Reiter's syndrome associated with HLA-B51: a case report.

A 32-year-old Japanese man developed polyarthritis with mild fever and conjunctivitis. Clinical assessment indicated non-specific arthritis, aseptic pyuria induced by infection with Chlamydia, and conjunctivitis. He was diagnosed with reactive arthritis (Reiter's syndrome). Serotyping of human leucocyte antigen (HLA) class I and II revealed positivity for B51(5), A2, A33(19), B44(12), Cw1, DR4 and DR6, but B27 was negative. He was treated with a combination of doxycycline, oral prednisolone, diclofenac sodium and salazosulphapyridine. Fever and arthralgia improved and he became negative for anti-Chlamydia immunoglobulin (Ig) A and IgG antibodies. HLA-B51 may be involved in the pathogenesis of Reiter's syndrome in this Japanese patient.

Dose-dependent effect of an oral adsorbent, AST-120, in patients with early chronic renal failure.

We evaluated the dose dependence of an oral adsorbent, AST-120, in 31 patients with early chronic renal failure (baseline serum creatinine: 1.2-3.0 mg/dl). Twenty-three patients were given AST-120 and eight patients were not. AST-120 was administered at three different maintenance doses, < 3.0 g, 3.0 g and 6.0 g/day, according to patients' ability to tolerate treatment. The treatment period was 12 months. The slope of the reciprocal of serum-creatinine concentration versus time was calculated to assess the progression of renal failure. This slope became significantly less steep after AST-120 treatment at 6.0 g/day, but did not change significantly at the other doses. These findings suggest that 6.0 g/day of AST-120 may delay the initiation of dialysis in patients with early chronic renal failure.

A case of CREST syndrome and myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis.

We report the first case of myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibody (MPO-ANCA)-associated glomerulonephritis in a patient with CREST syndrome. A 74-year-old Japanese man with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) developed rapidly progressive renal failure without elevation of blood pressure. Renal biopsy revealed glomerular sclerosis and fibrous crescents. The MPO-ANCA titer was elevated to 145 EU/ml. When patients with collagen diseases develop rapidly progressive glomerulonephritis, the possibility of MPO-ANCA-associated glomerulonephritis should be kept in mind.

A case of antiphospholipid antibody syndrome diagnosed after thrombosis of an arteriovenous shunt.

A 32-year-old male dialysis patient with lupus nephritis was admitted because of shunt obstruction. The arteriovenous fistula was reconstructed, but obstruction recurred twice within several hours after surgery. A high blood level of anticardiolipin beta2-glycoprotein I antibody suggested that shunt obstruction was caused by a thrombotic tendency related to the antiphospholipid antibody syndrome. Accordingly, for the third shunt procedure, antiplatelet therapy (which had been commenced for systemic lupus erythematosus) was combined with dalteparin sodium from before surgery and warfarin was added postoperatively. This regimen prevented shunt obstruction. In conclusion, hemodialysis patients who suffer repeated shunt obstruction should be examined for antiphospholipid antibody syndrome.

Factors influencing arteriovenous fistula dysfunction in Japanese patients on chronic hemodialysis.

Arteriovenous fistula dysfunction is a constant problem in chronic hemodialysis patients. We investigated the factors influencing fistula dysfunction in 184 patients on chronic hemodialysis. Stepwise regression analysis and Cox proportional hazards model were used to assess the relationship between fistula dysfunction and age, sex, duration of hemodialysis, diabetes mellitus, hematocrit, serum creatinine, blood urea nitrogen, Kt/V, prothrombin time, blood pressure, anticoagulant therapy, dose of erythropoietin, calcium channel blocker therapy, and angiotensin-converting enzyme inhibitor therapy. Fistula dysfunction showed a significant relationship with a low systolic blood pressure, a low hematocrit, the presence of diabetes mellitus, and angiotensin-converting enzyme inhibitor therapy. These results suggested that treatment with angiotensin-converting enzyme inhibitors may help to prevent fistula dysfunction.

Myeloperoxidase-antineutrophil cytoplasmic antibody-associated glomerulonephritis with membranous nephropathy in remission.

A 47-year-old woman developed pulmonary hemorrhage and an increase in proteinuria during remission of membranous nephropathy. Renal biopsy revealed crescentic glomerulonephritis. She also had a high perinuclear antineutrophil cytoplasmic antibody level, so a diagnosis of myeloperoxidase-antineutrophil cytoplasmic antibody-associated glomerulonephritis was made. After immunosuppressive therapy was started, the pulmonary hemorrhage resolved and her proteinuria decreased. Renal biopsy was repeated after treatment and showed histological improvement. This case suggests that there may be a relationship between membranous nephropathy and myeloperoxidase-antineutrophil cytoplasmic antibody-associated glomerulonephritis.