Severity of Glomerulosclerosis Predicts Prognosis of IgA Nephropathy with Proteinuria

We determined the natural history of IgA nephropathy (IgAN) among patients who presented with proteinuria, and factors associated with the development of clinical events, namely blood pressure(BP)竕ｧ130/85 mmHg, serum creatinine 竕ｧ1.4mg/dl. We analyzed data from 16 patients(mean age 35 ﾂｱ 14 years) with IgAN accompanied by proteinuria between 1990 and 1998. We also semiquantified scores of glomerulosclerosis (GS), tubulointerstitial damage (TID), hyaline arteriosclerosis (HA), and IgAN classification. The median duration of follow-up was 48 months. During clinical follow-up, seven (44%) patients became hypertensive, among who five (31%) developed impaired renal function and two (13%) progressed to treatment with hemodialysis. Events did not develop in the other 9 patients (56%). Clinical findings were not significantly different between the events and event-free groups. The GS and TID scores revealed significant differences between patient groups. Only the renal histological parameters of GS and events were statistically correlated with renal survival. We conclude that the severity of GS may be the important prognostic factor inpatients with IgAN accompanied by proteinuria at the time of the initial biopsy

Renal Outcome of Immunoglobulin A Nephropathy With Mild Proteinuria

We determined the natural history of immunoglobulin A nephropathy (IgAN) among patients who presented with mild proteinuria (0.2 to 0.4 g/day), and factors associated with development of adverse clinical events, defined as proteinuria 竕ｧ 1.0g/day, blood pressure > 130/80mmHg, serum creatinine 竕ｧ 1.4mg/dl. We did analyzed data from 27 patients(mean age 30 ﾂｱ 12 years) with IgAN accompanied by mild proteinuria between 1990 and 1998. We also evaluated semiquantitave scores of glomerulosclerosis, tubulointerstitial injury, hyaline arteriosclerosis, and IgAN classification. The median duration of follow-up was 51 months. During followup, at least one adverse clinical event affected 15 patients (56%): among who eight (53%) developed proteinuria. And one of 8 developed impaired renal function and 7 (47%) became hypertensive. Another 12 patients (44%) were not affected by adverse clinical events. The clinical findings were not significantly different between the adverse events and no evens group. The scores of glomerulosclerosis and tubulointerstitial injury reveled significant differences between events. The only renal histological parameters of glomerulosclerosis and adverse clinical events were statistically correlated with renal survival. We concluded that IgAN with mild proteinuria frequently follows a slow by progressive course and that the severity of glomerulosclerosis may be predictable prognostic factor in patients who have IgAN with by mild proteinuria

Usefulness of Transdermal Glyceryl Trinitrate for Radial Arterial Spasm on Arteriovenous Hemodialysis Fistula Operation in Uremic Patients

Vasospasm sometimes disturbs successful blood access for hemodialysis, and prevention of vasospasm is desirable when constructing arteriovenous fistulae. We first investigated vasospasm of the radial artery in this operation and analyzed factors associated with this phenomenon in 20 patients with end-stage renal disease. Alteration of blood flow in the radial artery was evaluated in them, and intima-media thickness (IMT), endothelial function index (EFI) and laboratory data were analyzed. Vasospasm occurred in 9 of 20 cases (45.0%) at 5 min after anastomosis, and displayed a marginally significant correlation (r=0.31, p=0.081) with EFI. We then conducted a randomized study of 84 patients with end-stage renal disease to examine the effects of administering transdermal glyceryl trinitrate (GTN) in this operation. EFI was significantly correlated with IMT (r= -0.45, p<0.001). At 5 min after anastomosis, vasospasm occurred in 12 (28.6%) of 42 patients who were administered GTN, while it occurred in 20 (47.6%) of 42 patients without GTN administration (controls); the difference was marginally significant (p=0.072). In patients with IMT?1.1, alteration of diameter (5 min/1 min after anastomosis) was significantly reduced compared with controls (p=0.032). These data suggest that IMT could offer a predictor of vasospasm occurrence during arteriovenous fistula operations. Use of preoperative transdermal GTN may be effective in preventing vasospasm during such surgery

Expression of heat shock proteins 47 and 70 in the peritoneum of patients on continuous ambulatory peritoneal dialysis

Expression of heat shock proteins 47 and 70 in the peritoneum of patients on continuous ambulatory peritoneal dialysis.BackgroundPeritoneal sclerosis, characterized by collagen accumulation, is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) therapy. Heat shock protein 47 (HSP47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis.MethodsWe determined the expression of HSP47 and HSP70 (nonspecific for collagen synthesis) by immunohistochemistry in peritoneal tissues of patients on CAPD. The tissue for collagen III, α-smooth muscle actin (α-SMA), and CD68 (a marker for macrophages) were also stained. Thirty-two peritoneal samples were divided into three groups (group A1, 11 patients who had no ultrafiltration loss; group A2, 9 patients who had ultrafiltration loss; and group B, 12 specimens who had end-stage renal disease prior to induction of CAPD.ResultsIn group B, staining for HSP47, HSP70, and collagen III in peritoneal tissues was faint, and only a few cells were positive for α-SMA and CD68. In contrast, HSP47, HSP70, and collagen III were expressed in areas of thickened connective tissues in fibrotic peritoneal specimens of CAPD patients. The expression level of HSP47, HSP70, collagen III, and α-SMA and the number of CD68-positive cells in group A2 were significantly higher than those in groups A1 and B. HSP47/HSP70-positive cells were mesothelial cells, adipocytes, and α-SMA–positive myofibroblasts. Furthermore, the expression level of HSP47 was significantly higher in peritoneal specimens from patients with refractory peritonitis than without it and was significantly higher in patients with more than 60 months of CAPD therapy than that in patients with less than 60 months of CAPD.ConclusionOur results indicate that CAPD therapy may induce HSPs in the peritoneal tissue, and that peritonitis in CAPD patients may be associated with the progression of peritoneal sclerosis at least through HSP47 expression and chronic macrophage infiltration. Our data also suggest that the progression of peritoneal sclerosis in such patients is associated with deterioration of peritoneal ultrafiltration function