The Japanese Journal of Nephrology
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
Volume 46, Issue 1
Displaying 1-7 of 7 articles from this issue
  • Yasushi ASANO
    2004 Volume 46 Issue 1 Pages 1
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
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  • Kidney transplantation update
    Kazuhide SAITO, Kota TAKAHASHI
    2004 Volume 46 Issue 1 Pages 2-11
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
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  • reatment of end stage renal disease-comparison between the Western world and Japan
    Isao ISHIKAWA
    2004 Volume 46 Issue 1 Pages 12-19
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
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  • based on the findings of a survey of transplant recipients
    Yugo SHIBAGAKI, Hiroshi TOMA, Satoshi TERAOKA
    2004 Volume 46 Issue 1 Pages 20-25
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
    The number of kidney transplantations (KTx) performed annually in Japan remains small even after enactment of the “Organ Transplant” law. One of the reasons for this paucity of KTx might be because most nephrologists or dialysis physicians who provide medical care to potential transplant candidates have little knowledge of KTx and are seldom involved in the care of recipients and donors. The extent to which Japanese physicians participate in KTx has not been well studied.
    We sent questionnaires to the 212 kidney transplant recipients who have received an allograft at Tokyo Women's Medical University and conducted a survey to examine the extent to which nephrologists or dialysis physicians are involved in KTx.
    There were 149 recipients, consisting of 95 males and 54 females with an average age of 46.5 years, who responded to the questionnaire. Only 23% of the patients had considered KTx before dialysis access placement. Lack of information on KTx was suspected for this delay in considering KTx. In fact, only 18% of patients were informed about KTx by their nephrologists before starting dialysis and as many as 49% did not receive any information at all. Forty-eight percent of the patients were not provided with the information even on registration for a cadaveric transplant list by their physicians. Only 20% of the patients received some information about KTx through their nephrologists. On the other hand, nearly 100% of patients think it is essential for nephrologists or dialysis physicians to provide information on KTx especially before the initiation on dialysis access. In addition, almost all of the patients would prefer nephrologists or a dialysis physician to participate in the care of transplant patients from the stage of preoperative evaluation through the post-transplant follow-up period.
    In conclusion, nephrologists or dialysis physicians have not provided information on KTx to their patients appropriately and most of the transplant recipients expect them to participate in KTx. Nephrologists and dialysis physicians need fundamental knowledge about KTx so that they can provide appropriate information to patients with end-stage renal disease.
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  • Shinichi TAMURA, Tsugiko SHIMIZU, Hidekazu KAWAKATSU, Shoji TATEISHI
    2004 Volume 46 Issue 1 Pages 26-34
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
    To collect 24-hour urine of infants and young children is so difficult that 24-hour urinary protein excretion (24H-UP) has been estimated from single voided urine samples. We investigated the correlation between 24H-UP and the protein/creatinine ratio of the first voided morning urine samples (MUP/Cr) and evaluated the problems associated with this method. Six hundred and thirty-nine specimens, pairs of morning spot urine and 24-hour collected urine, were collected from 158 patients, aged 3 to 28, who were being followed at Kyoto City Hospital. The study population was divided into different subgroups by age, disease category and inpatient or outpatient status and linear regression analysis was performed for every subgroup. Although MUP/Cr correlated well with 24H-UP, it was necessary to revise the estimation of 24H-UP from MUP/Cr, which is lower in infants and young children because of age-related differences in creatinine excretion. If the patient's age is younger, the creatinine excretion rate is lower. The difference in 24H-UP estimated from MUP/Cr was significant between inpatients and outpatients, with the estimated value being higher in outpatients than inpatients. The estimated value was also different according to disease category. We speculated that the difference in estimated 24H-UP was affected by different rate of creatinine excretion related to age and other factors.
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  • a propensity score analysis
    Ayumi HIRABAYASHI, Tetsuya OGAWA, Mitsuyoshi URASHIMA, Masayoshi SONE, ...
    2004 Volume 46 Issue 1 Pages 35-42
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
    To clarify the renal protection conferred by angiotensin II converting enzyme inhibitor (ACEI), we compared an ACEI group and a conventional therapy (control) group with matched propensity scores. The propensity score is used to control imbalances in the conditional probability of a subject receiving a particular exposure given a set of defined confounders. To calculate the propensity score, the confounders are used in a logistic regression to predict the exposure of interest, without including the outcome. We used a database of the characteristics and clinical data for 1, 309 renal insufficiency cases who visited our outpatient clinic between 1986 and 2001. The major contributing factors in the patient characteristics were primary disease, blood pressure, renal function (serum creatinine levels; sCr), urinary protein excretion (UP), and gender. The primary end-point was the doubling of the baseline sCr noted at the time of enrollment or endstage renal failure. The major characteristics of the two groups were not statistically different. An incidence of 90% was obtained at 95 months in the control group and at 183 months in the ACEI group. Using a Kaplan-Meier survival analysis, the survival rates of the two groups were found to be significantly different (p<0.001 by log-rank test), with ACEI having a beneficial effect on the survival rate and renal function. Using a sub-analysis, neither the starting point of ACEI treatment, based on an sCr above or below 2mg/dl, nor the amount of UP, more or less than 1g/day, affected the superiority of ACEI in the prevention of renal failure progression. The ACEI treatment was superior to conventional therapy in patients with renal insufficiency, and this superiority was independent of blood pressure, renal function and the amount of UP, based on the analysis of an observational database of renal insufficiency cases with matched propensity scores.
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  • Mario YAMAKI
    2004 Volume 46 Issue 1 Pages 43-48
    Published: 2004
    Released on J-STAGE: May 18, 2010
    JOURNAL FREE ACCESS
    A 56-year-old man with chronic hepatitis was admitted to the nephrology unit because of a progressive increase in serum creatinine (Cr). Blood Urea Nitrogen (BUN) and Cr, measured by the enzymatic method, were 15 and 2.0mg/dl, respectively, in 1999, and changed to 17 and 3.8mg/dl, respectively, on February 2000. However, urinalysis did not show any abnormalities. Hypergammaglobulinemia and hypocomplimentemia were observed, but the immune complex level was normal. Major self-antibodies were all negative. MRI renal angiography and renoscintigram, respectively, showed little abnormality. Renal biopsy performed in April revealed no abnormalities. Treatment was started with the administration of steroid, anticoagulation agents and activated charcoal under the hypothesis of serious glomerulonephritis. Cr and Cr clearance (Ccr) aggravated to 5.4mg/dl and 11.9ml/min in April, and then returned to 2.7mg/dl and 22.8ml/min in May, however, steroid and anticoagulation administration were terminated because the biopsy findings were identified as normal. When cryoglobulinemia was found in August, serum Cr was found to be 1.0mg/dl when measured by a modified Jaffés method. Clearance test of p-aminohippurate sodium and sodium thiosulfate, ie, CPAH and CTHIO, showed normal renal function. After the detection of macroglobulinemia (IgM-λ), the patient has been treated with the administration of melphalan and prednisolone in the hematology unit since July 2001. Analysis of plasma amino acid showed a high glutaminic acid (Glu) level before the subsequent chemotherapy and dissolution. His serum Cr was 0.9mg/dl even when measured by the enzymatic method after chemotherapy. A previous report referred to the possibility that enzymatic measurement is affected by the high proline level because of its structural resemblance to Cr, however, the high Glu level in this case did not seem to have this effect because of less resemblance to Cr. Therefore, paraproteinemia is thought to affect enzymatic Cr measurement, and CPAH and CTHIO should be used when as abnormally high Cr level appears.
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