The patient developed microscopic polyangiitis (MPA) and received treatment with cyclophosphamide and rituximab for induction of remission. However, renal function declined, leading to the initiation of hemodialysis 1 year and 3 months later. Maintenance therapy with prednisolone was administered, but myocarditis subsequently developed, prompting the addition of mizoribine to the treatment regimen. Approximately one year and eighteen months later, lung lesions were observed, and during induction remission therapy, aortitis and acute arterial dissection occurred. Remission was eventually achieved with the administration of abacopan. The patient had refractory MPA, with recurrent episodes even after starting dialysis; however, abacopan was effective in treating the condition.

Automated peritoneal dialysis (APD) is a dialysis method that is generally performed indoors. We report a case in which we were able to perform APD onboard a ship. The patient was a 55-year-old man who manages a shipping company. He required peritoneal dialysis due to end-stage renal failure resulting from diabetic kidney disease. The patient requested to continue working onboard as a manager during treatment. Because APD is performed indoors in principle and vibration caused by movement of the ship were expected, he initially opted for continuous ambulatory peritoneal dialysis (CAPD) while onboard. However, due to the demanding nature of his duties, he encountered difficulties in adhering to the fixed schedule for bag changes, leading to a reduction in the number of treatments and resulting in overhydration. Given the challenges of maintaining CAPD onboard a ship, the patient was switched to APD. Following the transition to APD, the patient was able to undergo stable dialysis. Our findings suggest the feasibility and safety of performing APD in onboard settings.

A 37-year-old Japanese woman presented with systemic edema at 19 weeks of gestation. She was diagnosed with nephrotic syndrome and treated with 500 mg/day of methylprednisolone at 21 weeks and 4 days of gestation. However, she developed oliguria and her estimated glomerular filtration rate (eGFR) deteriorated to 16.3 mL/min/1.73m². She was transferred to our hospital, and hemodialysis and plasma exchange were initiated at 22 weeks and 1 days of gestation. Thereafter, her urine volume increased, and hemodialysis and plasma exchange were stopped at 22 weeks and 4 days of gestation. At 23 weeks 3 days of gestation, urine protein and eGFR decreased to 0.13g/gCr and 85.8 mL/min/1.73m², respectively. She delivered a healthy baby at 38 weeks of gestation. Plasma exchange may be a therapeutic option for pregnant women with severe nephrotic syndrome.