative cell damage. A 48-year-old woman was referred to us from the surgical department of our hospital because of consciousness disturbance, panctytopenia and acute acceleration of chronic azotemia after postoperative radiation therapy. We diagnosed acute acceleration of chronic renal failure with severe acidemia and started hemodialysis therapy immediately. Two days after admission to our department, she developed upper abdominal sharp pain and bradyarrhythmia. Serum amylase activity was elevated markedly and the ECG finding showed myocardial ischemia. On the 24th hospital day these complications were treated successfully with conservative therapy and hemodialysis. We considered that radiation therapy in this patient with chronic renal failure evoked marked oxidative stress and that deficency of transferrin played an important role in peroxidative cell damage.View full abstractDownload PDF (777K)
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