Long-term outcomes of tonsillectomy for IgA nephropathy patients: A retrospective cohort study, two-centre analysis with the inverse probability therapy weighting method.

AIM: The effect of tonsillectomy on IgA nephropathy remains controversial. The aim of this study was to compare the effect of tonsillectomy on the outcome, end stage kidney disease (ESKD) and all-cause death in IgA nephropathy patients who did and did not undergo tonsillectomy. METHODS: All basic data were retrospectively gathered from patients who had undergone renal biopsies at two Japanese clinical centres. Two hundred and twenty-seven patients were eligible for the study, with a median age of 34 (Interquartile range (IQR): 25-43) years and median follow-up of 92 (IQR: 40-178) months. The primary endpoint was the composite outcome of the onset of ESKD and all-cause death before ESKD. We performed a Cox proportional hazard regression analysis after adjusting for patient characteristics using the inverse probability therapy weighting (IPTW) method and a Cox analysis using the Matching method. Similarly, we analyzed these outcomes in a mild cohort. RESULTS: We were unable to find any significant advantages of tonsillectomy in either analysis (IPTW and matching, HR: 0.40 (0.12-1.36) P = 0.072 and 0.78 (0.13-4.64) P = 0.786). However, in the mild cohort analysis, our data showed that the Tonsillectomy group tended to be less likely to reach the composite outcomes than the Not Tonsillectomy group with statistical significance (hazard ratio (HR), <0.001 [CI <0.001 to <0.001, P = 0.039]). CONCLUSION: In this study, our findings led us to conclude that performing tonsillectomy in an early and timely manner may have predisposition of less poor prognosis.

Importance of specific reference values for evaluation of the deteriorating thyroid function in patients with end-stage renal disease on hemodialysis.

BACKGROUND/AIM: We evaluated the thyroid function in end-stage renal disease (ESRD) on maintenance hemodialysis. MATERIAL/METHODS: Thyroid function and clinical hypothyroid score were evaluated in 145 ESRD patients. RESULTS: Comparison of thyroid function between 127 ESRD patients, excluding 18 patients with suppressed or elevated serum TSH level, and age/sex-matched healthy controls (76 in midlife group aged under 65 and 51 in late-life group aged 65 or over) using a multivariate logistic regression analysis suggested significant difference (P < 0.0001), mainly in serum fT4 level (P = 0.0099) and age (P = 0.0492), but not in serum fT3 (not significant; ns), TSH (ns) level or fT3/fT4 ratio (ns). Serum fT3 level and fT3/fT4 ratio were significantly lower (P < 0.001) in late-life group only in ESRD. Reference values calculated for midlife ESRD patients, such as 0.6-1.3 ng/dl for fT4 compared with 0.8-1.7 ng/dl for healthy control, were helpful for the diagnosis of mild but definite hyperthyroidism in whom serum fT4 level was 1.5 ng/dl. The prevalence of primary thyroid dysfunction, compared with the values for ESRD, was 0.7 % for hyperthyroidism, 1.4 % for overt hypothyroidism and 10.3 % for subclinical hypothyroidism. Hypothyroid score was high among those with ESRD independent of thyroid dysfunction. CONCLUSIONS: Serum fT4 level was markedly lower without a change in fT3/fT4 ratio in ESRD. This may suggest typical carbohydrate-sufficient non-thyroidal illness. The specific reference values for ESRD were useful to evaluate borderline thyroid dysfunction and to evaluate the prevalence of the patients with primary thyroid dysfunction in ESRD.

Factors affecting short- and long-term effects of leukocyte removal therapy in active ulcerative colitis.

BACKGROUND AND AIM: Leukocyte removal therapy (LRT) is recognized as an effective treatment for active ulcerative colitis (UC). In this study, factors associated with the efficacy and long-term effects of LRT were evaluated. METHODS: From April 1998 to March 2010, 98 patients with moderate to severe UC were randomly assigned to granulocyte and monocyte/macrophage adsorptive apheresis (GMA) (n = 47) or leukocytapheresis (LCAP) (n = 51) treatment. Patients received two sessions of LRT in the first week, followed by three weekly administrations. All patients were treated with 5-aminosalicylic acid and corticosteroid. Steroid doses were tapered if patients achieved clinical improvement. Clinical remission was defined as a decrease in clinical activity index to < 4 and endoscopic findings to Matts' grade 1 or 2. When clinical activity index decreased but still remained ≥ 5 and Matts' grading was 1 or 2, the patient was considered to have improved. Patients were observed for at least 1 year and diagnosed as relapsed when additional treatment was required. RESULTS: Seventy-one (73%) patients achieved clinical remission or improvement. No significant difference was found between LCAP and GMA. Increased age, ≥ 3 attacks of UC, and ≥ 2 sessions of LRT were indicative of refractoriness to LRT. During 1 year observation, 28 patients were relapsed. Duration of UC, ≥ 3 attacks of UC, and ≥ 2 sessions of LRT were indicative of refractoriness to the long-term effects of LRT. CONCLUSION: Both GMA and LCAP were effective to treat active UC. However, long duration of UC, multiple UC attacks, and past history of LRT reduce the efficacy.

Electrical mapping of thermoelectric power factor in WO3 thin film.

With growing environmental awareness and considerable research investment in energy saving, the concept of energy harvesting has become a central topic in the field of materials science. The thermoelectric energy conversion, which is a classic physical phenomenon, has emerged as an indispensable thermal management technology. In addition to conventional experimental investigations of thermoelectric materials, seeking promising materials or structures using computer-based approaches such as machine learning has been considered to accelerate research in recent years. However, the tremendous experimental efforts required to evaluate materials may hinder us from reaping the benefits of the fast-developing computer technology. In this study, an electrical mapping of the thermoelectric power factor is performed in a wide temperature-carrier density regime. An ionic gating technique is applied to an oxide semiconductor WO3, systematically controlling the carrier density to induce a transition from an insulating to a metallic state. Upon electrically scanning the thermoelectric properties, it is demonstrated that the thermoelectric performance of WO3 is optimized at a highly degenerate metallic state. This approach is convenient and applicable to a variety of materials, thus prompting the development of novel functional materials with desirable thermoelectric properties.

Prolonged effect of fluid flow stress on the proliferative activity of mesothelial cells after abrupt discontinuation of fluid streaming.

Encapsulating peritoneal sclerosis (EPS) often develops after transfer to hemodialysis and transplantation. Both termination of peritoneal dialysis (PD) and transplantation-related factors are risks implicated in post-PD development of EPS, but the precise mechanism of this late-onset peritoneal fibrosis remains to be elucidated. We previously demonstrated that fluid flow stress induced mesothelial proliferation and epithelial-mesenchymal transition via mitogen-activated protein kinase (MAPK) signaling. Therefore, we speculated that the prolonged bioactive effect of fluid flow stress may affect mesothelial cell kinetics after cessation of fluid streaming. To investigate how long mesothelial cells stay under the bioactive effect brought on by fluid flow stress after removal of the stress, we initially cultured mesothelial cells under fluid flow stress and then cultured the cells under static conditions. Mesothelial cells exposed to fluid flow stress for a certain time showed significantly high proliferative activity compared with static conditions after stoppage of fluid streaming. The expression levels of protein phosphatase 2A, which dephosphorylates MAPK, in mesothelial cells changed with time and showed a biphasic pattern that was dependent on the duration of exposure to fluid flow stress. There were no differences in the fluid flow stress-related bioactive effects on mesothelial cells once a certain time had passed. The present findings show that fluid flow stress exerts a prolonged bioactive effect on mesothelial cells after termination of fluid streaming. These findings support the hypothesis that a history of PD for a certain period could serve as a trigger of EPS after stoppage of PD.

First-Principles Calculations of the Protonation and Weakening of Epoxy Resin under Wet Conditions.

In this study, we investigated the protonation of the amine group in epoxy resins prepared using amine-based curing agents by theoretical methods. Density functional theory (DFT)-based free-energy calculations of the corresponding deprotonation subreactions showed that the amine group of the epoxy resin is protonated at equilibrium depending on the location of the amine group when the epoxy resin is embedded in water under standard conditions. Additional DFT calculations demonstrate that the energetic barrier for breaking the ether bond of the epoxy resin is lowered by about 0.6 eV as a result of the cooperative effect of H2O dissociation and that the transition-state energy for breaking the amine group bond is lowered by about 0.4 eV after the protonation of the amine group. Comparing the transition-state energies, we predict that the bond breakage of the protonated amine groups is the principal process causing the weakening of epoxy resins under wet conditions.

Risks and Benefits of Sodium Polystyrene Sulfonate for Hyperkalemia in Patients on Maintenance Hemodialysis.

BACKGROUND: Concerns about sodium overload when using sodium polystyrene sulfonate (Na-resin) as an ion-exchange resin for the treatment of hyperkalemia led our institution to gradually shift to the use of calcium polystyrene sulfonate (Ca-resin). However, as serum potassium levels were insufficiently controlled and patients experienced constipation, we returned to using Na-resin and observed better results than previously. OBJECTIVE: As few papers have examined the potassium adsorption ability of Ca-resin compared with Na-resin, we investigated this issue within our institution. METHODS: We studied potassium adsorption in patients who switched from Ca-resin to an equivalent amount of Na-resin (change group). We also investigated the incidence of sodium loading with Na-resin, including in patients newly commencing Na-resin treatment (new start group). RESULTS: Mean (± standard deviation) serum potassium levels decreased significantly, from 5.5 ± 0.6 to 4.9 ± 0.6 mEq/l in the change group and from 5.9 ± 0.4 to 4.7 ± 0.6 mEq/l in the new start group. No changes were observed in blood pressure, weight gain or serum sodium levels in the change group, but serum sodium levels in the new start group increased significantly, from 137.4 ± 2.3 to 139.0 ± 2.5 mEq/l, although they remained within the normal range. CONCLUSIONS: Our results indicate that Na-resin exhibited an advantage in treating hyperkalemia when used in small amounts. However, when prescribing an ion-exchange resin at a higher dose, physicians should select the type and amount of resin according to the sodium and/or calcium load in each case.

Significance of technetium-99m human serum albumin diethylenetriamine pentaacetic acid scintigraphy in patients with nephrotic syndrome.

It is thought that a large amount of albumin leaking from the glomerulus in nephrotic syndrome (NS) is reabsorbed at the proximal tubule and catabolized. Therefore, it is possible the final quantity of urinary protein does not always reflect the amount of leakage of protein from the glomerulus. We experienced two cases without nephrotic range proteinuria thought to involve hypoproteinemia due to the same pathophysiology as NS. On these patients, we performed protein leakage scintigraphy with technetium-99m human serum albumin diethylenetriamine pentaacetic acid (99mTc-HSAD) to exclude a diagnosis of protein-losing gastroenteropathy and observed diffuse positive accumulation in the kidneys with more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration. In healthy adults intravenously given 99mTc-HSAD, the same dynamics are observed as in albumin metabolism, and the organ radioactivity of the liver and kidneys after 24 hours is equal. Therefore, we thought it was possible that the renal uptake 24 hours after 99mTc-HSAD administration was a characteristic finding of NS. In order to confirm it, the subjects were divided into two groups: the NS group (n = 10) and the non-NS group (n = 7). We defined more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration as Dense Kidney (+). Furthermore, we designed regions of interest in the right and left kidneys and liver on anterior and posterior images, then calculated the kidney-liver ratio. Nine of the ten patients had Dense Kidney (+) in the NS group, compared to none in the non-NS group. And the kidney-liver ratio was significantly higher in the NS group than in the non-NS group on each view in the bilateral kidneys. In conclusion, our results suggest that the renal uptake 24 hours after 99mTc-HSAD administration is a characteristic finding of NS.

A report of an adult case of tubulointerstitial nephritis and uveitis (TINU) syndrome, with a review of 102 Japanese cases.

BACKGROUND: Although TINU syndrome is characterized by idiopathic TIN with bilateral anterior uveitis, few reports have provided a comprehensive summary of the features of this disorder. Previous reports have suggested that many Japanese patients had HLA-A2 and -A24 (7), but there is no evidence. CASE REPORT: A 44-year-old female was referred to our hospital due to renal dysfunction in March 2012. After admission, her symptoms improved spontaneously without medication within 2 weeks. In the outpatient clinic, she was diagnosed with idiopathic bilateral anterior uveitis in May, and her renal dysfunction relapsed in November. A renal biopsy showed diffuse TIN. We made a diagnosis of TINU syndrome because we could not explain the origin, and treated her with a systemic corticosteroid. Her renal function and ocular symptoms have been improving. The patient had HLA-A24, -B7, -DR1, -C*07: 02 and -DQB1*05: 01: 01. We collected 102 Japanese cases in PubMed, Ovid MEDLINE, and the Japanese Medical Abstracts Society and compared our case with the previous cases. CONCLUSIONS: This disorder affects primarily young females (median age, 14 years), and the most common symptom is fever (44/102 cases). We conducted a statistical analysis using contingency table and Pearson's chi-square test, for HLA-A2 and A24, and calculated the odds ratio (OR). There are no significant differences (A2 was present in 7/22 cases and in 19/50 controls, p value (P) 0.61, OR 0.76 (95% confidence interval (CI)) 0.27-2.2; A24 was present in 10/22 cases and in 33/50 controls, P 0.10, OR 0.43, CI 0.16-1.2).

[A case of systemic lupus erythematosus patient who died of rupture of abdominal aortic aneurysm].

Although many cardiovascular complications have been described in systemic lupus erythematosus (SLE), aortic involvement is rare. We report here a 51-year-old woman who suffered from SLE and died of a rupture of abdominal aortic aneurysm. She was diagnosed as having SLE in 1981, and administered prednisolone. She was admitted to our hospital for the treatment of nephrotic syndrome and hypocomplementaemia in December, 1996. Kidney biopsy revealed lupus nephritis(type IV of WHO classification). Methylprednisolone and cyclophosphamide pulse therapies were started, which resulted in an incomplete remission of nephrotic syndrome. After discharge, her clinical course was uneventful, and the dose of prednisolone was tapered. On April 22, 2001, she developed sudden abdominal pain and was admitted to a nearby hospital. Abdominal CT showed calcification of the aorta and an abdominal aortic aneurysm of 6.3 x 8 cm. She died of a rupture of abdominal aneurysm on the first hospital day. We think that prolonged prednisolone therapy might play a major role in accelerating atherosclerosis, which could result in aortic aneurysmal enlargement in this patient. Considerable attention should be paid to patients with SLE who are given prednisolone to detect and prevent vascular complications such as aneurysm.

Two cases of minor glomerular abnormalities with proteinuria disproportionate to the degree of hypoproteinemia.

We experienced two female cases of minor glomerular abnormalities with proteinuria disproportionate to the degree of hypoproteinemia. They did not have adequately large amounts of urine protein so as to cause nephrotic syndrome; however, we were unable to determine any cause of hypoproteinemia other than proteinuria. The renal pathology revealed foot process effacement, and hyaline droplet degeneration, suggesting urine protein hyper-reabsorption in the proximal convoluted tubule. Therefore, we thought these cases involved pathophysiological conditions, such as minimal change nephrotic syndrome. In both cases, the hypoproteinemia improved following the administration of oral prednisolone. As in past reports, it is thought that the principal causative factor of hypoalbuminemia in patients with nephrotic syndrome is a catabolic reaction after the serum albumin filtered at the glomerulus is reabsorbed in the proximal tubule. In the present two cases, it is supposed that a large amount of urine protein was filtered in the primitive urine; however, the amount of final urinary protein did not reach the nephrotic range because most of it was reabsorbed in the proximal tubule and reabsorbed in the blood after being disintegrated into amino acids by a catabolic reaction. Or we might simply observe the process before the case 1 got nephrotic syndrome and the healing process of nephrotic syndrome in the case 2.

A comparison of the long-term effects of lanthanum carbonate and calcium carbonate on the course of chronic renal failure in rats with adriamycin-induced nephropathy.

Lanthanum carbonate (LA) is an effective phosphate binder. Previous study showed the phosphate-binding potency of LA was twice that of calcium carbonate (CA). No study in which LA and CA were given at an equivalent phosphate-binding potency to rats or humans with chronic renal failure for a long period has been reported to date. The objective of this study was to compare the phosphate level in serum and urine and suppression of renal deterioration during long-term LA and CA treatment when they were given at an equivalent phosphate-binding potency in rats with adriamycin (ADR)-induced nephropathy. Rats were divided into three groups: an untreated group (ADR group), a CA-treated (ADR-CA) group and a LA-treated (ADR-LA) group. The daily oral dose of LA was 1.0 g/kg/day and CA was 2.0 g/kg/day for 24 weeks. The serum phosphate was lower in the ADR-CA or ADR-LA group than in the ADR group and significantly lower in the ADR-CA group than in the ADR group at each point, but there were no significant differences between the ADR and ADR-LA groups. The serum phosphate was also lower in the ADR-CA group than in the ADR-LA group, and there was significant difference at week 8. The urinary phosphate was significantly lower in the ADR-CA group than in the ADR or ADR-LA group at each point. The urinary phosphate was also lower in the ADR-LA group than in the ADR group at each point, and significant difference at week 8. There were no significant differences in the serum creatinine or blood urea nitrogen among the three groups. In conclusion, this study indicated the phosphate-binding potency of LA isn't twice as strong as CA, and neither LA nor CA suppressed the progression of chronic renal failure in the serum creatinine and blood urea nitrogen, compared to the untreated group.

Healing of Fatigue Crack by High-Density Electropulsing in Austenitic Stainless Steel Treated with the Surface-Activated Pre-Coating.

A technique to heal a fatigue crack in austenitic stainless steel SUS316 by applying a controlled, high-density pulsed current was developed. A surface-activated pre-coating (SAPC), which eliminates the oxide layer and coats a Ni film on the crack surface, was used to improve the adhesion between crack surfaces. Cracks were observed by scanning electron microscopy before and after the application of high-density electropulsing. To evaluate the healing effect of the SAPC during crack propagation, fatigue tests were conducted under a constant stress intensity factor. The fatigue crack treated with the SAPC was found to be effectively healed as a result of electropulsing, and also showed a slower rate of crack propagation.

Acute renal failure associated with acute non-fulminant hepatitis B.

A 38-year-old female presenting with a high fever of 39 °C developed severe liver dysfunction and acute renal failure (ARF). In tests for a hepatitis associated virus, an Immunoglobulin M-anti-hepatitis B virus core antibody was the only positive finding. Moreover, the progression of ARF coincided with the pole period of liver damage and all the other assumed causes for the ARF were unlikely. Therefore, this case was diagnosed as ARF caused by acute hepatitis B. ARF associated with non-fulminant hepatitis has been infrequently reported, usually in association with acute hepatitis A. This case is considered to be an extremely rare and interesting case.

A case of endocapillary glomerulonephritis associated with peripheral blood natural killer cell proliferation.

A 69-year-old male was admitted to our hospital due to rapidly progressive glomerulonephritis. A peripheral blood smear showed a marked increase in large granular lymphocytes. Flow cytometry analysis of the blood showed a marked increase in CD3-negative and CD56-positive natural killer (NK) cells. A renal biopsy showed a characteristic pathological pattern that involved endocapillary proliferation, a predominance of mononuclear cells and mesangiolysis. Prednisolone was administered, and the patient's renal function subsequently improved concomitant with the amelioration of NK cell proliferation. In our case, there was evidence of a strong association between NK cell proliferation and glomerulonephritis.

Potential benefit of statin therapy for dyslipidemia with chronic kidney disease: Fluvastatin Renal Evaluation Trial (FRET).

BACKGROUND: Dyslipidemia is a common complication of chronic kidney disease (CKD) and contributes to cardiovascular morbidity and mortality of CKD patients. AIM: The aim of the present study was to determine whether fluvastatin, which is mostly characterized by its pleiotropic anti-oxidant effects, has renoprotective effects in dyslipidemic patients with CKD. METHODS: In 43 dyslipidemic patients with CKD taking fluvastatin 10 mg/day, 20 mg/day or 30 mg/day, renal functions as well as lipid profiles were assessed. RESULTS: After 3 months of treatment with fluvastatin, LDL-cholesterol level significantly decreased. Serum creatinine level, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), urinary liver-type fatty acid binding protein (L-FABP) level and urinary 8-hydroxydeoxyguanosine (8-OHdG) level did not change in overall patients. However, in patients with microalbuminuria (baseline UAE ≥ 30 mg/g·creatinine; n = 23), the UAE significantly decreased [2.43 ± 0.67 to 1.98 ± 0.80 log(mg/g·creatinine), p = 0.01]. In patients with high L-FABP group (baseline L-FABP ≥ 11 µg/g·creatinine; n = 18), the urinary L-FABP level was significantly decreased (1.52 ± 0.45 to 1.26 ± 0.43 µg/g·creatinine, p < 0.01). In the limited 23 patients with microalbuminuria, the L-FABP level was significantly decreased [1.20 ± 0.62 to 1.03 ± 0.49 log(µg/g·creatinine), p = 0.042], although the LDL-cholesterol level (139 ± 28 to 129 ± 23 mg/dL, p = 0.08) only showed a tendency to decrease. The 8-OHdG level also was significantly decreased (13.6 ± 9.6 to 9.8 ± 3.8 ng/g·creatinine, p = 0.043). In the overall patients, changes in the values for UAE and urinary L-FABP were not correlated with the changes in LDL-levels. CONCLUSION: Fluvastatin reduces both UAE and the urinary L-FABP level, and thus, has renoprotective effects, independent of its lipid lowering effects in dyslipidemic patients with CKD.

Partial blood recirculation: a new trial for prolonging filter life during continuous hemodiafiltration.

Although continuous hemodiafiltration (CHDF) has been widely accepted in the management of complicated acute renal failure, the requirement for prolonged continuous systemic anticoagulation appears to be a major drawback. We herein describe the case of a patient who developed postoperative multiple organ failure and received CHDF therapy with partial blood recirculation (PBR). PBR is a mode of extracorporeal circulation used as an anticoagulation modality. The technique accelerates the blood flow rate with the goal of extending filter life, and it was performed because the filter life had been significantly shortened (10.5 +/- 5.1 h) during the CHDF process in this case. Despite increasing the dose of the anticoagulant, changing the hemofilter and changing the mode from postdilution to predilution, we did not obtain amelioration of filter life. The filter life was significantly improved (41.5 +/- 1.4 h) when we performed PBR. It is difficult to minimize the bleeding risk and maintain filter life during CHDF. Our success in prolonging the filter life during this case therefore suggests that PBR might resolve one of the main problems related to CHDF, although more study is needed to clarify the advantages of this system.

A case report of nephrotic syndrome due to collapsing focal segmental glomerulosclerosis treated with low-density lipoprotein apheresis.

We herein report the case of a 73-year-old woman with steroid and cyclosporine resistant collapsing focal segmental glomerulosclerosis (FSGS) whose refractory proteinuria and hypoproteinemia were controlled with low-density lipoprotein apheresis (LDL-A). She was initially treated with steroid therapy, including methylprednisolone pulse and cyclosporine therapy. However, her hypoproteinemia, accompanied with renal insufficiency, persisted despite these therapies. We treated her using LDL-A and found improvement in her urine protein excretion, hyperlipidemia, hypoproteinemia, and renal function as a result of this treatment. This suggests that LDL-A may therefore be an effective therapy for nephrotic syndrome due to collapsing FSGS.