The Japanese Journal of Nephrology
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
Volume 42, Issue 5
Displaying 1-6 of 6 articles from this issue
  • Hiroyuki TERAWAKI, Kenji KASAI, Hideyuki KOBAYASHI, Keita HIRANO, Akih ...
    2000 Volume 42 Issue 5 Pages 359-364
    Published: July 25, 2000
    Released on J-STAGE: July 04, 2011
    JOURNAL FREE ACCESS
    In the present study, we applied direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) to patients who developed endotoxin shock after laparotomy, and examined the influence of PMX-DHP on the kidney function. Seven patients were enrolled in this study, whose conditions were matched to the following criteria 1) endotoxin shock was highly suspected, 2) blood pressure became stable before PMX-DHP was indicated, 3) renal function (demonstrated with creatinine clearance (CCr) and fractional excretion of sodium (FENa) ) was proven before the surgery. All patients underwent emergency surgery in Fuji City General Hospital because of perforative peritonitis. A 2-hour session of PMX-DHP was performed on the day of the laparotomy and the second 2-hour treatment was performed the following day . Urine was collected at 2 hours before starting PMX, during the treatment, and 2 hours after PMX-DHP, and urine volume (U-Vol), sodium and creatinine levels of urine were monitored. Sodium and creatinine levels in the serum were measured at the start and end of the PMX-DHP session . Average atrial natriuretic polypeptide (ANP) was obtained using a total of 8 samples from the 14 treatment sessions. Parameters of hemodynamics such as pulmonary capillary wedge pressure (PCWP) were monitored at the start and end of PMX-DHP session. Urine volume increased significantly during and after PMX-DHP. The change in urine volume correlated significantly with the change in CCr during PMX-DHP, and with the change in FENa after PMX-DHP. The change in FENa was significantly correlated with the changes in hemodynamic factors such as PCWP and with the change in serum ANP, but no significant correlation was observed between the change of CCr and the other parameters. In conclusion, the early increase in urine volume with PMX-DHP treatment might be attributable to the increase in glomerular filtration independently of systemic hemodynamic factors.
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  • Tomonari OKADA, Hiroshi MATSUMOTO, Toshiyuki NAKAO, Yume NAGAOKA, Tama ...
    2000 Volume 42 Issue 5 Pages 365-373
    Published: July 25, 2000
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    PURPOSE : This study investigated the effect of dietary protein restriction on disease progression and how it is influenced by proteinuria in patients with type 2 diabetic nephropathy (DN) and renal failure. METHODS : One hundred and six type 2 DN patients whose baseline creatinine clearance (Ccr) values were 29±12 ml/min/1.73 m2 were maintained on a diet containing 0.66±0.05 g/kg/day of protein. They were classified into 3 groups according to mean dietary protein intake (DPI) estimated from urinary urea nitrogen excretion during the follow-up period of 23±14 months (I, <0.7 g/kg/day ; II, 0.7-0.89 g/kg/day ; III, ≥ 0.9 g/kg/day). Furthermore, they were divided into 3 subgroups according to mean urinary protein excretion (UP) during the follow-up period (a, ≥ 5.0 g/day ; b, 2.0-4.99 g/day ; c, <2.0 g/day) . Their rates of decline of Ccr (D-Ccr) and the changes in UP were examined. RESULTS : There were no significant differences in D-Ccr among Group Ia, IIa, and IIIa (1.1±0.6, 1.5±0.7, 1.2±0.6 ml/min/1.73 m2/month), among Group Ib, IIb, and IIIb (0.6±0.3, 0.7±±0.4, 0.8±0.4ml/min/1.73 m2/month), and also among Group Ic, IIc, and IIIc(0.1±0.3, 0.2±0.2, 0.2±0.6 ml/min/1.73 m2/month). On the other hand, significant differences were revealed in D-Ccr among Group Ia, Ib, and Ic, among Group IIa, IIb, and IIc, and among Group IIIa, IIIb, and IIIc. There were no significant differences in final UP and minimum UP during follow-up among 3 groups of different DPI levels in patients with 5.0 g/day≤baseline UP (n=49) and in patients with 2.0≤baseline UP<5.0 g/day (n=37).However, significant correlations were demonstrated between D-Ccr and the relative changes in UP between baseline and minimum during the follow-up period in both patients (r=0.49, 0.48, p<0.001, p <0.01). CONCLUSIONS : Irrespective of the level of dietary protein restriction, proteinuria has a great influence on disease progression, and the reduction in UP correlates with retardation of renal function loss in patients with type 2 DN and renal failure.
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  • Chiharu ITO, Yasuhiro ANDO, Tetsu AKIMOTO, Eiji KUSANO, Yasushi ASANO
    2000 Volume 42 Issue 5 Pages 374-380
    Published: July 25, 2000
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    The effect of plasmapheresis (PP) monotherapy and PP with corticosteroid administration were evaluated in a male with crescentic glomerulonephritis (CrGN). On the first admission, since he was positive for both anti-neutrophil cytoplasmic myeloperoxydase autoantibody (MPO-ANCA) and circulating immune complex (IC), the treatment was started with PP alone to reduce these autoantibodies immediately. During two months, three series of PP were performed : three sessions of plasma exchange (PEX) with fresh frozen plasma (FFP), two sessions of double filtration plasmapheresis (DFPP), and then, another two sessions of PEX, respectively. ANCA remained suppressed for 4 weeks after the first series of PEX, and increased thereafter. Subsequent DFPP caused a rebound of ANCA titer while the second PEX suppressed ANCA, at least, for 1 week. Though creatinine clearance (Ccr) improved after the first PEX and this level was maintained, ANCA increased again after the second PEX. Therefore the patient was treated with methyl-prednisolone (m-PSL) semipulse therapy followed by mild cocktail therapy including prednisolone (PSL) at 20 mg/day and mizoribine at 100 mg/day. In two weeks, ANCA and IC became negative and Ccr improved further. When PSL was tapered off, the ANCA became positive again. Since ANCA was not suppressed and Ccr declined gradually even after re administration of oral PSL at 30-40 mg/day, PP was superimposed on steroid therapy with 3 sessions of DFPP and PEX, respectively. Ccr was improved, but ANCA was not sufficiently decreased by DFPP. Subsequent PEX was more efficient than DFPP in reducing the ANCA level. However, m-PSL semipulse was eventually required for complete suppression of ANCA. Thus PP was partially effective, but not sufficient as monotherapy. However it was considered advantageous as an adjunct therapy to reduce the dose of immunosuppressive drugs in CrGN. As to the mode of PP, PEX with FFP appeard to be more effective than DFPP in reducing the plasma ANCA level.
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  • Ryuji SUZUKI, Hiroyuki MORITA, Masahide MIZOBUCHI, Takashi NEMOTO, Yos ...
    2000 Volume 42 Issue 5 Pages 381-387
    Published: July 25, 2000
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Previous reports have clarified that focal and segmental glomerulosclerosis (FSGS) appearing in membranous nephropathy (MN) is associated with a poorer prognosis than that of MN without FSGS. However, the etiology and pathogenesis of such FSGS lesions may show substantial individual differences. In some patients, hemodynamic alterations secondary to hypertension and vascular disorders seem to play a crucial role in the development of such FSGS lesions . In such instances, steady regulation of blood pressure might slow down further progression of FSGS lesions. Here we describe two cases of biopsyproven MN with FSGS. Case 1 was a 44-year-old man who had shown massive proteinuria with hematuria at the age of 39 years. Renal biopsy specimens obtained at the age of 40 and 41 years showed MN without FSGS and MN with FSGS, respectively. His blood pressure control was fairly goodthroughout the course. Although he was on a steroid, an immunosuppressant, a low protein diet, and an ACE inhibitor, his renal function declined in 5 years. Case 2 was a 61-year-old woman who showed nephrotic syndrome at the age of 39 years. A renal biopsy specimen obtained at the age of 58 years showed MN with FSGS and remarkable atherosclerotic changes of the interlobular arteries. Her blood pressure control was rather poor throughout the course. Her renal function gradually declined over 22 years. Since parts of the FSGS lesions of the second case may have been caused by hypertension, it is tempting to speculate that day-to-day control of blood pressure could improve the long-term prognosis. We believe that, at least in some patients of MN with FSGS, careful management may lead to a more favorable course of decline in renal function.
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  • Miyuki NAKAJI, Naoya IGAKI, Rintarou MORIGUCHI, Hiroyuki AKIYAMA, Fumi ...
    2000 Volume 42 Issue 5 Pages 388-393
    Published: July 25, 2000
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    We report a patient, a 23-year-old man, who was a hepatitis B virus (HBV) carrier complicated with nephrotic syndrome. He was admitted to our hospital because of generalized edema and massive ascites. Laboratory data on admission were as follows : proteinuria 9, 850 mg/day, Cr 2.7 mg/dl, BUN 73 mg/dl, albumin 1.9 g/dl, cholesterol 501 mg/dl, GOT 23 IU/l, GPT 19IU/l, HBsAg(+), and HBeAg(222.7). Since his nephrotic symptoms were seriously complicated with renal failure, we selected steroid therapy for nephrosis preference. His renal function was improved and the urinary protein decreased immediately, but his liver function deteriorated. The renal biopsy revealed focal mesangial proliferative glomerulonephritis. Immunofluorescent examination revealed slight deposits of IgG, IgM, and C3 along the glomerular basement membrane and mesangial matrix. He was not compliant and often stopped taking the steroid therapy, thereby causing nephrosis to recur each time. After all, nephrotic symptoms have been wellcontrolled with cyclosporin and steroid. In spite of the seroconversion of HB virus by formation of HBe antibody, mutant HBV infection continued. The fact that liver biopsy revealed severe lymphoid infiltration at the portal area suggested chronic active hepatitis. His clinicopathologic course suggests that HBV-associated nephropathy does not always remit as there are some cases in whom hepatitis remains in an active state even after seroconversion, due to its mutant status. In these cases, the long-term prognosis of HBV nephropathy has not been defined. Further study is necessary to establish the optimal treatment for HB nephropathy in adults.
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  • Keiko TAKAHASHI, Yoshihiko INOUE, Osamu MATSUDA, Tamiko TAKEMURA, Ashi ...
    2000 Volume 42 Issue 5 Pages 394-398
    Published: July 25, 2000
    Released on J-STAGE: July 05, 2010
    JOURNAL FREE ACCESS
    Myasthenia gravis is caused by antibodies against acetylcholine receptors and is treated with inhibition or elimination of antibody production. We report a 58-year-old woman who had been suffering from myasthenia gravis and underwent thymectomy in July 1995. Her myasthenic symptoms improved with immunosuppressive treatment using corticosteroid (100 mg/day) and azathioprine (100 mg/day). However she presented edema with massive proteinuria (7.54 g/day) and was admitted to our hospital on July 1997. She was diagnosed as having nephrotic syndrome and a renal biopsy was performed. The histological findings showed minimal change nephrotic syndrome. After pulse therapy with methylprednisolone (1 g/day × 3 days) following oral administration of prednisolone (60 mg/day), proteinuria disappeard after one month. Nephrotic syndrome is a rare complication in patients with myasthenia gravis. The increase in lymphokine production caused by thymectomy may be closely associated with the occurrence of nephrotic syndrome in spite of intensive immunosuppressive treatment in the present case. In this report, we also summarized reported cases of minimal change nephrotic syndrome with thymoma and myasthenia gravis.
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