Physical activity, high-density lipoprotein cholesterol subfractions and lecithin:cholesterol acyltransferase in dialysis patients.

BACKGROUND/AIMS: Although a low level of high-density lipoprotein cholesterol (HDL-C) is an independent risk factor for atherosclerotic heart disease, the mechanism of HDL-C abnormality in hemodialysis (HD) as well as peritoneal dialysis (PD) patients is not fully understood. The purpose of this study was to investigate the relationship of physical activity with HDL-C subfractions and lecithin:cholesterol acyltransferase activity in HD and PD patients. METHODS: Thirty-five HD and 26 PD patients were studied. Physical activity was estimated as the average number of steps taken per day over 7 days (steps/day). RESULTS: When possible confounding factors were included in the stepwise multiple regression analyses, in HD patients, steps/day was significantly positively related to HDL(2)-C and apolipoprotein (Apo) A-I, while it was significantly positively related to HDL(3)-C in PD patients. When subjects were subdivided into 3 groups according to steps/day, in HD patients, the highest category of steps/day had significantly higher HDL(2)-C and Apo A-I than the lowest category, while such results were not observed in PD patients. CONCLUSION: These results suggest that the associations of physical activity with HDL-C subfractions and Apo A-I that are known in the general population are more pronounced in HD patients than PD patients.

The improvement of renal survival with steroid pulse therapy in IgA nephropathy.

BACKGROUND: The benefits of steroid therapy in immunoglobulin A nephropathy (IgAN) have not been established. METHODS: The effect of steroids on kidney survival was retrospectively investigated in 702 patients with IgAN by multivariate analyses. RESULTS: There were 295 men and 407 women. The median follow-up period was 62 months. One hundred and ninety-four patients were treated with oral steroids (oral steroid group). Thirty-four patients were treated with methylprednisolone (mPSL) pulse therapy (pulse steroid group) followed by oral prednisolone (PSL). In 474 patients, no steroid was used (no steroid group). The urinary protein-creatinine ratio and histological grade were significantly different among treatment groups and were highest in the pulse steroid group followed by the oral steroid group and lowest in the no steroid patients. Serum creatinine was significantly higher in the pulse steroid group than in other two groups. Eighty-five patients developed end-stage renal failure (ESRF) requiring dialysis. [corrected] In multivariate analysis, steroid pulse therapy significantly decreased the risk of ESRF while oral steroid treatment did not improve renal survival in this cohort. CONCLUSION: We found that pulse steroid therapy improved kidney survivals in IgAN. Since the clinical findings and histological grade were the most severe in patients treated with mPSL pulse therapy, such therapy may prevent progression of IgAN.

Nodular glomerulosclerosis in patients without any manifestation of diabetes mellitus.

AIM/METHODS: Diabetic nodular glomerulosclerosis is considered to be the specific renal lesion of diabetes mellitus (DM). However, some cases, in which nodular glomerulosclerosis was found without any manifestation of DM, have also occasionally been reported. We clinicopathologically examined seven cases without a prior history of DM. They consisted of six men and one woman with a mean age of 57 years, and included three cases with family history of DM and six cases with hypertension. RESULTS: Mean body mass index was 26.2 +/- 5.9 (means +/- SD) kg/m(2) and haemoglobin A1c 5.3 +/- 1.1% or haemoglobin A1 7.0 +/- 0.6%. Mean plasma glucose levels were 5.3 +/- 0.7 mmol/L at fasting and 10.1 +/- 1.9 mmol/L at 2 h of 75 g OGTT (normal: 1 patient; impaired glucose tolerance: 4 patients; DM: 2 patients). None of them showed diabetic retinopathy in fundoscopic ophthalmoscopy. Mean serum creatinine was 268 +/- 215 micromol/L, urinary protein 5.2 +/- 4.0 g/day, and three patients had mild haematuria. Renal biopsy revealed typical nodular glomerulosclerosis, a negative deposition based on an immunofluorescence study, and neither any significant electron dense deposits nor fibrils on electron microscopy. CONCLUSION: These patients at presentation had no overt clinical manifestations of glucose intolerance. Diabetic nodular glomerulosclerosis can occur in patients without overt DM, suggesting the role of factors additional to prolonged hyperglycaemia in the pathogenesis of this disorder.

Recurrent nephrotic syndrome after living-related renal transplantation resistant to plasma exchange: report of two cases.

We encountered two patients of recurrent nephrotic syndrome (NS) after renal transplantation that was resistant to plasma exchange (PEX). Case 1 was a 34-year-old man with a living-related renal transplant for type-I membranoproliferative glomerulonephritis (MPGN) related end-stage renal disease (ESRD). He developed overt proteinuria 7 months post-transplant and presented with NS 5 months later. Biopsy of the transplant kidney revealed recurrent type I MPGN, but no features of acute rejection (AR) or chronic allograft nephropathy (CAN). He was treated with cyclophosphamide (CP), oral prednisolone (40 mg/d), an anti-platelet agent, heparin sulfate, and PEX, but the nephrotic state persisted and renal function was deteriorated. He recommenced hemodialysis 3 yr and 9 months after renal transplant. Case 2 was a 47-year-old male who underwent living-related renal transplant for ESRD due to focal segmental glomerulosclerosis (FSGS). He presented with proteinuria shortly after renal transplantation. He also had frequent episodes of AR. Graft biopsy revealed recurrent FSGS. Treatment of pulse methylprednisolone and PEX was transiently effective, but NS relapsed shortly after PEX. Graft biopsy at our hospital showed features of CAN with moderate interstitial fibrosis and tubular atrophy, presence of intraglomerular foam cells but no segmental sclerosis. Treatment with 12 courses of low-density lipoprotein apheresis (LDL-A) reduced proteinuria from 9.6 to 2.0 g/d, and incomplete remission has been maintained for more than 1 yr after LDL-A with slowly progressive renal dysfunction. Despite recent therapeutic advances, including the use of immunosuppressants and PEX, treatment of recurrent disease remains difficult. The LDL-A might be useful in cases with recurrent FSGS resistant to PEX.