記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

症例は70歳男性で、腎硬化症による末期腎不全に対して6ヵ月前に腹膜透析(PD)を導入されていた。今回、腹痛を自覚し、PD関連腹膜炎と診断され入院となった。培養陰性腹膜炎として広域抗菌薬の腹腔内、経静脈的投与を行ったが奏効せず、第26病日にPDカテーテル抜去術を施行し血液透析に移行した。以降も発熱が続き、第46病日から腹痛と下痢が出現し、CRP 13.2mg/dLと上昇していた。第54病日に腹部単純CTで腹水が貯留しており、腹水中のアデノシンデアミナーゼ(ADA)が85.7IU/Lと高値であることから結核性腹膜炎を疑い、抗結核薬による治療を開始した。第60病日から症状の改善が得られ、第93病日に退院となった。結核性腹膜炎は培養やPCRによる確定診断が困難であることが多く、腹水中ADAが診断に有用と考えられた。

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：日本語   出版者・発行元：(一社)日本透析医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tolvaptan is the first effective drug treatment for autosomal dominant polycystic kidney disease (ADPKD) patients, but few long-term observations of the effects of tolvaptan have been reported. METHODS: In this single center, retrospective cohort study, we investigated nine patients who participated in a phase 3 trial of tolvaptan for ADPKD patients at our hospital between 2008 and 2014. Six of the patients discontinued tolvaptan at the end of the clinical trial and were defined as the discontinuation group, and three continued to take it; these were defined as the continuation group. The observation period was 3 years before and after the end of the tolvaptan trial, and we compared the following data in each group: serum creatinine, estimated glomerular filtration rate (eGFR), total kidney volume, serum sodium concentration, and urine specific gravity. RESULTS: eGFR was significantly improved after the end of the trial in the continuation group (P = 0.0446), but there was no significant change in the regression line before and after the end of the trial in the discontinuation group. The increases in mean total kidney volume rates over the 3 years before and after the trial were 0.01%/year vs. 0.067%/year in the discontinuation group (P = 0.0247). On the other hand, serum sodium concentration and urine specific gravity showed no change during the observation period. CONCLUSION: This study suggested that long-term administration of tolvaptan may improve renal function and inhibit total kidney volume growth.

DOI： 10.1272/jnms.JNMS.2022_89-303

PubMed

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記述言語：英語  

BACKGROUND: There are numerous causes of liver function disorder in patients undergoing peritoneal dialysis (PD). Infection with the Hepatitis E virus (HEV) is a rare cause of liver injury, and the behavior of HEV in patients with PD is unclear. Since patients undergoing dialysis are frequently polypharmatic, liver injury caused by HEV infection may be misdiagnosed as drug-induced liver injury. CASE PRESENTATION: A 61-year-old woman with PD developed abrupt elevation of blood transaminase levels on a routine outpatient session. Since the patient has been receiving tolvaptan as the only new medication, we suspected tolvaptan induced liver injury. In further investigating the cause of liver injury, the blood screening test was found to be positive for HEV-IgA. The patient was diagnosed with HEV infection, and had a self-limited course. CONCLUSION: When encountered with patients developing liver injury during PD, HEV infection should be included in the differential diagnosis.

DOI： 10.2147/IMCRJ.S385393

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
The Japanese population is aging quickly. New methods of supporting peritoneal dialysis (PD) for elderly patients are essential if we are to increase the number of such patients.


</sec><sec>
<title>Methods</title>
We established a two-way communication system between a central hospital and stations for visiting nurses. Home care nurses provided physicians at the central hospital with clinical findings for patients undergoing assisted PD. We compared 11 patients undergoing PD assisted by home care nurses in continuous interactive communication with the central hospital (cases) with 11 patients undergoing unassisted PD who were matched by sex, primary disease, estimated glomerular filtration rate at the start of PD, and age at the start of PD (controls). The variables compared were hospitalization due to heart failure, exit-site infection, peritonitis, and the composite of these causes during a 1-year period. In addition, we compared patient clinical factors between groups.


</sec><sec>
<title>Results</title>
Although differences in the number of hospitalizations attributable to exit-site infection, peritonitis, and heart failure were not significant, the difference in the number of hospitalizations attributable to a composite of these causes was significant. Exit-site scores were significantly better in the case group than in the control group.


</sec><sec>
<title>Conclusions</title>
PD assisted by home care nurses using an established continuous interactive communication system was associated with significantly better exit-site scores. Fewer cases than controls were hospitalized.


</sec>

DOI： 10.1186/s41100-021-00359-3

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その他リンク： https://link.springer.com/article/10.1186/s41100-021-00359-3/fulltext.html

記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Central Ltd.  

DOI： 10.1186/s41100-020-00272-1

Scopus

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   出版者・発行元：臨床体液研究会  

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