日本腎臓学会誌
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
41 巻, 1 号
選択された号の論文の6件中1~6を表示しています
  • 田中 寛, 西川 治, 湯川 進, 吉本 充, 西出 巌
    1999 年 41 巻 1 号 p. 1-7
    発行日: 1999年
    公開日: 2011/03/01
    ジャーナル フリー
    Atherosclerosis and lipid abnormalities are still insuperable complications for maintenance hemodialysis patients. We observed the serum lipid profile of 27 maintenance hemodialysis patients (M F ; 20 : 7, age ; 54.9±6.2 y, o., hemodialysis duration ; 10.8±4.9 years, body weight ; 53.6±4.4 kg) using a low flux cellulose membrane, cellulose (1.5 m2), a vitamin-E-modified dialysis membrane, CL-15E (CL-15E 1.5 m2, Terumo), and polysulfon, PS (PS-1.3UW 1.3 m2, Fresenius) dialyzers. Each membrane dialyzer was used for 3 months. The blood flow rate was 200 ml/min, and hemodialysis time, 4 hours. When the dialyzers were replaced, fasting blood was collected at the beginning of hemodialysis and serum lipid parameters were measured. Seven additional maintenance hemodialysis patients were selected and TC, TG, HDL-C were measured as controls, because their dialyzers (low flux cellulose 1.5 m2) and hemodialysis conditions were not changed during the study. TC was decreased by PS and there were significant differences between cellulose and PS, and between CL-15E and PS. However, these changes were conducted within the normal range of TC. TG was not significantly changed during the study. HDL-C was decreased by CL-15E and PS as well as TC. There were significant differences in HDL-C between cellulose and CL-15E, and between cellulose and PS. Apo B, Apo B/A-I were decreased by PS and there were significant differences between cellulose and PS, respectively. LP (a) was not changed during the study. RLP-C (cellulose vs. PS, CL-15E vs. PS), VLDL-C (cellulose vs. PS), and LDL-C (cellulose vs. PS, CL-15E vs. PS) were significantly decreased between membranes, respectively. Although the precise mechanism is yet unknown, the uptake of LDL and remnant into receptors of the liver might be improved by PS hemodialysis. In conclusion, these data suggest that PS decreased the serum levels of the lipid profile in maintenance hemodialysis patients and may be effective in improving their lipid abnormality.
  • 沼田 美和子, 山本 裕康, 川口 良人, 小坂 直之, 中山 昌明, 久保 仁, 重松 隆, 細谷 龍男
    1999 年 41 巻 1 号 p. 8-13
    発行日: 1999年
    公開日: 2010/07/05
    ジャーナル フリー
    Malnutrition is one of the major issues associated with high mortality and morbidity in chronic dialysis patients. Several methods to evaluate the nutritional status of these patients have been attempted for example anthropometric measurement and biochemical parameters. Recently, it was reported that insulin-like growth factor-1(IGF-1) has been valuable for estimating nutritional status. In this study, we measured lean body mass (LBM) by dual energy X-ray absorptiometry (DXA), IGF-1 and other biochemi cal parameters in 35 patients on CAPD. Two years later, the second measurement of LBM was performed, and we assessed the percent changes of LBM and biochemical parameters. There was negative correlation between the percent changes of LBM and the duration of CAPD. In patients treated with CAPD for less than 36 months (group I ) LBM increased, however, it decreased significantly in those treated for more than 36 months (group II). On the other hand, in group I there was a positive correlation between the percent changes of LBM and IGF-1. In group II there was no correlation between the percent changes of LBM and any other biochemical parameters. It could be concluded that IGF-1 is one of the predisposing factors for improving LBM of patients on CAPD for a limited duration.
  • 望月 隆弘, 三戸部 倫大, 三舩 尚子, 高橋 元洋
    1999 年 41 巻 1 号 p. 14-20
    発行日: 1999年
    公開日: 2011/03/01
    ジャーナル フリー
    Dialysis-related amyloidosis (DRA) is a major complication of long-term hemodialysis patients. The onset of arthropathy is frequently preceded by carpal tunnel syndrome, but the early non-invasive diagnosis of DRA remains unclear. β 2-microglobulin amyloid deposits in joint synovia and soft tissue precede radiological abnormalities. Magnetic resonance imaging (MRI) may play a more important role in the early diagnosis of DRA, because it allows direct visualization of synovitis and deposition of abnormal soft tissue . The purpose of this study was to evaluate the usefulness of MRI of the wrist for the early diagnosis of DRA. The study included 72 patients (male 37, female 35) undergoing hemodialysis from initiation to 20 years. The patients were examined by MR images of synovitis, deposition of abnormal soft tissue and cystic bone lesions at the wrists. Normal MR images of synovia and soft tissue were defined in 6 control subjects (2 normal 4 non-dialysis patients) . Synovitis of the carpal bones was found in 23% of the patients at the start of hemodialysis. Deposition of abnormal soft tissue in the carpal canal and cystic bone lesions were detected after 1 and 2 years of hemodialysis, respectively. All findings were increased significantly with an increasing duration of dialysis. Synovitis was present in 90% of the patients with deposition of abnormal soft tissue, and in 80% of the patients with cystic bone lesions. β 2-microglobulin value was significantly higher in patients with synovitis, deposition of abnormal soft tissue and cystic bone lesions than in patients without these findings. Our experience suggests that synovitis examined by MRI of the wrists is useful for the early diagnosis of DRA. Thereby, intensive follow-up and management of DRA are required in patients with synovitis at the start of hemodialysis.
  • 堀田 修, 伊藤 克己, 古田 隆史, 千葉 茂実, 田熊 淑男
    1999 年 41 巻 1 号 p. 21-28
    発行日: 1999年
    公開日: 2011/03/01
    ジャーナル フリー
    A clinical trial of the immunosuppressive drug, deoxyspergualin (DSG), was conducted in five patients with various forms of proliferative glomerulonephritis (GN), such as IgA nephropathy in 2 patients, purpura nephritis in 1, membranoproliferative GN (MPGN) in 1, and rapidly progressive GN(RPGN) in 1 patient, respectively. DSG was intravenously administered at a daily dose of 0 .25 or 0.5 mg/kg for 4 weeks. A marked decrease in proteinuria (to less than 50 % of baseline) was observed in four patients. The other patient showed 38 % reduction of proteinuria. However, proteinuria exacerbated again after discontinuation of DSG in three patients during a four-week follow-up period. Marked decrease (3, 000/, μ l) in white blood cell (WBC) counts was observed in three patients during the course of DSG treatment. We concluded that DSG therapy is beneficial in reducing proteinuria in patients with various forms of proliferative GN. However, since proteinuria increased after the discontinuation of DSG and serious leukocytopenia was observed, indiscriminate use of DSG in proliferative GN should be discouraged.
  • 和田 庸子, 佐伯 敬子, 宮村 祥二, 大澤 豊, 上野 光博, 西 慎一, 荒川 正昭
    1999 年 41 巻 1 号 p. 29-33
    発行日: 1999年
    公開日: 2010/07/05
    ジャーナル フリー
    We report a case of acute renal failure associated with cryoglobulinemic glomerulonephritis. The patient, a 49-year-old woman, was referred to our hospital because of acute nephritic syndrome. After admission, she developed oliguria, and hemodialysis was instituted. Renal biopsy was performed and the specimens showed moderate endocapillary proliferation, large deposits filling the capillary lumen (“ intraluminal thrombi” ), and a double-contoured appearance, which are typical morphologic features of cryoglobulinemic glomerulonephritis. Immunoelectrophoresis showed a monoclonal increase of IgM x. On the basis of these findings, we diagnosed type II essential mixed cryoglobulinemia. Cryofiltration was performed with oral administration of prednisolone. Following the start of therapy, the patient's renal function gradually improved. Because of severe hypoproteinemia, cryofiltration was discontinued after three sessions. However, renal function recovered and was maintained with prednisolone only. This case shows that acute oliguric renal failure caused by cryoglobulinemic glomerulonephritis can be reversible if immunosuppressive therapy, together with plasmapheresis in more severe cases, is instituted promptly.
  • 1999 年 41 巻 1 号 p. 34
    発行日: 1999年
    公開日: 2010/07/05
    ジャーナル フリー
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