担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Combination therapy, consisting of immune checkpoint inhibitors and traditional chemotherapeutic agents, has significantly improved the clinical outcomes of non-small cell lung cancer. Therefore, it will be a promising first-line therapy, whereas, there is a prospect that associated kidney injury may increase during treatment. We presented four patients, diagnosed with advanced non-small cell lung cancer, who received combination therapy, consisting of pembrolizumab, cisplatin, and pemetrexed as first-line treatment. All of them had been referred to nephrologists and had undergone renal biopsy. We observed that three of four patients presented a very rapid time course for acute kidney injury development. Notably, the three patients received only one or two cycles of the combined chemotherapy. In a renal biopsy, one patient showed severe acute tubular injury rather than interstitial nephritis. Another patient presented focal segmental glomerular sclerosis concomitant with tubulointerstitial nephritis. However, it was challenging to distinguish which agent was primarily responsible for kidney injury. Regarding the treatment, all the patients discontinued pembrolizumab and received corticosteroid treatment. We adjusted the dose and duration of corticosteroid according to the pathological results and patient conditions. The current cases provide a further understanding of clinical features and appropriate management in patients treated with combination therapy including pembrolizumab.

DOI： 10.1007/s13730-021-00636-4

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Despite the abundant experience of tonsillectomy with steroid pulse therapy (TSP) for patients with immunoglobulin A (IgA) nephropathy, the therapeutic efficacy of TSP on renal prognosis remains controversial. The purpose of this study was to evaluate the efficacy of whether TSP effectively prevents chronic kidney disease (CKD) progression. Methods This was a single-center, retrospective observational study. A total of 149 patients were enrolled in the current study who were confirmed with IgA nephropathy by renal biopsy between February 2011 and August 2019. The impact of TSP on CKD progression was compared with conservative treatment during a follow-up period of 3 years. Results In total, 110 patients received TSP and 39 patients received conservative treatment. There were no differences between the two groups in the initial CKD stages: 65.1% of patients had CKD G1-2, 32.2% had CKD G3, and 2.7% had CKD G4-5. The initial urine protein was 0.7 g/gCr, which was not different between the two groups. Kaplan-Meier analysis showed that patients with TSP had a significantly better renal prognosis than those in the conservative treatment group after one and a half years (p = 0.007). Multivariable analysis revealed that TSP had a significant impact on the prevention of CKD progression, with an adjusted odds ratio of 0.07 (95% confidence interval, 0.01-0.87; p=0.039). However, we could not confirm the predictive value of the Oxford Classification on TSP efficacy. Additionally, the initial urinary protein level was a risk factor for CKD progression. Conclusions TSP was associated with a lower risk of CKD progression. In this regard, our study supports that TSP may be a reasonable treatment option for patients with IgA nephropathy. In the featured study, it needs to be elucidated which histopathological classifications benefit from TSP treatment.

DOI： 10.7759/cureus.15736

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Peritonitis is one of the most common complications in patients who are undergoing peritoneal dialysis (PD). However, it is difficult to predict or prevent the onset of endogenous peritonitis. In this study, we investigated the risk of developing endogenous peritonitis in patients receiving PD. METHODS: We included all of the patients who underwent PD at our hospital from April 2015 to March 2020. There were 22 cases of peritonitis, including 18 cases of endogenous peritonitis without evidence of exit-site infection or technical failure. We considered older age, female sex, obesity, diabetes mellitus, diverticulosis, and constipation as important risk factors for endogenous peritonitis. We included these as confounding factors with a current or previous history of smoking in univariate logistic regression models. RESULTS: In this study, previous or current history of smoking (p = 0.0065) was the most significant risk factor for endogenous peritonitis in univariate logistic regression model. In addition, smoking was also the most significant independent risk factor for endogenous peritonitis (p = 0.0034) in our multivariate logistic regression models. It was not primary objective that diabetes mellitus was also significant in univariate and multivariate logistic regression analysis. CONCLUSIONS: Smoking is the significant independent risk factor for endogenous peritonitis in patients undergoing PD. The discontinuation of smoking may lower the risk of endogenous peritonitis in this patient group.

DOI： 10.1272/jnms.JNMS.2021_88-604

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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>
Renal anemia is the important complication in patients undergoing peritoneal dialysis (PD), and heart failure (HF) is the important complication in patients on dialysis. Decreasing endogenous erythropoietin (EPO) in patients with chronic kidney disease is a major cause of renal anemia. On the other hand, high levels of EPO have been associated with the prognosis of patients with chronic HF. The association between plasma EPO and HF in patients on PD remains unclear. This study was designed to test our hypothesis that the plasma EPO level in patients on PD was associated with the markers of HF.


</sec><sec>
<title>Methods</title>
We investigated 39 patients undergoing PD at our hospital. We measured plasma EPO before erythropoiesis-stimulating agent (ESA) administration at the regular outpatient visits and then at 2 weeks after the final dose of ESA was administered and investigated the clinical factors. We estimated the correlations between the plasma EPO and the other parameters, and constructed univariate and multivariate logistic regression models for the risk for HF to estimate the effectiveness of plasma EPO and other factors on HF treatment in patients undergoing PD.


</sec><sec>
<title>Results</title>
The plasma EPO concentration was positively correlated with the ESA dose and negatively correlated with serum ferrum, transferrin saturation, and body mass index and showed no correlation with other factors, such as the New York Heart Association (NYHA) classification and ferritin level. In univariate analysis, the factors significantly associated with HF risk were N-terminal pro-brain natriuretic peptide (NT-pro BNP), cardiothoracic ratio (CTR), serum creatinine (Cr), serum beta 2 microglobulin, dialysate dose, left ventricular mass index, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and weekly Kt/V. We performed a multivariate analysis with NT-pro BNP, Cr, and CTR, and all three factors were significant in the analysis.


</sec><sec>
<title>Conclusion</title>
The plasma EPO level in patients undergoing PD was positively correlated with the monthly ESA dose and was not significant as a marker of HF, as judged with the NYHA classification. Therefore, the plasma EPO level may not be a useful marker for HF in patients undergoing PD.


</sec>

DOI： 10.1186/s41100-021-00319-x

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その他リンク： http://link.springer.com/article/10.1186/s41100-021-00319-x/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: Peritoneal dialysis (PD)-related peritonitis and lower limb ulcer are the important complications in patients undergoing PD. Although the association between lower limb ulcer and peritonitis in patients undergoing PD is unclear, based on our clinical experience and the clinical importance of the complications in patients undergoing PD, we hypothesized that lower limb ulcer is associated with peritonitis in patients on PD. Patients and Methods: In this single center, retrospective cohort study, we studied 87 patients who started undergoing PD at our hospital from April 2015 to March 2020. We compared these 8 patients with lower limb ulcer with the other 79 patients without lower limb ulcer. We compared between the patients in the objection period of this study about peritonitis using Log rank test, and used the unpaired t-test and Fisher's exact test to compare the clinical factors between the two groups. Moreover, we used univariate and multivariate logistic regression analyses to study the association of PD-related peritonitis with the clinical factors. Results: The period developed first peritonitis of the patients on PD with lower limb ulcer was significant shorter than those without lower limb ulcer in Log rank test (P = 0.011). The Fisher's exact test and unpaired t-test showed that the difference in the prevalence of PD-related peritonitis (P = 0.009), peritonitis/patient years (P = 0.036), the BMI (P = 0.007) and icodextrin (P = 0.001) were significant. Lower limb ulcer had significant associations with peritonitis in patients on PD in both univariate [odds ratio (OR) 8.461, 95% confidence interval (CI) 1.854-45.60, P = 0.006] and multivariate [OR 7.169, 95% CI 1.519-39.480, P = 0.013] logistic regression analysis. Conclusion: In conclusion, lower limb ulcer may be associated with peritonitis in patients undergoing PD. Further large-scale, prospective studies are required to confirm these results.

DOI： 10.2147/IJNRD.S295948

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Keio Journal of Medicine  

DOI： 10.2302/kjm.2020-0008-cr

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In patients undergoing peritoneal dialysis (PD), peritonitis is one of the most common complications, and causes PD catheter removal, permanent transfer to hemodialysis, and potentially death. Therefore, the prediction and prevention of PD-related peritonitis are extremely important. In 2016, the International Society for Peritoneal Dialysis published guidelines for peritonitis in patients undergoing PD; these guidelines cover most cases of PD-related peritonitis caused by various bacteria. Furthermore, the guidelines clearly propose the indications for catheter removal. However, difficulties often arise when deciding on the best time for catheter removal. Peritonitis with the identification of multiple enteric organisms from a culture of dialysis effluent may be caused by intra-abdominal pathology, and if a patient with peritonitis has such pathology, the mortality rate is high, and the catheter removal is considered in that case. In this report, we describe a case in which, during antibiotic therapy for PD-related peritonitis due to Enterococcus faecalis alone, the patient suffered another occurrence of peritonitis due to newly revealed Gram-negative rod-like Pseudomonas aeruginosa. He required catheter removal due to the peritonitis being suspected of relapsing. Although so further investigations are required, it is possible that early catheter removal is effective in cases in which another organism is newly detected during antibiotic therapy for PD-related peritonitis caused by a different responsible organism not meeting the definition of refractory peritonitis.

DOI： 10.1272/jnms.JNMS.2020_87-511

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Informa UK Limited  

添付ファイル： Bacillus subtilis-associated abdominal catastrophe in a Japanese patient with peritoneal dialysis-related peritonitis.pdf

DOI： 10.1080/2331205x.2020.1747343

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1272/jnms.JNMS.2020_87-108

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s13730-019-00420-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s13730-019-00412-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12882-019-1375-1

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/s41598-018-34893-8

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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：W.B. Saunders  

The Renal Pathology Society proposed a pathological classification for diabetic nephropathy (DN) (RPS 2010). We retrospectively examined the renal structural-functional relationships using the RPS 2010 classification in 49 DN cases. We also evaluated the importance of the percentage of glomeruli with nodular diabetic glomerulosclerosis and their morphological characteristics (cellular, cellular and extracellular matrix [ECM] or ECM types) in the pathology of DN. The classes of DN (RPS 2010) were significantly correlated with the duration of diabetes mellitus (DM), degree of proteinuria, a decreased estimated glomerular filtration rate (eGFR), and the stages of Japanese clinical DM and chronic kidney disease (CKD). When the percentage of glomeruli with nodular glomerulosclerosis (IIIA &lt
25%, IIIB 25–50%, IIIC 50–75%, and IIID &gt
75%) was added to class III in this classification, the classes of DN had a greater correlation with the levels of proteinuria. The morphological characteristics of nodular glomerulosclerosis such as cellular, cellular and ECM, or ECM type were associated with several clinical parameters including the duration of DM, degree of proteinuria, a decreased eGFR, and/or the stages of clinical DM and CKD. Mesangial red blood cell fragments that is indicative of microvascular injury was found in cellular or cellular and ECM types of nodular glomerulosclerosis. The RPS 2010 classification is useful as a DN pathological classification that indicates a good correlation with the clinical characteristics of DN. In addition, the frequency and morphological characteristics of nodular diabetic glomerulosclerosis is important for the evaluation of the pathology in DN.

DOI： 10.1016/j.humpath.2018.01.019

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担当区分：責任著者   記述言語：英語   出版者・発行元：WILEY  

DOI： 10.1111/nep.12944

Web of Science

PubMed

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担当区分：責任著者   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  

Background: Even with abundant evidence for osmotic demyelination in patients with hyponatremia, the risk factors for overcorrection have not been fully investigated. Therefore the purpose of this study is to clarify the risks for overcorrection during the treatment of chronic profound hyponatremia.
Methods: This is a single-center retrospective observational study. We enrolled 56 adult patients with a serum sodium (SNa) concentration of &lt;= 125 mEq/L who were treated in an intensive care unit by nephrologists using a locally developed, fixed treatment algorithm between February 2012 and April 2014. The impact of patient parameters on the incidence of overcorrection was estimated using univariable and multivariable logistic regression models. Overcorrection was defined as an increase of SNa by &gt; 10 mEq/L and &gt; 18 mEq/L during the first 24 and 48 h, respectively.
Results: The median age was 78 years, 48.2% were male, and 94.6% of the patients presented with symptoms associated with hyponatremia. The initial median SNa was 115 mEq/L (quartile, 111-119 mEq/L). A total of 11 (19.6%) patients met the criteria for overcorrection with 9 (16.0%) occurring at 24 h, 6 (10.7%) at 48 h, and 4 (7.1%) at both 24 and 48 h. However, none of these patients developed osmotic demyelination. Primary polydipsia, initial SNa, and early urine output were the significant risk factors for overcorrection on univariable analysis. Multivariable analysis revealed that the initial SNa had a statistically significant impact on the incidence of overcorrection with an adjusted odds ratio of 0.84 (95% confidence interval, 0.70-0.98; p = 0.037) for every 1 mEq/L increase. Additionaly, the increase in SNa during the first 4 h and early urine output were significantly higher in patients with overcorrection than in those without (p = 0.001 and 0.005, respectively).
Conclusions: An initial low level of SNa was associated with an increased risk of overcorrection in patients with profound hyponatremia. In this regard, the rapid increase in SNa during the first 4 h may play an important role.

DOI： 10.1186/s12882-017-0732-1

Web of Science

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Microscopic polyangiitis (MPA) is a primary systemic vasculitis that predominantly affects small and medium vessels. MPA is rarely complicated with central nervous system or cardiovascular disease. We report a very rare case of MPA complicated with cerebral infarction, cardiovascular disease, and fatal subarachnoid hemorrhage in a 54-year-old man. During the first six days of hospitalization the patient was diagnosed with rapid progressive glomerulonephritis (RPGN), cerebral infarction, and unstable angina. According to patient's symptoms and laboratory findings, were consisted with a diagnosis of severe MPA. Steroid pulse therapy was immediately introduced. However, the patient developed massive subarachnoid hemorrhage on the 8th day of hospitalization. The condition progressively deteriorated, and the patient died on the 33rd hospital day.

DOI： 10.1272/jnms.84.251

Web of Science

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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：Elsevier Inc  

DOI： 10.1016/j.ekir.2016.05.004

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総ページ数：426   担当ページ：25-41   記述言語：日本語  

CiNii Books

ASIN

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担当ページ：462-465  

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総ページ数：xviii, 213p   担当ページ：121-123   記述言語：日本語  

CiNii Books

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総ページ数：343p   担当ページ：10-41   記述言語：日本語  

CiNii Books

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担当ページ：544-549  

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担当ページ：543-552  

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担当ページ：562-567  

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記述言語：日本語  

CiNii Books

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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   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：日本基礎老化学会  

DNAのメチル化はエピゲノムの最も重要な分子基盤である。加齢とともに、DNAメチル化は様々な変化を遂げる。これまで統計学的手法や計算式を駆使して、DNAメチル化の変化が定量化され、その動態がとらえられてきた。加齢に伴うDNAメチル化の変化は、個体老化の一次的な原因であると同時に、体内の加齢性変化を反映し、心血管病変、がん、アルツハイマー病など様々な加齢性疾患とも関連している。変化をもたらす機序も、幹細胞分裂との関連、概日リズムの崩壊、代謝障害、DNA損傷によるものなど、新たな知見から解明されてきている。そのような分子基盤に基づいたDNAメチル化を標的とした若返り法(リジュベネーション)が考案され、動物モデルだけでなくヒトでの応用も進みつつある。我々は、健康長寿を全うするための新たな標的として、加齢に伴うDNAメチル化の変化に注目し、実臨床への応用に向け、その分子学的メカニズムを根底から理解していきたい。(著者抄録)

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記述言語：日本語   出版者・発行元：(公財)金原一郎記念医学医療振興財団  

＜文献概要＞人はなぜ老いるのか?この誰もが必ず経験する生命現象は,時の権力者らにより強い興味の対象となった最も古い科学的命題の一つである。しかしながら,現代科学をもってしてもこの疑問に対して多くは回答できない。近年の研究から,加齢に伴う臓器・組織の微小慢性炎症が個体の老化の原因の一つであることがわかってきた。更に老化細胞が分泌する炎症性サイトカインが微小慢性炎症に大きく関わっていることも提唱されている。本稿では,老化細胞を標的としてこれを除去することで,慢性炎症を抑制して老化を改善・予防する可能性について概説する。

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04290&link_issn=&doc_id=20210831330001&doc_link_id=%2Fai1aamdd%2F2021%2F001704%2F003%2F0318-0323%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai1aamdd%2F2021%2F001704%2F003%2F0318-0323%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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：(公社)日本皮膚科学会  

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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：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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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)日本腎臓学会  

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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：(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：(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：(株)東京医学社  

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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：(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：(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：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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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：(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：(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：(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：(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：(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：(一社)日本腎臓学会  

J-GLOBAL

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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：(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：(一社)日本病理学会  

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

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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：(一社)日本腎臓学会  

J-GLOBAL

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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  

J-GLOBAL

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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：(株)東京医学社  

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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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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：(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：(一社)日本病理学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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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：(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：日本内科学会-関東地方会  

J-GLOBAL

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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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J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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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：羊土社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015210668

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：(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：(株)東京医学社  

バイオインピーダンス法を用いて腹膜透析患者の体液量評価を行い、これまでの臨床評価の妥当性、体液濾過量との関連性を検討した。腹膜透析患者21例を対象とした。尿量は平均1260±780mL/日で、18例が利尿薬を投与され、半数はループ利尿薬とサイアザイド利尿薬を併用していた。腹膜平衡試験は12例がHAであった。胸部単純X線写真は、ほとんどの患者が心拡大ではなく、心胸比の平均は47.5±6.1であった。血液検査では、ALB 3.3±0.8/dL、BUN 61.4±17.3mg/dL、Cr 7.9±2.8mg/dL、GFR 5.4±3.8mL/min、HGB 10±0.8g/dL、CRP 0.35±0.4mg/dLであった。バイオインピーダンス法による体液過剰量は平均1.95±2.8Lで、10例が体液過剰状態であった。体液濾過量と臨床評価の関連は、血圧と尿量は正の相関、腎機能は負の相関を認めた。

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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：(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：(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：(一社)日本感染症学会  

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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：(一社)日本内科学会  

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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：日本語   出版者・発行元：(一社)日本腎臓学会  

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