Yanagisawa N, Miyazaki M, Sato H
… +2 more, Taguma Y, Ito S
Nihon Jinzo Gakkai Shi
· 2014 · PMID 24730351
BACKGROUND: The prevalence of chronic kidney disease (CKD) and its complications, such as cardiovascular disease (CVD), cerebral vascular disease and end-stage kidney disease (ESKD), has been increasingly recognized as a...BACKGROUND: The prevalence of chronic kidney disease (CKD) and its complications, such as cardiovascular disease (CVD), cerebral vascular disease and end-stage kidney disease (ESKD), has been increasingly recognized as a global health problem in Japan. OBJECTIVE: We surveyed the awareness about CKD among medical professionals and the general public in Miyagi Prefecture. Additionally, we considered ways to lower the prevalence of CKD, CVD and ESKD. METHOD: We offered an annual educational lecture on CKD for the general population in Miyagi prefecture from 2010 to 2012. At each lecture, we distributed an anonymous survey to the participants about CKD and its complications. RESULTS: The number of survey respondents was 355, and their mean age was 63.9 years. Awareness about CKD among the participants, excluding medical professionals, was 58.0 %. Terms such as "serum creatinine" and "estimated GFR" were recognized in only about 60% and 40% of the respondents, respectively. Knowledge of risk factors for CKD, such as "elderly person" and "smoker," was at a low level. Furthermore, anemia and osteoporosis were not well-recognized as comorbidities of CKD. CONCLUSION: We found that the participants at the CKD educational lectures had limited knowledge about CKD and its complications; therefore, educational intervention regarding CKD, CVD and ESKD should be continued. Public awareness about CKD must be addressed to reduce CVD not only to prevent ESKD. The educational intervention will require a wide range of specialists in CKD care, general physicians, health nurses, and nutritionists, who contribute to community-based health care.
Yoshioka T, Yamakawa T, Yamaguchi M
… +1 more, Nomura R
Nihon Jinzo Gakkai Shi
· 2013 · PMID 24568038
The patient is a 41-year-old man diagnosed with uveitis in 2004. Although the patient was positive for HLA-B51, the primary disease could not be identified, and oral administration of prednisolone (PSL) was initiated. A...The patient is a 41-year-old man diagnosed with uveitis in 2004. Although the patient was positive for HLA-B51, the primary disease could not be identified, and oral administration of prednisolone (PSL) was initiated. A subsequent gradual decrease in the PSL dose was accompanied by the development of recurrent spasmodic chorioretinopathy and hypopyon. In November 2007, the patient was diagnosed with Behçet's disease based on the findings of erythema nodosum, acneiform eruption, and oral aphtha. In order to control the ocular symptoms, infliximab was administered. However, the patient's renal function began to deteriorate in November 2011, and he was transferred to our department after 6 months. At that time, his creatinine level was 8.56 mg/dL. Renal biopsy examination revealed granulomatous interstitial nephritis. Moreover, only infliximab yielded a positive result in a drug-induced lymphocyte stimulation test (DLST). Following initiation of PSL administration at 60 mg/day, his renal function improved. His creatinine level remained constant at approximately 3 mg/dL. In the present case, Behçet's disease, sarcoidosis, and infection were excluded as the underlying disease causing granulomatous interstitial nephritis. Moreover, infliximab is reportedly involved in the development of granulomas. Recent reports have stated that administration of TNF-alpha inhibitors occasionally results in the development of granulomas in the lungs and skin, and sometimes, in the kidneys as well. When renal dysfunction occurs in patients receiving TNF-alpha inhibitors, we believe that it is essential to include adverse events associated with TNF-alpha inhibitors in the differential diagnoses.
Naito T, Ohtani H, Kobayashi K
… +5 more, Miyazaki M, Yamada K, Sugawara M, Naka Y, Saruta T
Nihon Jinzo Gakkai Shi
· 2013 · PMID 24568037
OBJECTIVE: The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan. METHODS: We conducted a nationwide...OBJECTIVE: The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan. METHODS: We conducted a nationwide questionnaire survey on CKD management for PCPs from December 2012 to March 2013. The questionnaire included 32 items about CKD management and medical cooperation. PCPs' subspecialties were categorized as follows: general internal medicine, nephrology, cardiology, diabetology/endocrinology, gastroenterology, pulmonology, neurology, neurosurgery, hematology, collagen disease/rheumatology, allergology. The PCPs' training history of nephrology was classified into three categories: none, experienced, active-nephrologist. Response distributions for each question were compared between the PCPs' subspecialties and the three categories of training history. RESULTS: 2,287 out of 28,200 PCPs (8.1%) of all 47 prefectures responded. The majority (86.5%) of responders were PCPs at clinics, and 90.9% were non-nephrologists. The PCPs' subspecialty influenced the response distributions in the following questions: utilization of the CKD guidebook, urinalysis at the first and follow-up examinations, frequency of blood testing, counselling with eGFR, self-monitoring of blood pressure, prescription and cessation of renin-angiotensin system (RAS) inhibitors, anemia treatment with erythropoiesis stimulating agents (ESA). The PCPs' training history of nephrology had a strong impact on various aspects of CKD management. The PCPs' subspecialties also influenced the responses regarding medical cooperation of CKD: relationship with nephrologists, utilization of critical path, criterion of patient referral, requests for nephrologists, discontent with the nephrologists' response. CONCLUSION: We elucidated that the PCPs' subspecialty and training history of nephrology substantially influenced CKD management and medical cooperation in Japan. Effective promotion activities to improve CKD management and medical cooperation should be proposed on the basis of these data.
Naito T, Ohtani H, Kobayashi K
… +5 more, Miyazaki M, Yamada K, Sugawara M, Naka Y, Saruta T
Nihon Jinzo Gakkai Shi
· 2013 · PMID 24568036
OBJECTIVE: The goal of this study was to figure out the current status of and regional differences in CKD management and medical cooperation in Japan. METHODS: We conducted a nationwide questionnaire survey on CKD manage...OBJECTIVE: The goal of this study was to figure out the current status of and regional differences in CKD management and medical cooperation in Japan. METHODS: We conducted a nationwide questionnaire survey on CKD management for primary care physicians (PCPs) from December 2012 to March 2013. The questionnaire included 36 items about CKD management and medical cooperation. In order to compare the current status of CKD care and cooperation, we divided the country into 11 areas; Hokkaido, Tohoku, Kanto, Koshin-etsu, Hokuriku, Chubu-Tokai, Kinki, Chugoku, Shikoku, Kyushu and Okinawa. RESULTS: 28,200 sets of questionnaires were delivered to PCPs throughout Japan, and 2,287 (8.1%) doctors responded. Doctors at clinics accounted for 86.5%, and 90.9% were non-nephrologists. Regional differences were evident in the following items regarding CKD management; urinalysis at the first examination, measurement of urinary protein/albumin excretion, frequency of blood testing, counselling with eGFR, prescription of erythropoiesis stimulating agents (ESA). Urinalysis at the first examination was relatively rare in Koshin-etsu and Kanto (p < 0.01), and counseling with eGFR was relatively rare in Tohoku, Shikoku and Koshin-etsu (p = 0.05). Regional differences regarding medical cooperation were evident in the following items; functional level of cooperation, critical path, presence of consulting nephrologist, personal relationship, satisfaction with the nephrologists' reaction to referral, CKD involvement in Specific Medical Checkup/Specific Medical Guidance. Functional level of cooperation was higher in Chugoku, Okinawa, Chubu-Tokai and Hokuriku, and lower in Shikoku, Koshin-etsu and Kinki (p < 0.05). Serum creatinine measurement in the Specific Medical Checkup was involved more frequently in Okinawa, Shikoku, Kanto, Chubu-Tokai, Kyushu and Hokuriku, and less frequently in Tohoku, Chugoku and Kinki (p < 0.01). CONCLUSION: We elucidated the current status of CKD management by PCPs and medical cooperation in Japan. Effective actions to improve CKD care must be proposed on the basis of these data, especially the existing regional differences.
Ikeda M, Tsukamoto T, Miyake T
… +4 more, Kakita H, Komiya T, Yonemoto S, Muso E
Nihon Jinzo Gakkai Shi
· 2013 · PMID 24288972
An 80-year-old man with well controlled hypertension for eight years and monoclonal IgM gammopathy was referred to our hospital in May 2010 due to persistent elevation of serum creatinine(s-Cr). At our hospital, urine an...An 80-year-old man with well controlled hypertension for eight years and monoclonal IgM gammopathy was referred to our hospital in May 2010 due to persistent elevation of serum creatinine(s-Cr). At our hospital, urine and blood tests showed no abnormal findings as BUN and Cr were 15.0 mg/dL and 0.91 mg/dL, respectively. In contrast the referring hospital had obtained values of 10.4 mg/dL and 4.8 mg/dL, respectively. This discrepancy was replicated when s-Cr was measured in another sample from this patient using the enzyme assay kits employed by the referring hospital and our hospital. High-performance liquid chromatography (HPLC), which is the standard method for measuring s-Cr, gave a value in the normal range. After removing high molecular weight proteins (>3,000 D)from the serum sample, the s-Cr levels measured with the respective kits were similar. Since elevation of s-Cr was linked to that of IgM at the referring hospital, we diagnosed the patient as having pseudohypercreatininemia with monoclonal IgM gammopathy.
Sasaki E, Shibata M, Kato A
… +5 more, Hamano N, Katsuki T, Katsuma A, Tada M, Hinoshita F
Nihon Jinzo Gakkai Shi
· 2013 · PMID 24288971
A previously healthy 46-year-old black man visited the other hospital because of fever, appetite loss and nausea. Renal dysfunction, liver injury, and a highly markedly elevated LDH level were found. Abdominal CT demonst...A previously healthy 46-year-old black man visited the other hospital because of fever, appetite loss and nausea. Renal dysfunction, liver injury, and a highly markedly elevated LDH level were found. Abdominal CT demonstrated enlarged liver, spleen, kidney and lymph nodes. Human immunodeficiency virus (HIV) was serologically positive. His serum BUN, creatinine and potassium were 74.9 mg/dL, 11.78 mg/dL, and 5.6 mEq/L, respectively. After admission, anuria persisted and the progression of renal failure continued despite various treatment methods, necessitating the introduction of maintenance hemodialysis(HD). A kidney biopsy was performed to confirm classical HIV-associated nephropathy (HIVAN). Antiretroviral therapy (ART) was started. Although urine was transiently excreted, HD could not be discontinued. It has been reported that HIVAN is too difficult to treat and that kidney dysfunction seldom recovers. HIVAN is well-known to occur frequently in black HIV-infected patients. However, in Japan, there have been only a few reports describing patients with serious HIVAN and renal failure necessitating HD. We present here a very rare case with HIVAN, with reference to some recent findings.
Matsuura T, Hiramoto N, Iwasa T
… +2 more, Shoji M, Ohashi K
Nihon Jinzo Gakkai Shi
· 2013 · PMID 24288970
A 64-year-old man with treatment-related myelodysplastic syndrome (MDS) underwent non-myeloablative allogeneic peripheral blood stem cell transplantation from a fully HLA-matched sibling. Seven months after transplantati...A 64-year-old man with treatment-related myelodysplastic syndrome (MDS) underwent non-myeloablative allogeneic peripheral blood stem cell transplantation from a fully HLA-matched sibling. Seven months after transplantation, he suffered from nephrotic syndrome (proteinuria 16.67 g/day) around two weeks atter tapering tacrolimus (TAC) for the prophylaxis of graft-versus-host disease(GVHD). A renal biopsy revealed membranous nephropathy (Stage I ). Treatment with prednisolone (PSL), starting with 50 mg daily, resulted in incomplete remission type I. Although remission was maintained for 7 months, nephrotic syndrome recurred (proteinuria 7.81 g/day)after tapering PSL(5 mg/day) (18 months after transplantation). His PSL dose was increased again to 50 mg daily, and proteinuria improved again. Two weeks after discontinuation of TAC as it was suspected of worsening his renal function, proteinuria increased again to 6.37 g/day (21.5 months after transplantation). After administration of cyclosporin A (CsA) (30 mg/day) instead of TAC, proteinuria re-improved and complete remission of nephrotic syndrome was achieved. In this case, nephrotic syndrome worsened twice just after tapering or discontinuing immunosuppressive medication, and reinforcement of immunosuppression was effective in improving proteinuria. As hematopoietic cell transplantation (HCT) is an increasingly common treatment worldwide, the opportunities to see patients with nephrotic syndrome after HCT are also increasing. Our case serves as a reference to manage the recurrence of nephrotic syndrome after HCT.
AIM: Dietary advice by dietitians based on various factors of nutrient intake and dietary habit is important for preventing postoperative complications in adult kidney transplant recipients, but little is known about whe...AIM: Dietary advice by dietitians based on various factors of nutrient intake and dietary habit is important for preventing postoperative complications in adult kidney transplant recipients, but little is known about whether such advice is also important for pediatric, adolescent, and young adult kidney transplant recipients. The purpose of this study was to examine the nutrient intake profiles and dietary habits of these recipients and to ascertain the need for dietary advice by dietitians. SUBJECTS AND METHODS: This study involved 22 kidney transplant recipients with an estimated glomerular filtration rate> or =60 mL/min/1.73 m2 with no dietary restrictions. Nutrient intake was measured using a food frequency questionnaire based on food groups and evaluated using the reference values given in the Dietary Reference Intakes for Japanese (DRIs-J)for 2010 and the daily average intake of the National Health and Nutrition Survey Japan, 2010. RESULTS: The mean age of the patients at the time of enrollment was 17.6+/-4.4 years(8.7 28.5 years). Energy and carbohydrate intakes were below the DRIs-J reference value in 18 patients(81.8 %), and the ratio of total fat to total energy was above the DRIs-J reference value in 20 patients(90.9 %). Vitamin B, vitamin B6, magnesium, and zinc intakes were below the DRIs-J reference value in all patients (100 %). Food group intakes that were less than 75 % of the values reported in the National Health and Nutrition Survey Japan were pulses and algae in 18 patients(81.8 %), green and yellow vegetables in 14 patients(63.6 %), other vegetables in 19 patients(86.4 %), and nuts and seeds in 16 patients(72.7 %). CONCLUSION: This study suggests that dietary advice by dietitians is necessary for pediatric, adolescent, and young adult kidney transplant recipients to improve their nutrient intake and dietary habits.