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

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

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)

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

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

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

Changed Diabetic Treatment from Multiple Daily Injection (MDI), Dulaglutide to Xultophy

The patient is a 56-year old (yo) female with type 2 diabetes mellitus (T2DM). Medical histories include persisting T2DM from 35yo, renal stone at 43yo, hypertension from 45yo, photocoagulation for retinopathy on 54yo. An incidentaloma was found in the left adrenal gland, where endocrinological exams were negative for functional tumor. Her diabetic control situation became worse with HbA1c > 10%, then the treatment has been changed from multiple daily injection (MDI), Dulaglutide to Xultophy which is combined agents of degludec and liraglutide (IDegLira). It was provided 10-18 doses daily, and then glucose variability profile was improved satisfactory, suggesting the dual synergistic effects

Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet

Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(<86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research