IgA nephropathy diagnosed as a result of acute exacerbation due to G-CSF administration.

Granulocyte colony-stimulating factor (G-CSF) is commonly used to stimulate bone marrow production. G-CSF is usually safe but sometimes causes serious adverse effects and, in rare cases, exacerbates glomerulonephritis. We report a case of immunoglobulin A (IgA) nephropathy that was aggravated by G-CSF. A 56-year-old Japanese man with no relevant medical history was admitted to our hospital as a donor of peripheral blood stem cells (PBSCs) for transplantation. To mobilize PBSCs, he received subcutaneous G-CSF (lenograstim), 500 µg for 4 days. Three days after the first dose of lenograstim, gross hematuria appeared, and after administration on the fourth day, renal dysfunction and nephrotic-range proteinuria were observed. Renal biopsy and light microscopic study revealed mild mesangial proliferation with expansion in association with the presence of cellular segmental crescents. Immunofluorescence study revealed diffuse, granular staining in the mesangium for IgA, complement component 3 (C3), and lambda light chains. We diagnosed highly active IgA nephropathy and initiated treatment with prednisolone and azathioprine. Three months later, renal function returned to normal. Screening for hidden chronic glomerulonephritis should be performed when G-CSF is administered, as in PBSC donors. Immunosuppressant therapy, such as prednisolone or azathioprine, is considered for exacerbations of highly active glomerulonephritis.

A case of juvenile-onset fibrillary glomerulonephritis diagnosed by mass spectrometry and immunohistochemistry of DNAJB9.

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease. FGN is characterized by the deposition of randomly arranged, nonbranching microfibrils in the mesangium and glomerular basement membrane. The discovery of DNAJ homolog subfamily B member 9 (DNAJB9) in 2017 was a breakthrough, and DNAJB9 has been proven to be extremely useful for the definitive diagnosis of FGN. While FGN often occurs in middle-aged individuals, this case was diagnosed at a relatively young age of 17. We performed renal biopsy, and light microscopic study revealed mesangial proliferation with expansion and subepithelial deposits. Electron microscopic study showed glomerular deposition of randomly oriented nonbranching fibrils with a mean of 20 nm. However, direct first scarlet stain for amyloidosis was weakly positive. Therefore, we confirmed the diagnosis of FGN and eliminated the presence of amyloidosis with mass spectrometry. This is the first case in Japan in which the complication of amyloidosis was ruled out with mass spectrometry and FGN was diagnosed using immunostaining and mass spectrometry of DNAJB9. We began treatment with cyclosporine A. One and a half years after the start of the treatment, kidney function continues to be normal.

A Case of Effective Mepolizumab Induction Therapy for Severe Eosinophilic Granulomatosis with Polyangiitis Diagnosed by Eosinophilic Cholecystitis and Interstitial Nephritis.

A 66-year-old man with a history of bronchial asthma and sinusitis was admitted with cholecystitis and peripheral neuropathy. The histopathological findings of the gallbladder revealed necrotic vasculitis and granulomatous inflammation with marked eosinophilic infiltration. Kidney biopsy also showed marked eosinophilic infiltration in the tubulointerstitial area and eosinophilic tubulitis. He was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) and treated with corticosteroids. However, he showed no response. Therefore, he was administered mepolizumab 300 mg, which resulted in clinical improvement, including normalization of the eosinophil and CRP levels. We herein describe the first case of successful induction therapy of EGPA using mepolizumab.

Relationship between Oral Assessment Guide score and hypoalbuminemia in newly hospitalized patients.

This cross-sectional study investigated the relationship between Oral Assessment Guide (OAG) scores and malnutrition in newly hospitalized patients. A total of 880 hospitalized adults were enrolled. Hypoalbuminemia was defined as serum albumin less than 3.5 g/dL. Patients with hypoalbuminemia were older (P < 0.001), had a higher prevalence of respiratory diseases (P < 0.01), a higher prevalence of digestive diseases (P < 0.01), a lower prevalence of oral feeding (P < 0.001), a lower body mass index (P < 0.001), and higher OAG scores (P < 0.001) than those without hypoalbuminemia. Multivariate logistic regression analyses showed that the prevalence of hypoalbuminemia was significantly related to age (odds ratio [OR] = 1.05, P < 0.001), absence of oral feeding (OR = 2.72, P < 0.001), presence of respiratory diseases (OR = 2.53, P < 0.01), presence of digestive diseases (OR = 1.64, P < 0.01), and OAG scores (OR = 1.14, P < 0.01). Regarding OAG scores, the OR of hypoalbuminemia was greater in patients with disorders (scores 2 or 3) of swallowing (vs. score 1, OR = 1.83, P < 0.05) and saliva (vs. score 1, OR = 1.51, P < 0.05). There appears to be a positive association between OAG scores and hypoalbuminemia in hospitalized patients.

Scaling Law for Three-Body Collisions of Identical Fermions with p-Wave Interactions.

We experimentally confirmed the threshold behavior and scattering length scaling law of the three-body loss coefficients in an ultracold spin-polarized gas of ^{6}Li atoms near a p-wave Feshbach resonance. We measured the three-body loss coefficients as functions of temperature and scattering volume, and we found that the threshold law and the scattering length scaling law hold in limited temperature and magnetic field regions. We also found that the breakdown of the scaling laws is due to the emergence of the effective-range term. This work is an important first step towards a full understanding of the loss of identical fermions with p-wave interactions.