A Case of Nephrotic Syndrome with Nephrotoxicity Induced by Low-Dose Cyclosporin Treatment

We report a 3-year-old girl with steroid resistant nephrotic syndrome (NS) who developed nephrotoxicity by low-dose cyclosporin (CsA) treatment. Initial prednisolone (PSL) treatment and subsequent additional cyclophosphamide treatment were not successful in leading her into remission. The first renal biopsy finding revealed neither a glomerular nor interstitial change. CsA therapy was initiated in addition to ongoing glucocorticoid therapy at 6 months from the time of onset. Proteinuria disappeared 3 weeks later and the patient went into complete remission. After experiencing the first relapse, the patient was gradually weaned from CsA, and treatment continued with 30 to 50 ng/mL of trough concentration. No elevations of the serum creatinine, serum urea, serum potassium, excretion of urinary β2-microglobulin, or urinary N-acetyl-β-D-glucosaminidase were demonstrated in the follow-up. A second renal biopsy specimen obtained 1 year later showed a tubulo-interstitial change, containing tubular atrophy and interstitial fibrosis, both of which are consistent with the morphological change associated with CsA nephrotoxicity. A follow-up biopsy should be done in order to evaluate the CsA nephrotoxicity, regardless of the treatment dosage

Supplemental Materials: Associations of homocysteine metabolism with the risk of spinal osteoarthritis progression in postmenopausal women

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Molecular evidence of the multiple genotype infection of a wild Hokkaido brown bear (Ursus arctos yesoensis) by Babesia sp. UR1

A frozen-stored blood clot of a wild brown bear cub Ursus arctos yesoensis that had been captured in Hokkaido, Japan was examined for piroplasma infection using polymerase chain reaction (PCR). Two 18S ribosomal RNA gene (SSU rDNA) sequences were generated. One 1565-bp sequence showed the highest similarity with B. gibsoni (95.9% identity) but, phylogenetically, was found to belong to a distinct lineage. The other sequence (1709-bp) could not be definitively assigned to a described taxon, sharing only limited homology to the closest named species (90.1% identity with C. felis). In order to enhance information obtained from the SSU rDNA sequence, further detection and sequence analysis of the CCTη gene sequence were done revealing the simultaneous presence of three closely related genotypes (all in a monophyletic lineage) within a single bear host. This finding suggested the possibility that a new Babesia species (Babesia sp. UR1) might have been maintained in nature in wild brown bears. While the parasite\u27s biology is yet unknown, to our knowledge, this is, excepting the single case documentation in 1910 of a hemoparasite in a bear at Russian zoo, the first reported case of piroplasms inhabiting a bear species