Various roles of renal rehabilitation including prevention and improvement of renal function, cardiovascular disease, flail and life prognosis

Historically speaking, there was two supreme physicians in the rehabilitation medicine, which were Dr. George Morris Piersol and Dr. Howard Archibald Rusk. Thanks to their efforts, rehabilitation medicine has been developed for long years. There has been a paradigm shift in the rehabilitation, and several kinds of rehabilitation are found, including cardiac, pulmonary and renal rehabilitation. For patients with chronic kidney disease (CKD) and hemodialysis (HD), exercise was restricted in the past. However, the need for exercise therapy has been recently advocated with various evidence and a drastic change. Exercise therapy in the renal rehabilitation has various roles such as prevention and improvement of flail, Activities of Daily Living (ADL), Quality of Life (QOL), renal function, life prognosis by prevention of cardiovascular disease

Recent Trends for Clinical Nephrology and Pharmacology Concerning Glomerular Filtration Rate (GFR)

Recently, chronic kidney disease (CKD), diabetic kidney disease (DKD), glomerular filtration rate (GFR) and related matters have been in focus. Estimated GFR (eGFR) has been usually calculated by serum creatinine and age corrected by body surface area (BSA). In contrast, Cockcroft-Gault formula is another way that is not corrected by BSA. When the patient's physique is significantly larger or smaller, BSA correction may remarkably change the value of eGFR. Based on the data of Japan Multi-institutional Collaborative Cohort (J-MICC) study, various factors influencing renal function were investigated. As a result, problem solving degree in men revealed inverse relationship with eGFR

Perspectives Concerning the Influence of Protein Intake for Renal Function in Diabetic Nephropathy

Regarding the diet treatment of diabetic nephropathy, protein restriction has been recommended. American Diabetes Association (ADA) proposed protein restriction guidelines in the 2008 edition. However, this comment was deleted in the 2013/2019 edition, because of insufficient evidence. A recent report showed that the intake of plant protein has a protective effect on the decrease of estimated glomerular filtration rate (eGFR), and the intake of animal protein has neither protection nor deterioration. There are controversies about the relationship between protein intake and the reduction of renal function. Further research will be expected for diabetic nephropathy, diabetic kidney disease (DKD), and chronic kidney disease (CKD)

Current topics of possible pharmacotherapy for chronic kidney disease (CKD) and diabetes

The authors and colleagues have been involved in Non-Communicable Diseases (NCDs), especially including diabetes, chronic kidney disease (CKD) and hemodialysis. Some topics are described as possible therapy for CKD. (i) Metformin has inhibitory effect on cardiovascular events, and has an evidence for safe administration in mild to moderate renal impairment. (ii) Canagliflozin reduced moderately cardiovascular and renal outcomes across the primary and secondary prevention groups, from mega studies of CANVAS and CREDENCE. (iii) erythropoiesis stimulating agent (ESA) has been effective for improving anemia in HD for years. Some hypoxia-inducible factor (HIF) seems to be applied for clinical practice soon

Recent Topics on Various Clinical Problems Related with Diabetic Neuropathy

Diabetes has been a crucial disease worldwide, and authors have continued diabetic practice and research. Recent topics on neuropathy are described. For diabetic patients, common symptoms of dysesthesia and loss of protective sensation (LOPS) should be checked annually. Diabetic peripheral neuropathy (DPN) has been treated by pregabalin, duloxetine, gabapentin and tapentadol. Autonomic Neuropathy (AN) includes Orthostatic Hypotension (OH), Cardiac Autonomic Neuropathy (CAN), gastroparesis and genitourinary disturbances. Diabetic foot may be related with Peripheral Arterial Disease (PAD), Diabetic Foot Infection (DFI), diabetic foot osteomyelitis (DFO) and amputation. For those, Hyperbaric Oxygen Therapy (HBOT) may be effective with continuing discussion

Clinical Significance of Chest CT Scan for Previous Heavy Smoker

The patient is an 83-year-old male, who smoked 20-40 cigarettes daily during 20-75 years and quit after that. In March 2021, he revealed normal chest X-P and was explained to take chest computed tomography (CT) next year. In April 2022, chest X-P was unremarkable, but CT showed a small solid abnormal shadow in the upper left lung region nearby aortic arch and abdominal aortic aneurysm (AAA) in the upper abdomen. Almost lung cancer cases are found in current smokers or ex-smokers. Using CT, lung cancer screening shows a 20-26% decrease in cancer death. Consequently, Low-Dose CT (LDCT) for smokers would be recommended

Clinically Both Effects of Weight and Glucose Variability by Oral Semaglutide (Rybelsus) for Younger Female Patient with Type 2 Diabetes (T2D)

Background: Obesity and Type 2 Diabetes (T2D) are crucial problems worldwide. Oral semaglutide (Rybelsus) was introduced to medical practice for Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA). Case presentation: The patient is 24-year-old female with obesity (BMI 39.3 kg/m2), T2D and fatty liver. Results: She started and increased Rybelsus from 3mg, 7mg to 14mg/day each 4 weeks. She showed significant efficacy for 4 months as HbA1c 6.3% to 5.6% and weight 107kg to 103kg, without Gastrointestinal Adverse Events (GIAEs). Discussion: Rybelsus is provided just after waking up, and kept >30 min fasting period. Longer fasting time may contribute current effect