[Video-assisted thoracoscopic surgery for pleuroperitoneal communications as a complication of continuous ambulatory peritoneal dialysis( CAPD)].

A 54-year-old female who was started on continuous ambulatory peritoneal dialysis( CAPD) for endstage renal disease secondary to focal developed 2 pleuroperitoneal communications. At first, she developed chest pain and cough on the day following introduction. A 99m-technetium-macroaggregated albumin (99mTc-MAA) radionuclide scan showed a communication between the abdomen and the right pleural cavity. We diagnosed a right pleuroperitoneal communication. Four months later, she developed similar symptoms and was diagnosed with a left pleuroperitoneal communication. Video-assisted thoracoscopic surgery was performed for each lesion. However, the communications were detected using different methods. During the 1st surgery, the communication was detected using peritoneal dialysis fluid containing indigocarmine introduced through a CAPD catheter. During the 2nd surgery, the communication was detected by pneumoperitoneum. With regards to diaphragmatic pressure regulation, pneumoperitoneum was more rapid and convenient, so pneumoperitoneum was considered more effective for the identification and treatment of pleuroperitoneal communications. Diaphragmatic plication and pleurodesis with polyglycolic acid felt and fibrin glue on both sides were performed. No recurrence of hydrothorax was detected after treatment.

Expression of angiotensin II type 1 receptor-interacting molecule in normal human kidney and IgA nephropathy.

The intrarenal renin-angiotensin system plays a crucial role in the regulation of renal circulation and sodium reabsorption through the activation of vascular, glomerular, and tubular angiotensin II type 1 (AT(1)) receptor signaling. We previously cloned a molecule that specifically interacted with the murine AT(1) receptor to inhibit AT(1) receptor signaling, which we named ATRAP (for AT(1) receptor-associated protein). Since murine ATRAP was shown to be highly expressed in the kidney, in the present study we investigated expression and distribution of human ATRAP in normal kidney and renal biopsy specimens from patients with IgA nephropathy. In the normal human kidney, both ATRAP mRNA and protein were widely and abundantly distributed along the renal tubules from Bowman's capsule to the medullary collecting ducts. In all renal tubular epithelial cells, the ATRAP protein colocalized with the AT(1) receptor. In renal biopsy specimens with IgA nephropathy, a significant positive correlation between ATRAP and AT(1) receptor gene expression was observed. There was also a positive relationship between tubulointerstitial ATRAP expression and the estimated glomerular filtration rate in patients with IgA nephropathy. Furthermore, we examined the function of the tubular AT(1) receptor using an immortalized cell line of mouse distal convoluted tubule cells (mDCT) and found that overexpression of ATRAP by adenoviral gene transfer suppressed the angiotensin II-mediated increases in transforming growth factor-ß production in mDCT cells. These findings suggest that ATRAP might play a role in balancing the renal renin-angiotensin system synergistically with the AT(1) receptor by counterregulatory effects in IgA nephropathy and propose an antagonistic effect of tubular ATRAP on AT(1) receptor signaling.

Behçet's disease complicated by IgA nephropathy with nephrotic syndrome.

A 65-year-old woman with a 48-year history of Behçet's disease associated with nephrotic syndrome is described. Immunofluorescence study revealed IgA nephropathy. Following treatment with an angiotensin II type-I receptor-blocker, an anti-platelet drug, and an HMG-CoA reductase inhibitor, accompanied by dietary restrictions of protein and sodium, proteinuria was markedly decreased. This report describes our experience with a rare entity of Behçet's disease complicated by nephrotic syndrome due to IgA nephropathy. Routine urine examination and renal biopsy are needed for the detection and diagnosis of renal problems with Behçet's disease.