Efficacy and limitations of additional steroid pulse therapy in IgA nephropathy patients whose hematuria did not remit on tonsillectomy and protocol steroid pulse therapy.

BACKGROUND: Hematuria is the essential symptom of IgA nephropathy that has been suggested to be associated with long-term renal prognosis, Tonsillectomy and steroid pulse therapy (TSP), which is widely practiced in Japan, is effective for achieving hematuria remission. However, some cases are refractory to TSP, and additional steroid pulse therapy (SP) administered to these cases to achieve remission of hematuria. Nonetheless, the clinical significance of additional SP is unknown. METHODS: In this retrospective study, we enrolled 99 patients from Okubo Hospital whose hematuria persisted following TSP. Patients were divided into the hematuria remission and non-remission groups. A multivariate regression analysis was performed on the factors that contributed to hematuria remission. RESULTS: Following TSP, 103 of 403 patients (32.3%) did not achieve hematuria remission. Additional SP were performed in 99 of these patients, and remission of hematuria was achieved in 57 (57.6%). Patients with a greater degree of improvement in hematuria with TSP were significantly more likely to have remission of hematuria with additional SP (p = 0.0084*). Even in the hematuria non-remission group, both hematuria and proteinuria improved after additional SP. CONCLUSION: In IgA nephropathy, additional SP could induce hematuria remission and reduce proteinuria.

Benign angiopathy of the central nervous system associated with phenytoin intoxication.

We report a patient with epilepsy who presented with acute onset of left hemiparesis associated with phenytoin intoxication due to interaction with clobazam. Magnetic resonance angiography of the head revealed stenosis of the M2 segment of the right middle cerebral artery, whereas an erythrocyte sedimentation rate and cerebrospinal fluid analysis were normal, being consistent with a diagnosis of benign angiopathy of the central nervous system. The patient exhibited an elevated plasma level of thrombin-antithrombin III complex along with a marginally increased plasma concentration of soluble E-selectin. The present case suggests that phenytoin intoxication can cause cerebral vasospasm, which may be associated with some inflammatory endothelial injury accompanied by activated intravascular coagulation.

Elevated pitch perception owing to carbamazepine-activating effect on the peripheral auditory system: auditory brainstem response study.

Auditory disturbance is an uncommon side effect of carbamazepine, the pathophysiologic mechanism of which has not been clearly elucidated. We performed an auditory brainstem response study in a 9-year-old boy with epilepsy who had suffered from falsely higher pitch perception immediately after the start of carbamazepine treatment. The auditory brainstem response results showed that both the peak latency of wave V and the interpeak latencies of waves I to V were significantly prolonged with 85 dB HL click stimulation and that the peak amplitudes of the waves were noticeably elevated, particularly with lower click stimulation intensity. Although it has been shown that carbamazepine has a suppressive effect on the central nervous system, these auditory brainstem response findings might constitute evidence of a carbamazepine-activating effect on the peripheral auditory system, which probably increased the sensitivity to low-pitched sounds, causing the development of falsely higher pitch perception in our patient.