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1. Type B insulin resistance syndrome induced by increased activity of systemic lupus erythematosus in a hemodialysis patient

Author

Yoshikuni Nagayama, Watanabe S, Morita H, Ashio Yoshimura, and Komukai D

Subjects
Adult, medicine.medical_specialty, Anti-nuclear antibody, Fasting Hypoglycemia, medicine.medical_treatment, Hypoglycemia, Insulin resistance, Renal Dialysis, Internal medicine, medicine, Humans, Insulin, Lupus Erythematosus, Systemic, Metabolic Syndrome, Lupus erythematosus, biology, business.industry, General Medicine, medicine.disease, Insulin receptor, Endocrinology, Nephrology, Disease Progression, biology.protein, Female, Hemodialysis, Metabolic syndrome, business, Follow-Up Studies
Abstract

A-23-year-old woman with systemic lupus erythematosus (SLE) and on hemodialysis for 5 years was admitted to the hospital because of severe general fatigue. On admission, laboratory findings showed that fasting plasma glucose levels ranged from 25 â 45 mg/dl, a test for antinuclear antibody (ANA) was positive (1 : 320, with a discrete-speckled pattern), serum C3 and C4 complement and CH50 level were remarkably depressed (22.5 mg/dl, < 5.1 mg/dl, < 13 U/ml, respectively), and insulin receptor antibodies were present (89.3% inhibition of 125I-insulin binding to cultured human lymphocytes by a binding inhibition assay). She also showed acanthosis nigricans. The patient was diagnosed to suffer from a Type B insulin resistance syndrome. The patient's serum insulin and C-peptide levels were markedly elevated during hypoglycemia without insulinoma (2,313.8 microU/ml, 55 ng/ml, respectively). Interestingly, not only postprandial hyperglycemia but also fasting hypoglycemia was observed. Treatment with steroid pulse and subsequent high dose of prednisolone resulted in restoration of euglycemia associated with disappearance of insulin receptor antibodies and improvement of both serum hypocomplementemia and the high titer of ANA. Later, the patient's course was complicated by hemorrhagic shock due to duodenal ulcer and she died of subsequent pneumocystis carinii pneumonia. The presented patient developed a Type B insulin resistance syndrome induced by increased activity of SLE after she had been treated with hemodialysis for 5 years. This is the first reported case with such a history and constellation. It is recommended that SLE patients on dialysis are carefully followed-up by clinical and serological monitoring. Type B insulin resistance syndrome must be considered in the differential diagnosis of hypoglycemia in SLE patients on dialysis.

Published
2008
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2. DIALYSIS. PATHOPHYSIOLOGY AND CLINICAL STUDIES

Author

Humalda, J. K., primary, Assa, S., additional, Navis, G. J., additional, Franssen, C. F. M., additional, De Borst, M. H., additional, Ogawa, H., additional, Ota, Y., additional, Watanabe, T., additional, Watanabe, Y., additional, Nishii, H., additional, Sato, A., additional, Waniewski, J., additional, Debowska, M., additional, Wojcik-Zaluska, A., additional, Ksiazek, A., additional, Zaluska, W., additional, Guastoni, C. M., additional, Turri, C., additional, Toma, L., additional, Rombola, G., additional, Frattini, G., additional, Romei Longhena, G., additional, Teatini, U., additional, Siriopol, D.-C., additional, Stuard, S., additional, Ciolan, A., additional, Mircescu, G., additional, Raluca, D., additional, Nistor, I., additional, Covic, A., additional, De Roij Van Zuijdewijn, C. L., additional, Chapdelaine, I., additional, Nube, M. J., additional, Blankestijn, P. J., additional, Bots, M. L., additional, Konings, S. J., additional, Van Den Dorpel, M. A., additional, Van Der Weerd, N. C., additional, Ter Wee, P. M., additional, Grooteman, M. P., additional, Djuric, P. S., additional, Jankovic, A., additional, Tosic, J., additional, Bajcetic, S., additional, Damjanovic, T., additional, Popovic, J., additional, Dimkovic, N., additional, Marinkovic, J., additional, Djuric, Z., additional, Knezevic, V., additional, Lazarevic, T., additional, Ljubenovic, S., additional, Markovic, R., additional, Rabrenovic, V., additional, Djukanovic, L., additional, Radovic Maslarevic, V., additional, Mathrani, V., additional, Drew, P., additional, Chess, J. I., additional, Williams, A. I., additional, Robertson, S., additional, Jibani, M., additional, Aithal, V. I., additional, Kumwenda, M., additional, Roberts, G., additional, Mikhail, A. I., additional, Grzegorzewska, A. E., additional, Ostromecki, G., additional, Mostowska, A., additional, Sowi ska, A., additional, Jagodzi ski, P. P., additional, Wu, H.-Y., additional, Chen, H.-Y., additional, Hsu, S.-P., additional, Pai, M.-F., additional, Yang, J.-Y., additional, Peng, Y.-S., additional, Hirose, M., additional, Hasegawa, T., additional, Kaneshima, N., additional, Sasai, F., additional, Komukai, D., additional, Takahashi, K., additional, Koiwa, F., additional, Shishido, K., additional, Yoshimura, A., additional, Selim, G., additional, Stojceva-Taneva, O., additional, Tozija, L., additional, Dzekova-Vidimliski, P., additional, Trajceska, L., additional, Petronievic, Z., additional, Gelev, S., additional, Amitov, V., additional, Sikole, A., additional, Moon, S. J., additional, Yoon, S. Y., additional, Shin, D. H., additional, Lee, J. E., additional, Kim, H.-J., additional, Park, H.-C., additional, Hadjiyannakos, D., additional, Filiopoulos, V., additional, Loukas, G., additional, Pagonis, S., additional, Andriopoulos, C., additional, Drakou, A., additional, Vlassopoulos, D., additional, Catarino, C., additional, Cunha, P., additional, Ribeiro, S., additional, Rocha-Pereira, P., additional, Reis, F., additional, Sameiro-Faria, M., additional, Miranda, V., additional, Bronze-Rocha, E., additional, Belo, L., additional, Costa, E., additional, Santos-Silva, A., additional, De Mauri, A., additional, Brambilla, M., additional, Chiarinotti, D., additional, Lizio, D., additional, Matheoud, R., additional, Conti, N., additional, Conte, M. M., additional, Carriero, A., additional, De Leo, M., additional, Karpetas, A. V., additional, Sarafidis, P. A., additional, Georgianos, P. I., additional, Koutroumpas, G., additional, Divanis, D., additional, Vakianis, P., additional, Tzanis, G., additional, Raptopoulou, K., additional, Protogerou, A., additional, Stamatiadis, D., additional, Syrganis, C., additional, Liakopoulos, V., additional, Efstratiadis, G., additional, Lasaridis, A. N., additional, Tersi, M., additional, Stamatiadis, D. N., additional, Kuczera, P., additional, Adamczak, M., additional, Wiecek, A., additional, Bove, S., additional, Giacon, B., additional, Corradini, R., additional, Prati, E., additional, Brognoli, M., additional, Tommasi, A., additional, Sereni, L., additional, Palladino, G., additional, Moriya, H., additional, Mochida, Y., additional, Ishioka, K., additional, Oka, M., additional, Maesato, K., additional, Hidaka, S., additional, Ohtake, T., additional, Kobayashi, S., additional, Moura, A., additional, Madureira, J., additional, Alija, P., additional, Fernandes, J. C., additional, Oliveira, J. G., additional, Lopez, M., additional, Filgueiras, M., additional, Amado, L., additional, Vieira, M., additional, Seok, J.-H., additional, Choi, H. Y., additional, Ha, S. K., additional, Park, H. C., additional, Bossola, M., additional, Laudisio, A., additional, Antocicco, M., additional, Tazza, L., additional, Colloca, G., additional, Tosato, M., additional, Zuccala, G., additional, Ettema, E. M., additional, Kuipers, J., additional, Groen, H., additional, Gansevoort, R. T., additional, Stade, K., additional, Bakker, S. J. L., additional, Gaillard, C. A. J. M., additional, Westerhuis, R., additional, Bacchetta, J., additional, Couchoud, K., additional, Semlali, S., additional, Sellier-Leclerc, A.-L., additional, Bertholet-Thomas, A., additional, Cartier, R., additional, Cochat, P., additional, Ranchin, B., additional, Kim, J. C., additional, Park, K., additional, Van Ende, C., additional, Wilmes, D., additional, Lecouvet, F. E., additional, Labriola, L., additional, Cuvelier, R., additional, Van Ingelgem, G., additional, Jadoul, M., additional, Doriana, C., additional, David, P., additional, Capurro, F., additional, Brustia, M., additional, Ruva, C. E., additional, Giungi, S., additional, Di Stasio, E., additional, Lemesch, S., additional, Leber, B., additional, Horvath, A., additional, Ribitsch, W., additional, Schilcher, G., additional, Zettel, G., additional, Tawdrous, M., additional, Rosenkranz, A. R., additional, Stadlbauer-Kollner, V., additional, Matsushima, H., additional, Oyama, A., additional, Bosch Benitez-Parodi, E., additional, Baamonde Laborda, E., additional, Batista Garcia, F., additional, Perez Suarez, G., additional, Anton Perez, G., additional, Garcia Canton, C., additional, Toledo Gonzalez, A., additional, Lago Alonso, M. M., additional, Checa Andres, M. D., additional, Cobo, G., additional, Di Gioia, C., additional, Camacho, R., additional, Garcia Lacalle, C., additional, Ortega, O., additional, Rodriguez, I., additional, Herrero, J., additional, Oliet, A., additional, Ortiz, M., additional, Mon, C., additional, Vigil, A., additional, Gallar, P., additional, Pellu, V., additional, Nebiolo, P. E., additional, Sasaki, K., additional, Yamguchi, S., additional, Hesaka, A., additional, Iwahashi, E., additional, Sakai, S., additional, Fujimoto, T., additional, Minami, S., additional, Fujita, Y., additional, Yokoyama, K., additional, Shutov, E., additional, Ryabinskya, G., additional, Lashutin, S., additional, Gorelova, E., additional, Volodicheva, E., additional, Podesta, M. A., additional, Cancarini, G., additional, Cucchiari, D., additional, Montanelli, A., additional, Badalamenti, S., additional, Graziani, G., additional, Distasio, E., additional, Pchelin, I., additional, Shishkin, A., additional, Fedorova, Y., additional, Kao, C.-C., additional, Chu, T.-S., additional, Tsai, T.-J., additional, Wu, K.-D., additional, Wu, M.-S., additional, Raikou, V., additional, Kaisidis, P., additional, Tsamparlis, E., additional, Kanellopoulos, P., additional, Boletis, J., additional, Ueda, A., additional, Hirayama, A., additional, Owada, S., additional, Nagai, K., additional, Saito, C., additional, and Yamagata, K., additional

Published
2014
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3. Peritoneal dialysis

Author

Liu, J., primary, Liu, J., additional, Liu, Y., additional, Xu, Y., additional, Zhao, X., additional, Qian, J., additional, Sun, B., additional, Xing, C., additional, Kanda, R., additional, Hamada, C., additional, Nakano, T., additional, Wakabayashi, K., additional, Io, H., additional, Horikoshi, S., additional, Tomino, Y., additional, Ishimatsu, N., additional, Miyamoto, T., additional, Morimoto, H., additional, Nakamata, J., additional, Baba, R., additional, Kanegae, K., additional, Serino, R., additional, Kabashima, N., additional, Otsuji, Y., additional, Doi, Y., additional, Tamura, M., additional, Kusumoto, T., additional, Fukami, K., additional, Yamagishi, S.-I., additional, Ueda, S., additional, Kaida, Y., additional, Hazama, T., additional, Nakayama, Y., additional, Ando, R., additional, Obara, N., additional, Okuda, S., additional, Matsumoto, M., additional, Furuno, Y., additional, Bang-Gee, H., additional, Mazzotta, L., additional, Rosati, A., additional, Carlini, A., additional, Henriques, V. T., additional, Zangiacomi Martinez, E., additional, Divino-Filho, J. C., additional, Pecoits-Filho, R., additional, Cardeal Da Costa, J. A., additional, Gama Axelsson, T., additional, Lindholm, B., additional, Carrero, J. J., additional, Heimburger, O., additional, Stenvinkel, P., additional, Qureshi, A. R., additional, Akazawa, M., additional, Uno, T., additional, Kanda, E., additional, Maeda, Y., additional, Aktsiali, M., additional, Antonopoulou, S., additional, Tsiolaki, K., additional, Bakirtzi, N., additional, Patrinou, A., additional, Georgopoulou, M., additional, Liaveri, P., additional, Afentakis, N., additional, Tsirpanlis, G., additional, Hasegawa, T., additional, Nishiwaki, H., additional, Hirose, M., additional, Komukai, D., additional, Tayama, H., additional, Koiwa, F., additional, Yoshimura, A., additional, Lui, S. L., additional, Lui, S., additional, Yung, S., additional, Tang, C., additional, Ng, F., additional, Lo, W. K., additional, Chan, T. M., additional, Koo, H. M., additional, Doh, F. M., additional, Yoo, D. E., additional, Oh, H. J., additional, Yoo, T.-H., additional, Choi, K. H., additional, Kang, S.-W., additional, Han, D. S., additional, Han, S. H., additional, Fernandes, N., additional, Bastos, M. G., additional, Gianotti Franco, M. R., additional, Chaoubah, A., additional, Gloria Lima, M. D., additional, Kang, S., additional, Do, J., additional, Cho, K., additional, Park, J., additional, Yoon, K., additional, Chen, J.-B., additional, Cheng, B.-C., additional, Chen, T.-C., additional, Su, Y.-J., additional, Wu, C.-H., additional, Park, Y., additional, Jeon, J., additional, Tsikeloudi, M., additional, Pateinakis, P., additional, Patsatsi, K., additional, Manou, E., additional, Sotiriadis, D., additional, Tsakiris, D., additional, Teixeira, L., additional, Rodrigues, A., additional, Carvalho, M. J., additional, Cabrita, A., additional, Mendonca, D., additional, Bruschi, M., additional, Candiano, G., additional, Santucci, L., additional, Luzio, S., additional, Cannavo, R., additional, Ghiggeri, G. M., additional, Verrina, E., additional, Varadarajan, Y., additional, Raju, B., additional, Cho, K.-H., additional, Park, J.-W., additional, Yoon, K.-W., additional, Kim, T.-W., additional, Kimmel, M., additional, Braun, N., additional, Latus, J., additional, Alscher, M. D., additional, Struijk, D., additional, Van Esch, S., additional, Krediet, R. T., additional, Van den Beukel, T., additional, Hoekstra, T., additional, Tirapani, L., additional, De Andrade Bastos, K., additional, Bastos, M., additional, Dekker, F., additional, Yasuhisa, T., additional, Kanai, H., additional, Harada, K., additional, Kawai, Y., additional, Sugiyama, H., additional, Ito, Y., additional, Tsuruya, K., additional, Yoshida, H., additional, Maruyama, H., additional, Goto, S., additional, Nakayama, M., additional, Nakamoto, H., additional, Morinaga, H., additional, Matsuo, S., additional, Makino, H., additional, DI Gioia, M. C., additional, Gallar, P., additional, Laso, N., additional, Rodriguez, I., additional, Cobo, G., additional, Oliet, A., additional, Hynostroza, J., additional, Herrero, J. C., additional, Mon, C., additional, Ortiz, M., additional, Vigil, A., additional, Tomo, T., additional, Portoles, J., additional, Uta, S., additional, Tato, A. M., additional, Lopez-Sanchez, P., additional, Rivera, M., additional, Rodriguez-Pena, R., additional, Del Peso, G., additional, Ortega, M., additional, Felipe, C., additional, Tsampikaki, E., additional, Aperis, G., additional, Kaikis, A., additional, Paliouras, C., additional, Karvouniaris, N., additional, Maragaki, M., additional, Alivanis, P., additional, Kortus-Gotze, B., additional, Hoferhusch, T., additional, Hoyer, J., additional, Martino, F., additional, Kaushik, M., additional, Rodighiero, M. P., additional, Creapldi, C., additional, Ronco, C., additional, Lacquaniti, A., additional, Donato, V., additional, Fazio, M. R., additional, Lucisano, S., additional, Cernaro, V., additional, Lupica, R., additional, Buemi, M., additional, Aloisi, C., additional, Bavbek Ruzgaresen, N., additional, Secilmis, S., additional, Yilmaz, H., additional, Akcay, A., additional, Duranay, M., additional, Akalin, N., additional, Altiparmak, M. R., additional, Trabulus, S., additional, Yalin, A. S., additional, Ataman, R., additional, Serdengecti, K., additional, Schneider, K., additional, Bator, B., additional, Niko, B., additional, Peter, F., additional, Ulmer, C., additional, Joerg, L., additional, Martin, K., additional, Dagmar, B., additional, German, O., additional, Fabian, R., additional, Juergen, D., additional, Stephan, S., additional, Dominik, A., additional, Fritz, P., additional, Rettenmaier, B., additional, Hirschburger, S., additional, Segerer, S., additional, Biegger, D., additional, Lang, T., additional, Ott, G., additional, Habib, M., additional, Korte, M., additional, Hagen, M., additional, Dor, F., additional, Betjes, M., additional, Zietse, R., additional, Scharpf, C., additional, Chang, T. I., additional, Shin, D. H., additional, Han, D.-S., additional, Choi, H. Y., additional, Lee, Y. K., additional, Kim, B. S., additional, Yoo, T. H., additional, Park, H. C., additional, Lee, H. Y., additional, Horimoto, N., additional, Tuji, K., additional, Kitamura, S., additional, Isshiki, R., additional, Iwagami, M., additional, Tsutsumi, D., additional, Mochida, Y., additional, Ishioka, K., additional, Oka, M., additional, Maesato, K., additional, Moriya, H., additional, Ohtake, T., additional, Hidaka, S., additional, Kobayashi, S., additional, Higuchi, C., additional, Tanihata, Y., additional, Ishii, M., additional, Sugimoto, H., additional, Sato, N., additional, Kyono, A., additional, Ogawa, T., additional, Nishimura, H., additional, Otsuka, K., additional, Do, J.-Y., additional, Du Halgouet, C., additional, Latifa, A., additional, Anne Sophie, V., additional, Emmanuel, D., additional, Christine, R., additional, Francois, V., additional, Grzelak, T., additional, Czyzewska-Majchrzak, L., additional, Kramkowska, M., additional, Witmanowski, H., additional, Czyzewska, K., additional, Janda, K., additional, Krzanowski, M., additional, Dumnicka, P., additional, Sulowicz, W., additional, Rroji, M., additional, Seferi, S., additional, Barbullushi, M., additional, Likaj, E., additional, Petrela, E., additional, Thereska, N., additional, Cabiddu, G., additional, Dessi, E., additional, Arceri, A., additional, Laura, P., additional, Manca, E., additional, Conti, M., additional, Cao, R., additional, Pani, A., additional, Liao, C.-T., additional, Vega Vega, O., additional, Mendoza de la Garza, A., additional, Correa-Rotter, R., additional, Ueda, A., additional, Nagai, K., additional, Morimoto, M., additional, Hirayama, A., additional, Owada, S., additional, Tonozuka, Y., additional, Saito, C., additional, Yamagata, K., additional, Matsuda, A., additional, Tayama, Y., additional, Iwanaga, M., additional, Noiri, C., additional, Hatano, M., additional, Kiba, T., additional, Kanozawa, K., additional, Katou, H., additional, Hasegawa, H., additional, Mitarai, T., additional, Ros-Ruiz, S., additional, Fuentes-Sanchez, L., additional, Jironda-Gallegos, C., additional, Gutierrez-Vilches, E., additional, Garcia-Frias, P., additional, Hernandez-Marrero, D., additional, Lee, S., additional, Lai, X., additional, Chen, W., additional, Guo, Z., additional, Braide, M., additional, Cristina, V., additional, Popa, S. G., additional, Maria, M., additional, Eugen, M., additional, DI Loreto, P., additional, Spahia, N., additional, Sanchez Macias, L. O., additional, Lares Castellanos, K. I., additional, Hernandez Pacheco, J. A., additional, Correa Rotter, R., additional, Pedro Ventura, A., additional, Olivia, S., additional, Joana, V., additional, Francisco, F., additional, Maria Joao, C., additional, Antonio, C., additional, Rodrigues, A. S., additional, Atas, N., additional, Erten, Y., additional, Onec, K., additional, Inal, S., additional, Topal, S., additional, Akyel, A., additional, Celik, B., additional, Okyay, G. U., additional, Tavil, Y., additional, Zeiler, M., additional, Monteburini, T., additional, Agostinelli, R. M., additional, Marinelli, R., additional, Santarelli, S., additional, Yaylaci, C., additional, Sahin, G., additional, Guz, G., additional, Sindel, S., additional, Pinho, A., additional, Malho Guedes, A., additional, Fragoso, A., additional, Carreira, H., additional, Pinto, I., additional, Bernardo, I., additional, Leao, P., additional, Kusnierz-Cabala, B., additional, Krasniak, A., additional, Chowaniec, E., additional, Tabor-Ciepiela, B., additional, Turkmen, K., additional, Ozbek, O., additional, Kayrak, M., additional, Samur, C., additional, Guler, I., additional, Tonbul, H. Z., additional, Rusai, K., additional, Herzog, R., additional, Kratochwill, K., additional, Kuster, L., additional, Aufricht, C., additional, Meier, C.-M., additional, Fliser, D., additional, Schilling, M. K., additional, Klingele, M., additional, Fukasawa, M., additional, Takeda, M., additional, Kamiyama, M., additional, Song, Y. R., additional, Kim, H. J., additional, Kim, S. G., additional, Kim, J.-K., additional, Noh, J. W., additional, Yoon, J. W., additional, and Koo, J.-R., additional

Published
2012
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6. A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan.

Author

Sakurada T, Kojima S, Yamada S, Koitabashi K, Taki Y, Matsui K, Murasawa M, Kawarazaki H, Shimizu S, Kobayashi H, Asai T, Hashimoto K, Hoshino T, Sugitani S, Maoka T, Nagase A, Sato H, Fukuoka K, Sofue T, Koibuchi K, Nagayama K, Washida N, Koide S, Okamoto T, Ishii D, Furukata S, Uchiyama K, Takahashi S, Nishizawa Y, Naito S, Toda N, Naganuma T, Kikuchi H, Suzuki T, Komukai D, Kimura T, Io H, Yoshikawa K, Naganuma T, Morishita M, Oshikawa J, Tamagaki K, Fujisawa H, Ueda A, Kanaoka T, Nakamura H, Yanagi M, Udagawa T, Yoneda T, Sakai M, Gunji M, Osaki S, Saito H, Yoshioka Y, and Kaneshiro N

Subjects
Adult, Humans, Catheters, Indwelling adverse effects, Japan, Catheterization methods, Peritoneum, Peritoneal Dialysis adverse effects, Peritoneal Dialysis methods, Kidney Failure, Chronic therapy, Kidney Failure, Chronic etiology
Abstract

Background: This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications., Methods: Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest., Results: Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines., Conclusion: PD catheter placement in Japan was proven to be safe and appropriate., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors have read and understood Peritoneal Dialysis International’s policy on conflicts of interest disclosures. TS has received speaker honorarium from Baxter Healthcare and received research grant from Terumo Corporation. HI has received research grant from Baxter Healthcare. KU has received salaries from an endowed chair at Baxter Healthcare. KU has received research grant, also from Baxter Healthcare. NW has received speaker honorarium from Baxter Healthcare. MY has received speaker honorarium from Terumo Corporation. DK has received speaker honorarium from JMS Co., Ltd. KT has received speaker honorarium from Baxter Healthcare and JMS Co., Ltd. The other authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Published
2023
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7. Disseminated Intravascular Coagulation-like Reaction after Rituximab Infusion in a Patient with Nephrotic Syndrome.

Author

Nishiwaki H, Oikawa M, Kajitani H, Komukai D, Inoue Y, and Koiwa F

Subjects
Disseminated Intravascular Coagulation diagnosis, Fatal Outcome, Humans, Japan, Male, Middle Aged, Disseminated Intravascular Coagulation chemically induced, Disseminated Intravascular Coagulation mortality, Nephrotic Syndrome drug therapy, Rituximab adverse effects, Rituximab therapeutic use, Thrombocytopenia chemically induced, Thrombocytopenia mortality
Abstract

Several case series have suggested that rituximab is efficacious in adult patients with minimal change disease. We herein report a case of disseminated intravascular coagulation-like reaction after rituximab infusion in a patient with nephrotic syndrome. A 58-year-old Japanese man with minimal change disease diagnosed 15 years earlier was started on rituximab to prevent relapse of nephrotic syndrome when he presented to our clinic with low albuminemia, massive proteinuria, and leg edema. Eleven days after rituximab infusion, he presented with abdominal pain, appetite loss, and tarry stool. A laboratory examination revealed severe thrombocytopenia and coagulopathy, and upper gastrointestinal endoscopy revealed multiple hemorrhagic ulcers in his esophagus and stomach. The patient died two days later. Physicians should consider disseminated intravascular coagulation-like reaction when encountering cases with thrombocytopenia after rituximab infusion for any disease.

Published
2019
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8. Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study.

Author

Komukai D, Hasegawa T, Kaneshima N, Takayasu M, Sato Y, Hirose M, and Yoshimura A

Subjects
Adolescent, Adult, Disease Progression, Female, Glomerular Filtration Rate, Humans, Japan epidemiology, Kaplan-Meier Estimate, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prevalence, Remission Induction methods, Acute Kidney Injury diagnosis, Acute Kidney Injury epidemiology, Acute Kidney Injury physiopathology, Creatinine analysis, Glucocorticoids therapeutic use, Nephrosis, Lipoid diagnosis, Nephrosis, Lipoid epidemiology, Nephrosis, Lipoid physiopathology, Nephrosis, Lipoid therapy
Abstract

Aim: Acute kidney injury (AKI) is a common complication of minimal change nephrotic syndrome (MCNS), particularly in adults. We evaluated the prevalence of AKI at the onset of adult MCNS and analyzed the influence of AKI on the duration of achieving complete remission (CR)., Methods: A retrospective, single-centre, dynamic cohort study was conducted with biopsy-proven, first-onset, adult MCNS patients treated with corticosteroids. Fifty-three consecutive patients diagnosed with MCNS from January 2000 to April 2014 were enrolled. Age, gender, daily urinary protein excretion, and serum creatinine levels were measured. To evaluate AKI during induction, we used the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI and judged AKI stage according to the fluctuations in serum creatinine levels during the first 4 weeks of starting corticosteroid therapy., Results: Twenty patients (37.7%) met the AKI criteria and all 53 patients achieved CR within 1 year. Kaplan-Meier analysis showed that the median time to CR was significantly longer in patients with AKI than in patients without AKI. Cox proportional hazard analysis showed that the hazard ratio (HR) associated with the presence of AKI for achieving CR within 4 weeks was 0.36 after adjustment for age, gender, serum albumin, daily urinary protein excretion, hypertension, administration of 25% albumin, and methylprednisolone pulse therapy. A graded association was also observed between AKI stage and HR for achieving CR., Conclusions: The prevalence of AKI is high in adult patients with MCNS during induction therapy. AKI is an independent factor that delays the time to CR., (© 2015 Asian Pacific Society of Nephrology.)

Published
2016
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9. Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy.

Author

Nagayama Y, Nishiwaki H, Hasegawa T, Komukai D, Kawashima E, Takayasu M, Tayama H, Inoue Y, Inui K, and Yoshimura A

Subjects
Adult, Female, Glomerulonephritis, IGA epidemiology, Humans, Japan epidemiology, Male, Middle Aged, Multivariate Analysis, Remission Induction, Retrospective Studies, Risk Assessment, Young Adult, Glomerulonephritis, IGA drug therapy, Glomerulonephritis, IGA surgery, Glucocorticoids administration & dosage, Methylprednisolone administration & dosage, Tonsillectomy
Abstract

Background: In 2011, the Japanese Society of Nephrology (JSN) published new clinical guidelines for IgA nephropathy (IgAN) with a new risk stratification based on clinical and histological severity. For classification, patients are divided into four groups (low, medium, high, and very high risk). However, differences in responsiveness to each treatment among different groups remain unclear. We evaluate the responsiveness of tonsillectomy plus steroid pulse (TSP) therapy using the new risk stratification., Methods: We retrospectively reviewed 111 IgAN patients with TSP therapy between January 2003 and January 2013. Study patients were divided into three groups [low- (n = 40), medium- (n = 43) and high-/very high-risk group (n = 28)]. The primary outcome was clinical remission (CR). The observation period was 1 year following tonsillectomy., Results: 57 out of 111 patients (51.4 %) reached CR. The CR incidence was 70.0, 41.9 and 39.3 % (the low-, the medium- and the high-/very high-risk group, respectively). The incidence of CR was significantly higher in the low-risk group (P = 0.013). In a multivariate logistic regression analysis, both the medium- and the high-/very high-risk group showed significantly lower incidence of inducing CR than the low-risk group [(odds ratio 0.324; 95 % confidence interval 0.106-0.939, P = 0.041) (odds ratio 0.239; 95 % confidence interval 0.058-0.910, P = 0.040), respectively]., Conclusions: The new risk stratification in the 2011 JSN clinical guidelines for IgAN had a positive impact on early CR of TSP therapy.

Published
2015
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10. Absence of mesangial C1q deposition is associated with resolution of proteinuria and hematuria after tonsillectomy plus steroid pulse therapy for immunoglobulin a nephropathy.

Author

Nishiwaki H, Hasegawa T, Nagayama Y, Kaneshima N, Takayasu M, Hirose M, Komukai D, Inoue Y, Koiwa F, and Yoshimura A

Subjects
Adult, Aged, Anti-Inflammatory Agents adverse effects, Anti-Inflammatory Agents therapeutic use, Biomarkers analysis, Biomarkers metabolism, Cohort Studies, Complement C1q analysis, Female, Hematuria etiology, Humans, Male, Middle Aged, Occult Blood, Predictive Value of Tests, Prednisolone adverse effects, Prednisolone therapeutic use, Proteinuria etiology, Retrospective Studies, Treatment Outcome, Complement C1q metabolism, Glomerular Mesangium metabolism, Glomerulonephritis, IGA drug therapy, Glomerulonephritis, IGA surgery, Hematuria metabolism, Postoperative Complications drug therapy, Postoperative Complications metabolism, Proteinuria metabolism, Steroids adverse effects, Steroids therapeutic use
Abstract

Introduction and Aims: Deposition of C1q occurs in 0 to 45% of patients with IgAN. In order to identify whether mesangial C1q deposition in IgAN is a novel marker for the response to tonsillectomy plus steroid pulse therapy (TSP), we studied the association between mesangial C1q deposition in IgAN and the remission rate after TSP therapy for IgAN., Methods: We conducted a retrospective cohort study at a single Japanese center. We analyzed data on 110 patients diagnosed with IgA nephropathy who received TSP between January 2003 and December 2012. Positive C1q findings were defined as diffuse mesangial C1q deposition. The study outcome was the resolution of abnormal urinary findings and was defined as negative proteinuria and negative occult blood 1 year after steroid pulse therapy., Results: In all enrolled cases, 69 patients (62.7%) went into remission. Ten out of 24 (41.7%) C1q-positive patients experienced remission, and 59 out of 86 (68.6%) C1q-negative patients experienced remission. Multiple logistic regression model analysis showed that the absence of C1q deposition increased the odds ratio for remission (odds ratio 4.41; 95% confidence interval 1.33-15.75, p = 0.017)., Conclusions: These results suggest that the absence of diffuse C1q deposition in the mesangial area of the glomerulus in patients with IgA nephropathy is a positive predictive sign for a response to TSP and is associated with the resolution of urinary abnormalities 1 year after TSP., (© 2015 S. Karger AG, Basel.)

Published
2015
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11. Evaluation in vitro of the efficacy of colistin methanesulfonate against biofilm-forming multidrug-resistant Pseudomonas aeruginosa (MDRP).

Author

Marumo K, Komukai D, Hirose M, Nakamura H, Tanaka H, Ugajin K, Nagashima G, and Yoshimura A

Subjects
Drug Resistance, Multiple, Bacterial, Humans, Microbial Sensitivity Tests, Pseudomonas Infections microbiology, Anti-Bacterial Agents pharmacology, Biofilms drug effects, Colistin pharmacology, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa physiology
Abstract

The aim of this study was to evaluate in vitro the efficacy of clinically using colistin methanesulfonate against biofilm-forming multidrug-resistant Pseudomonas aeruginosa (MDRP), with minimum inhibitory concentrations (MICs) of ciprofloxacin, imipenem, and amikacin showing ≥4, 16, and 32 μg/ml, respectively, by disk diffusion susceptibility testing (CLSI document M100-S21). The minimum eradication biofilm concentration (MBEC) of colistin methanesulfonate for strain MDRP-YMD isolated from a patient's urine, which formed a biofilm on plastic pegs attached to a microplate lid, was compared with that of P. aeruginosa ATCC27853 for quality control testing with MICs of ciprofloxacin, imipenem, and amikacin showing ≤1, 4, and 16 μg/ml, respectively. In an uneven biofilm approximately 10 μm thick, as determined with confocal laser scanning microscopy (CLSM), ratios of MBEC to MIC of colistin methanesulfonate against strains MDRP-YMD and ATCC27853 were 10.5 and 8.0, whereas those of minimum bactericidal concentration (MBC) to MIC in planktonic cells were 1.0 and 2.0 μg/ml, respectively. Morphological examination using scanning electron microscopy and CLSM verified that embedded cells in biofilm matrices of the two strains were disrupted and died under the MBEC. Therefore, bactericidal effects of colistin methanesulfonate on biofilm-forming cells of strain MDRP-YMD as well as strain ATCC27853 were significantly decreased compared with those on the planktonic cells.

Published
2013
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12. Influence of renin-angiotensin system on serum parathyroid hormone levels in uremic patients.

Author

Koiwa F, Komukai D, Hirose M, Yoshimura A, Ando R, Sakaguchi T, Komatsu Y, Shinoda T, Inaguma D, Joki N, Nishida H, Ikeda M, and Shigematsu T

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Kidney Failure, Chronic therapy, Male, Middle Aged, Renal Dialysis, Renin-Angiotensin System drug effects, Uremia blood, Vitamin D therapeutic use, Angiotensin Receptor Antagonists therapeutic use, Calcium blood, Kidney Failure, Chronic blood, Parathyroid Hormone blood, Renin-Angiotensin System physiology
Abstract

Introduction: The aim of this study was to investigate the factors influencing serum parathyroid (PTH) levels, including medications for treating chronic kidney disease-mineral and bone metabolism disorder (CKD-MBD) in patients with end-stage renal disease., Methods: We enrolled 1,076 patients in nine Japanese facilities who had begun hemodialysis (HD) due to ESRD. We investigated the relationships between intact PTH (iPTH) levels and clinical parameters and medications just prior to beginning HD., Results: Significant decreases in serum iPTH levels were seen in males, in the presence of diabetes mellitus (DM), and with administration of renin-angiotensin system inhibitors (RASIs). Significant correlations were found between serum calcium and iPTH levels. In the patients administered RASIs, there was a significant decrease in serum iPTH levels with DM, male gender, and administration of active vitamin D sterols (VDs) compared with those not administered RASIs, although serum-corrected calcium levels were not different. Multiple regression analysis found gender, age, presence of DM, and serum calcium and phosphate levels to be significant contributing factors. In addition, administration of angiotensin II receptor blockers (ARBs) may also be a contributing factor to iPTH levels at the beginning HD (p = 0.050)., Conclusions: In this study, serum iPTH levels were related to administration of ARBs besides gender, age, the presence of DM and serum calcium levels. Our study suggests that the RA system involve serum iPTH levels in uremic patients.

Published
2012
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13. Reversible posterior leukoencephalopathy syndrome after blood transfusion in a patient with end-stage renal disease.

Author

Sato Y, Hirose M, Inoue Y, Komukai D, Takayasu M, Kawashima E, Koiwa F, and Yoshimura A

Subjects
Adult, Anemia etiology, Brain Edema etiology, Cerebral Angiography methods, Delayed Diagnosis, Diffusion Magnetic Resonance Imaging, Epilepsy, Tonic-Clonic etiology, Female, Glucocorticoids therapeutic use, Glycerol therapeutic use, Headache etiology, Humans, Kidney Failure, Chronic complications, Methylprednisolone therapeutic use, Posterior Leukoencephalopathy Syndrome diagnosis, Posterior Leukoencephalopathy Syndrome drug therapy, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Anemia therapy, Kidney Failure, Chronic therapy, Posterior Leukoencephalopathy Syndrome etiology, Renal Dialysis adverse effects, Transfusion Reaction
Abstract

A 42-year-old female end-stage renal disease (ESRD) patient with reversible posterior leukoencephalopathy syndrome (RPLS) post-transfusion during initiation of hemodialysis is reported. Eleven days after the onset of illness, we diagnosed encephalopathy as a grand mal seizure resulting from diffuse cerebral edema. One reason for the delayed diagnosis was that her symptom, a throbbing headache that occurred during her first dialysis, indicated dialysis disequilibrium syndrome. We must bear in mind that a small amount of transfusion could cause RPLS even during the first dialysis. To our knowledge, this is the first case report on RPLS after blood transfusion in an ESRD patient.

Published
2011
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14. A strict low protein diet during the predialysis period suppresses peritoneal permeability at induction of peritoneal dialysis.

Author

Hasegawa T, Yoshimura A, Hirose M, Komukai D, Tayama H, Watanabe S, Koiwa F, Yamazaki S, and Ideura T

Subjects
Adult, Blood Glucose metabolism, Cohort Studies, Creatinine blood, Female, Humans, Male, Middle Aged, Permeability, Retrospective Studies, Treatment Outcome, Diet, Protein-Restricted, Kidney Failure, Chronic metabolism, Kidney Failure, Chronic therapy, Peritoneal Dialysis, Peritoneum metabolism
Abstract

Background: The factors that predict baseline peritoneal permeability remain largely unknown. We noticed that patients that adhered to a strict low protein diet (LPD) during the predialysis period seldom showed high peritoneal permeability on the peritoneal equilibration test (PET) at the introduction of peritoneal dialysis (PD). Therefore, we investigated whether a strict LPD during the predialysis period affects peritoneal permeability., Method: We retrospectively analyzed 37 patients that started PD in a single Japanese center. Patients were divided into group A and group B by the median amount of daily protein intake (PI) during the predialysis period using urine collected over 24 hours., Results: There were no differences between groups A and B in age, gender, proportion of diabetic nephropathy, blood pressure, body mass index, or body surface area. There were also no differences between the groups in laboratory findings, including hematocrit, serum albumin, and serum creatinine. The PETs showed a significantly lower dialysate-to-plasma ratio of creatinine at 4 hours (Cr D/P) for group A than for group B (p = 0.02). Furthermore, a significant positive correlation between Cr D/P and PI was observed (r = 0.53, p < 0.01)., Conclusion: It is suggested that a strict LPD during the predialysis period may suppress peritoneal permeability at induction of PD.

Published
2009

15. Mixed cryoglobulinemia due to chronic hepatitis C with severe pulmonary involvement.

Author

Suzuki R, Morita H, Komukai D, Hasegawa T, Nakao N, Ideura T, and Yoshimura A

Subjects
Aged, Female, Humans, Kidney pathology, Cryoglobulinemia etiology, Hepatitis C, Chronic complications, Respiratory Distress Syndrome complications
Abstract

Pulmonary involvement in cryoglobulinemia usually is mild. We present a rare case of severe lung involvement in mixed cryoglobulinemia. A 73-year-old woman with cryoglobulinemic glomerulonephritis was admitted. Dyspnea appeared suddenly two days later. She received the diagnosis of acute lung injury according to the concept proposed by the American-European Consensus Conference. Management required corticosteroid pulse therapy and plasma exchange. This case is the first description of successful early and long-term management of severe lung involvement observed in cryoglobulinemia. Although she has been free of chest symptoms for seven months, further follow-up may be necessary to assess the potential danger of relapse.

Published
2003
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