Thalidomide Prevents the Progression of Peritoneal Fibrosis in Mice

Thalidomide is clinically recognized as a therapeutic agent for multiple myeloma and has been known to exert anti-angiogenic actions. Recent studies have suggested the involvement of angiogenesis in the progression of peritoneal fibrosis. The present study investigated the effects of thalidomide on the development of peritoneal fibrosis induced by injection of chlorhexidine gluconate (CG) into the mouse peritoneal cavity every other day for 3 weeks. Thalidomide was given orally every day. Peritoneal tissues were dissected out 21 days after CG injection. Expression of CD31 (as a marker of endothelial cells), proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF), α-smooth muscle actin (as a marker of myofibroblasts), type III collagen and transforming growth factor (TGF)-β was examined using immunohistochemistry. CG group showed thickening of the submesothelial zone and increased numbers of vessels and myofibroblasts. Large numbers of VEGF-, PCNA-, and TGF-β-positive cells were observed in the submesothelial area. Thalidomide treatment significantly ameliorated submesothelial thickening and angiogenesis, and decreased numbers of PCNA- and VEGF-expressing cells, myofibroblasts, and TGF-β-positive cells. Moreover, thalidomide attenuated peritoneal permeability for creatinine, compared to the CG group. Our results indicate the potential utility of thalidomide for preventing peritoneal fibrosis

Effect of switching from sevelamer hydrochloride to lanthanum carbonate on metabolic acidosis in dialysis patients

Treatments for hyperphosphatemia in dialysis patients include dietary therapy and oral administration of phosphate binders; however, it has recently been suggested that oral administration of sevelamer hydrochloride, a phosphate binder, may cause metabolic acidosis. Owing to the decreased supply of sevelamer hydrochloride after the Eastern Japan Great Earthquake Disaster on March 11, 2011, hyperphosphatemia patients switched to another phosphate binder, lanthanum carbonate. Here, we retrospectively evaluated the effect of this medication substitution on metabolic acidosis in patients on maintenance hemodialysis. 32 patients, who underwent maintenance hemodialysis at Nagasaki Kidney Center in Japan, were enrolled in our study and followed to evaluate the effect of switching medication on metabolic acidosis at 3 months after switching from sevelamer hydrochloride to lanthanum carbonate. The mean dose of sevelamer hydrochloride prior to the earthquake disaster was 3 g/day, and the mean dose of lanthanum carbonate thereafter was 0.9 g/day. Three months after the medication was changed, the concentration of bicarbonate ion did not increase significantly (p = 0.186), whereas pH and base excess increased significantly (p = 0.007 and p = 0.036, respectively). In this study, although the HCO3 - level was not significantly changed, the pH and base excess were significantly increased. Our findings indicate that lanthanum carbonate ameliorates metabolic acidosis

Tubulointerstitial Nephritis Complicated by Fanconi Syndrome and Renal Tubular Acidosis Associated with three autoimmune diseases

A 45-year-old woman experiencing back pain showed signs of metabolic acidosis and electrolyte imbalances. The results of blood and urine tests indicated Fanconi syndrome and renal tubular acidosis. An x-ray showed vertebral fractures, which were thought to responsible for the back pain. In addition, the patient had proteinuria and renal dysfunction; therefore, renal biopsy was performed, and tubulointerstitial nephritis (TIN) was diagnosed. While investigating TIN, primary biliary cirrhosis and Sjögren’s syndrome were also detected. She had been previously diagnosed with chronic thyroiditis. We report a rare case of TIN and 3 autoimmune disorders with review of literature

A case of a chronic expanding hematoma in a hemodialysis patient

A 70-year-old woman undergoing chronic maintenance hemodialysis had felt a mass in her left hip 4 years prior. As the mass gradually expanded, magnetic resonance imaging (MRI) was performed. The MRI findings showed mosaic patterns with various signal intensities inside the mass and a low-signal band at its periphery. Because of the slow expansion of the mass over a course of at least 4 years and its characteristic MRI findings, the patient was diagnosed with a chronic expanding hematoma (CEH), a comparatively rare type of hematoma. To our knowledge, this is the first report of a CEH occurring in a hemodialysis patient in the English literature

血液透析患者の栄養状態ならびに栄養摂取状況が生活の質(QOL)に及ぼす影響

血液透析患者において透析治療を長期に継続していく上で種々の透析合併症の予防のため適切な食事療法の実践が重要である｡厳格な食事療法は生活の質(QOL)や栄養状態の低下に繋がる可能性もある｡本研究では､外来血液透析患者70名を対象に栄養摂取状況と栄養状態及び QOL について評価､解析を行った｡その結果､約30%の患者が栄養状態にﾘｽｸありと判定された｡栄養状態と食事摂取量には相関は認められなかったが､栄養状態が低下した群では､豆類の摂取量が少なかった｡透析患者の栄養状態と QOL を詳細に解析すると女性は栄養状態が低下しても包括的尺度(SF-36)､腎疾患特異的尺度ともに比較的維持されていたが､男性は栄養状態の悪化により有意な低下が認められた｡SF-36 では身体的健康度だけでなく､精神的健康度も悪化していた｡男性患者にはより早期からの栄養面での管理と指導が重要であり､またきめ細やかなｹｱや周囲の人々からの精神的な支えや理解が大切である｡For patients undergoing long-term hemodialysis treatment, appropriate nutrition therapy is important to prevent complications. However, strict dietary regimens sometimes reduce the Quality of Life(QOL)and nutritional status. In this study, we examined and analyzed the nutrient intake, nutritional status, and QOL of 70 outpatients undergoing hemodialysis. As the results, approximately 30% of the subjects were judged to have nutritional problems. Although no association was observed between the nutritional status and amount of food intake, the consumption of bean products was lower in subjects with a reduced nutritional status. Analysis of the nutritional status and QOL of the dialysis patients showed that female subjects had favorable scores on the Short-Form 36(SF-36)Health Survey and Kidney Disease Quality of Life(KDQOL)despite a reduction in the nutritional status; however, a significant score reduction was observed in male subjects in association with the deterioration of their nutritional status. The results of SF-36 showed not only physical, but also mental health deteriorations. For male patients, early dietary interventions and guidance, as well as thoughtful care, emotional support, and understanding from people around them are essential

A case of minimal change nephrotic syndrome with immunoglobulin A nephropathy transitioned to focal segmental glomerulosclerosis

A 50-year-old woman with a 1-month history of lower extremity edema and a 5 kg weight increase was admitted to our hospital with suspected nephrotic syndrome in October 1999. Urine protein level was 3.5 g per day, 10-15 erythrocytes in urine per high-power field, and serum albumin level 2.5 g/dl. Furthermore, an accumulation of pleural effusion was confirmed by chest X-ray. The results of a renal biopsy indicated slight mesangial proliferation in the glomeruli by light microscopy, and an immunofluorescence study confirmed the deposition of immunoglobulin (Ig) A and C3 in the mesangial area. Diffuse attenuation of foot processes and dense deposits in the mesangial area were observed by electron microscopy. Treatment with 40 mg/day of prednisolone was effective, and proteinuria was negative 1 month later. Because of this course, we diagnosed minimal change nephrotic syndrome complicated by mild-proliferative IgA nephropathy. In November 2000, there was a relapse of nephrotic syndrome, which was believed to be induced by an influenza vaccination, but response to increased steroid treatment was favorable, and proteinuria disappeared on day 13 of steroid increase. A second relapse in May 2001, showed steroid resistance with renal insufficiency, and an increase in the selectivity index to 0.195. Light microscopy revealed focal sclerotic lesions of the glomeruli, and an immunofluorescence study revealed attenuation of mesangial IgA and C3 deposition. These findings led to the diagnosis that minimal change nephrotic syndrome had transitioned to focal segmental glomerulosclerosis, whereby mesangial IgA deposition was reduced by immunosuppressive treatment. Subsequently, her renal function gradually worsened to the point of end-stage renal failure by 27 months after the second relapse of nephrotic syndrome

Causative bacteria and risk factors for peritoneal dialysis-related peritonitis: A retrospective study

Background: Although peritoneal dialysis (PD) is beneficial for patients with end-stage renal diseases (ESRD), there are some critical complications. PD-related peritonitis accounts for about 30% of all cases of catheter removal and transition to hemodialysis. We investigated the incidence, causative bacteria, and risk factors of PD-related peritonitis and peritonitis-related withdrawal in patients treated in the Nagasaki University Hospital. Methods: Subjects were 43 PD patients in the Nagasaki University Hospital observed between January 1, 2008 and December 31, 2012. We established the incidence of PD-related peritonitis, investigated causative bacteria and culture-negative peritonitis rates, and examined potential risk factors, including laboratory data obtained at the commencement of PD. Results: 20 episodes of peritonitis occurred in 12 patients during the observation period, and the incidence of PD-related peritonitis was one episode per 62 patient-months. The culture-negative peritonitis rate was 10%. In the isolated causative bacteria, 55% were Gram-positive cocci and 25% were Gram-negative rods. Two episodes were associated with methicillin-resistant Staphylococcus aureus (MRSA), and each episode was accompanied with an exit-site infection. PD catheter removal caused by PD-related peritonitis occurred in 4 patients. As a result of investigation for association between PD-related peritonitis and patient’s factors including laboratory data, sex, age, and cause of ESRD, the patients who experienced PD-related peritonitis had significantly lower hemoglobin levels at the initiation of PD.Conclusions: PD-related peritonitis remains an important complication of PD. We found that low hemoglobin level at the commencementof PD was a risk factor of PD-related peritonitis. In addition, MRSA peritonitis was a risk factor of peritonitis-relatedwithdrawal. Thus, improvement in anemia might be important to prevent PD-related peritonitis. It is also important to preventMRSA-associated peritonitis to avoid technical failure of PD