Fungal granulomatous interstitial nephritis presenting as acute kidney injury diagnosed by renal histology including PCR assay.

We describe two cases of fungal granulomatous interstitial nephritis (GIN) presenting as acute kidney injury (AKI). Increased serum creatinine was detected in Patient 1 after chemotherapy for pharyngeal cancer and in Patient 2 after steroid pulse therapy for bronchial asthma. Renal histology of both patients revealed GIN. Polymerase chain reaction (PCR)-based detection of fungal DNA sequences from kidney tissue demonstrated Trichosporon laibachii and Candida albicans, respectively. When AKI occurs in an immunocompromised host, differential diagnosis of fungal interstitial nephritis should be considered. Furthermore, PCR-based detection of fungal DNA sequences from renal specimens can be useful for rapid diagnosis.

Cataracts in airline pilots: prevalence and aeromedical considerations in Japan.

INTRODUCTION: Despite modern aviation being increasingly less dependent on human factors, the pilot is still part of the aircraft systems and vision is critical for flight safety. The incidence of cataract increases with age, but as most epidemiological studies focus on senior age groups, there is no data relevant to working age groups. PURPOSE: The aim of our study was to elucidate the prevalence of lens opacity in Japanese airline pilots. METHODS: A retrospective cohort study was conducted at the Japan Aeromedical Research Center. Medical records for all ophthalmological assessments performed in the 12-mo period prior to March 2008 were reviewed. Data collected included whether there was documented lens opacity or a history of previous cataract surgery. RESULTS: Over 12 mo, 3780 pilots underwent slit-lamp examination with an ophthalmologist as part of their scheduled medical and 105 pilots were identified with cataract. Out of these, 59/105 were bilateral, 29/105 were congenital types (of which 19 were bilateral), and 12/105 pilots gave a history of previous cataract surgery. In all 105 pilots, the visual acuity was sufficient to continue the privileges of their licenses. CONCLUSIONS: This study offers insight into the clinical iceberg of early cataracts in persons of working age. Mild and early lens opacities can cause significant glare and haze, and changes in color vision, which might compromise pilot performance even in the absence of decreased visual acuity. Cataracts in otherwise fit pilots have important aeromedical significance which requires further consideration.

Medical status of airline pilots over 60 years of age: Japanese experience, 1991-2007.

INTRODUCTION: Since 1991, the Japan Civil Aviation Bureau has allowed pilots over the age of 60 to continue flying for the airlines, subject to regular medical review. To date, we now have almost 18 yr of hands-on experience in the aeromedical assessment of senior pilots. This paper shares some of our findings. METHODS: Medical data for all pilots over 60 yr of age, including examination findings, results from screening, and causes of unfitness, were reviewed. Postal questionnaires were used to survey medical status, and subjective changes in memory and fatigue resistance in pilots between the ages of 60 to 64 yr old, and also in subjects who had been denied medicals at the age of 60. RESULTS: There is greater variation in medical fitness of pilots with age, and an increase in the number of denials of medical certification. Malignancy and coronary artery disease both tended to increase with age. During 2005-2007, 30 (7%) of 499 otherwise healthy pilots were denied certification as a consequence of abnormal brain MRI screening findings, mainly because of asymptomatic cerebral infarction. Over half of pilots stated that their memory and fatigue resistance had subjectively diminished with age. DISCUSSION: Since the International Civil Aviation Organization (ICAO) amended the upper age limit for commercial pilots in 2006 it is likely that there will be an increase in the number of senior pilots worldwide. We question the value of routine MRI screening in the senior pilot age group. Aeromedical decision makers must understand the relationship between age, health, and safe piloting in the modern flight environment to ensure the maintenance of flight safety.

[Analyses of factors concerning the short-term outcome of elderly patients beginning dialysis].

The aim of the present study is to clarify relevant factors concerning the short-term outcome of elderly patients beginning dialysis. One hundred nineteen patients aged 60 years and over who had newly started dialysis at our hospital were studied. The male/female ratio was 70:49. The age was 74 +/- 7 years (mean +/- standard deviation). In all patients, the timing of referral to a nephrologist (early/late), the urgency of the initiation of dialysis (non-urgent/urgent), the cause of renal failure (nondiabetes/diabetes), serum albumin concentration, comorbid conditions (cerebrovascular disease, ischemic heart disease, etc.), ambulation, cognitive function, and the outcome (relief/death) were surveyed. Twelve patients did not obtain relief and finally died. The influence of the timing of referral on the urgency of the initiation of dialysis was studied. Furthermore the influence of the urgency of the initiation of dialysis on the outcome was studied. The chi 2 test was used for statistical comparisons. The need for urgent dialysis was less among early referral cases as compared with late referral cases (p < 0.0001). The incidence of death was more frequent in urgent dialysis than in non-urgent dialysis (p = 0.016). Multivariate logistic regression analysis was performed using background factors as explanatory variables and the outcome as a dependent variable. Statistically significant factors were the urgency of the initiation (p = 0.040), serum albumin concentration (p = 0.022), and cerebrovascular disease (p = 0.002). The most common cause of death was severe infectious diseases (pneumonia, sepsis). It was speculated that background factors associated with the outcome could contribute to the onset and the progression of infectious diseases.

[Acceptance of dialysis therapy in elderly patients with chronic renal failure].

The aim of the present study is to clarify relevant factors concerning acceptance of dialysis therapy in elderly patients with chronic renal failure. Patients with advanced renal failure aged 60 years and over (152 cases) were investigated. The male/female ratio was 85:67. The age was 76 +/- 7 years (mean +/- standard deviation). The proportion of patients with acceptance of dialysis to patients with non-acceptance was 121:31. In all patients, the cause of renal failure (non-diabetes/diabetes), serum albumin level, comorbid conditions, ambulation, cognitive function, marital status, and presence of younger cohabitants were surveyed. The patients were divided into two groups for each category. Patients were categorized as the young-old (aged 60 to 74 years) and the old-old (aged 75 years and over). Serum albumin level was categorized as either low (less than 3.5 g/dl) or normal (3.5 g/dl and over). The number of patients who accepted dialysis therapy was evaluated for each group. Intergroup comparisons were carried out by the chi 2 test. Statistically significant factors were age (p < 0.0001), serum albumin level (p = 0.016), ambulation (p = 0.011), cognitive function (p < 0.0001), and marital status (p = 0.009). Multivariant logistic regression analysis was also performed using background factors as explanatory variables and acceptance or non-acceptance of dialysis therapy as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were age (p < 0.0001) and cognitive function (p < 0.0001). Serum albumin level, ambulation, and marital status were significant only in the chi 2 test. This could be explained by the close correlations of these factors with age and cognitive function. The old-old category and poor cognitive function were dominant factors with regard to non-acceptance of dialysis therapy.

The negative Ca(2+) balance is involved in the stimulation of PTH secretion.

The low calcium (Ca(2+)) dialysate have been developed to diminish the risk of hypercalcemia with the administration of active vitamin D and Ca(2+) carbonate as phosphate binder. Today, increasing numbers of hemodialysis (HD) patients have been on the low Ca(2+) dialysate (Ca(2+) = 2.5 mEq/l). However, the clinical consequences of a negative calcium net-balance which may be induced by the use of low Ca dialysate are not well evaluated. In the present study, we explored the effects of low Ca(2+) dialysate on the calcium balance and the PTH secretion. Eighty one chronic HD patients (male/female: 47/34; mean age: 60.2 +/- 1.5 years; mean HD periods: 11.1 +/- 0.8 years) who had been dialyzed with 3.0 mEq/l Ca(2+) dialysate were studied. All patients were transferred to the low Ca dialysate, which actually brought about a negative net-balance in Ca (mean: -94.5 mg) and an increase in serum intact PTH levels (mean: +23.7%: p = 0.03) during a single HD session. However, no changes in serum ionized Ca(2+) were found in spite of negative Ca(2+) balance. One month after change to the low Ca(2+) dialysate (total 12 sessions in each case), serum intact PTH levels increased significantly (186.7 +/- 19.5 vs. 216.2 +/- 21.9 pg/ml: p = 0.01) in spite of the fact that no changes were found in serum ionized Ca(2+), Pi and Mg. This result indicates that the negative Ca(2+) balance during low-Ca(2+) hemodialysis-stimulated PTH secretion, which offset the decrease of serum Ca(2+); a trade-off phenomenon between negative Ca balance and PTH. This suggests that low Ca(2+) dialysate may exaggerate the progression of secondary hyperparathyroidism.

[Differences in features between young-old and old-old patients beginning dialysis].

We investigated differences in features between young-old and old-old patients beginning dialysis. Patients aged over 60 years who had newly started dialysis (121 cases) were studied. These were 71 men and 50 women. The age was 74 +/- 7 years (mean +/- standard deviation). The patients were divided into the young-old group (aged 60 to 74 years) and the old-old group (aged over 75 years), 64 patients were young-old and 57 were old-old. In every patient, the cause of renal failure (non-diabetes/diabetes), body indexes, comorbid conditions, laboratory data of nutritional status, ambulation, cognitive function, and psychosocial status (acceptance of dialysis therapy, marital status, younger cohabitants, and engagement in work) were surveyed. Data were assessed in each group. Intergroup comparisons were made using Student's t-test, the chi 2 test, and the Mann-Whitney's U-test. Diabetes was frequent in the young-old group. The results concerning body indexes, comorbid conditions, and laboratory data reflected age-related phenomena or skew distribution of diabetic patients. Though differences were not statistically significant, both the percentage of patients with inability to walk and the percentage of patients with impaired cognitive function were lower in the old-old. These results could not be interpreted as age-related phenomena or skew distribution of diabetic patients. From the data of psychosocial indexes, it would speculate that the young-old had some advantage over the old-old for initiation of dialysis. We look for the explanation to psychosocial aspects of dialysis therapy.