[in Japanese]

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β₂-Microglobulin (β₂M) isolated from the amyloid tissue of patients with dialysis-related amyloidosis (DRA) has been reported to be modified by advanced glycation end products (AGE) via the Maillard reaction. We produced anti-AGE monoclonal antibody and used it to immunohistochemically localize AGE in amyloid tissue obtained during surgical operations on patients with carpal tunnel syndrome (CTS). AGE was found to be localized in β₂M-positive amyloid tissues. AGE was also detected in infiltrating cells surrounding the amyloid tissue. In conclusion, β₂M-positive amyloid tissue was immunohistochemically demonstrated to be modified by AGE.

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The effects of infection by human T-cell leukemia virus type I (HTLV-I) on lymphocyte subpopulations in hemodialysis (HD) patients were investigated using monoclonal antibodies on two occasions, in 1986 and 1992, 6 years apart. 1) In HD patients positive for anti-ATLA (adult T-cell leukemia-associated antigen) antibody (Ab), the percentages of OKT3 positive cells and OKT 8 positive cells were significantly higher after the 6-year interval. 2) Although at the start in 1986, there were no significant differences in lymphocyte subpopulations between patients positive and negative for anti-ATLA Ab, six years later the percentage of OKT8 positive cells was significantly higher, and the OKT4/OKT8 ratio lower in the patients positive for anti-ATLA Ab. Based on these findings, it is concluded that HTLV-I infection altered the lymphocyte subpopulations of the HD patients during the 6 year-period of infection.

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We investigated the effect of menopause on bone in female hemodialyzed patients. The patients were divided into two groups, pre-menopausal (PRE, n=16) and post-menopausal (POST, n=32). Mean age at menopause in the POST group was 45.1 years, i.e., 4-5 years younger than in healthy Japanese females. Bone mineral density (BMD) of the lumbar spine (L2-L4) was measured by dual-energy X-ray absorptiometry. BMD was negatively correlated with age in the POST group (r=-0.68), but no such correlation was observed in the PRE group. The decrease in lumbar spine BMD estimated from the slope of the linear regression line was 0.0106g/cm²/year in the POST group. We measured lumbar spine BMD 3-7 times over 2-4 years in 17 patients under 50 years of age (n=10 in the PRE group and n=7 in the POST group). The mean decrease in lumbar spine BMD was 0.0057g/cm²/year in the PRE group and 0.0339g/cm²/year in the POST group.
These findings suggest that post-menopausal osteoporosis is one of causes of bone loss in female hemodialyzed patients.

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Twenty-three patients started on hemodialysis (HD) therapy in our dialysis center in 1992 were assessed regarding the validity of the recommended criteria in the initial stage of HD therapy with special reference to uremic symptoms, blood chemistry and urea kinetics.
Patients who had met the criteria for instituting HD therapy recommended by an ad hoc committee sponsered by Japanese Ministry of Health and Welfare were able to be discharged 28±9 (mean±SD) days after the start of HD therapy or after 13±4 HD sessions with concomitant amelioration of hematocrit values to 27.9±3.5% and normalization of serum calcium levels to 4.4±0.3mEq/l.
TAC_BUN and PCR values, as parameters of urea kinetics of HD patients in the initial stage, were 43.0±11.8mg/dl and 0.91±0.27g/kg/day, respectively, and Kt/V was 0.82±0.22.
The values of TAC_BUN and PCR in this study were the same as those of maintenance HD patients who rarely had complications with adequate protein intake in the NCDS study.
HD therapy in our dialysis center for patients meeting the criteria proved the validity of the recommended criteria for instituting HD therapy by demonstrating reductions in uremic symptoms, amelioration of blood chemistry data and improving urea kinetics in the initial stage.

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We compared cardiac sympathetic nerve abnormalities in patients hemodialyzed because of diabetic nephropathy (DN, n=18) and chronic glomerulonephritis (CGN, n=21). ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed in this study. SPECT and anterior planar myocardial images were obtained 15 minutes after (initial images) and 4 hours after (delayed images) an injection of MIBG. The following results were obtained: (1) SPECT showed more defects in DN than in CGN. (2) The heart to superior mediastinum uptake ratio (H/M) was lower in DN than in CGN.
These findings suggest that myocardial uptake of MIBG in DN is significantly impaired because of cardiac sympathetic nerve abnormalities. These abnormalities may affect the prognosis in DN.

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Recent reports on the detection of intraperitoneal free elastase in CAPD peritonitis may have important implications concerning the pathogenesis of peritoneal membrane damage. In order to assess the release of proteases from neutrophils infiltrating the peritoneal cavity in CAPD peritonitis, we investigated the regulation of CD43, LAM-1 and Mac-1 expression on the neutrophil plasma membrane by FACS analysis. Down-regulation of CD43 and LAM-1, and up-regulation of Mac-1 were found on neutrophils obtained from dialysates after a 1-hour dwell-time. Up-regulation of Mac-1 continued to increase until a 4-hour dwell-time. Immunoblot analysis for neutrophil lysate from dialysate showed the presence of asialo form CD43 molecules and their fragments, which may have been produced by cleavage of CD43 molecules at extracellular sites.
These results suggest that the intraperitoneal neutrophils in CAPD peritonitis are continuously activated during dwell-time, and that proteases may be released from neutrophils in dialysate even after a short dwell-time, in spite of the low pH and high lactate concentration.

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In order to elucidate the clinical utility of bone mineral quantitation by computed X-ray densitometry (CXD) in patients with renal osteodystrophy (ROD), we investigated the correlation between ∑GS/D, MCI measured by CXD and bone mineral densities (BMDs) by dual energy X-ray adsorptiometry (DXA) in the whole body and 10 regions (head, R, L-arms, R, L-ribs, thoracic spine, lumbar spine, pelvis, R, L-legs), and the correlations between ∑GS/D, MCI, BMDs and clinical parameters related to bone metabolism (duration of dialysis therapy, serum PTH-c, Al, ALP, ALP3, BGP, TRACP) in 125 men on hemodialysis.
In addition, changes in bone mineral values by bone densitometry were observed for a year in 63 patients, and for two years in 32 patients.
1) ∑GS/D, MCI by CXD and BMDs in the whole body and the 10 regions by DXA were significantly correlated. The correlation coefficient was largest in the arms. 2) ∑GS/D was correlated with duration on dialysis therapy, serum Al, ALP, ALP3 and TRACP. 3) The mean values for the change in ∑GS/D for both one year and two years were very similar to those of BMD in the arms. 4) The percentage change in ∑GS/D for one year was correlated significantly with the change in BMD of the whole body. 5) The 32 patients observed for two years were divided into two groups, 18 patients in which PTH-c<5ng/ml (group A), and 14 patients in which PTH-c≥5ng/ml (group B). ∑GS/D in group B was significantly lower than in group A at the start of observation year and further significantly reduced after two years, but not in group A.
These results indicate the clinical utility of bone mineral quantitation by CXD in patients with ROD, and show that characteristics of ∑GS/D is similar to that of BMD in the arms by DXA.

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A 39-year-old man with Laurence-Moon-Bardet-Biedl syndrome (LMBB syndrome) was admitted because of severe anemia in spite of frequent blood transfusions. He had an 18-year history of NIDDM. Hemodialysis had been instituted one year before hospitalization because his renal function had grown worse. Gastroenoscopic examination performed after admission revealed advanced gastric cancer (Borrmann type III). The patient died of gastric cancer complicated by carcinomatous peritonitis, obstructive jaundice and DIC syndrome.
Renal involvement has recently been reported in LMBB syndrome. Although the patient had a long history of NIDDM, autopsy data showed histopathological changes which included the mesangial proliferation and interstitial fibrosis previously described in LMBB syndrome, but no typical changes of diabetic nephropathy.
We concluded that renal involvement in LMBB syndrome may have caused the deterioration of this patient's renal function.

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We describe a 62-year-old man who developed porphyria cutanea tarda (PCT) and viral hepatitis (type C) while on chronic hemodialysis. About two years after the start of hemodialysis therapy, the patient complained of increasing skin pigmentation, multiple bullous changes and skin ulcers in areas exposed to light. As the erythrocyte coproporphyrin and protoporphyrin concentrations were extremely high, we made a diagnosis of aggravation of PCT. From December 1992 to July 1993, we treated the patient with hemodiafiltration (HDF) using a high-performance membrane (HPM) dialyzer by the post-dilution method with 10 liters of fluid, once a week by regular hemodialysis. Within 1 month of the start of HDF, his skin pigmentation decreased and the bullous changes and ulcers had improved as the erythrocyte porphyrin level decreased. These findings suggested that other factors, such as hemodialysis or C type hepatitis, may have aggravated his PCT besides the genetic factor. Furthermore, it PCT was successfully treated by HDF using a HPM dialyzer.

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