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The paper presents the results of thermoanalytical studies by TG/DTG/DTA, FTIR and GC/MS for the oil sand used in art and precision foundry. On the basis of course of DTG and DTA curves the characteristic temperature points for thermal effects accompanying the thermal decomposition reactions were determined. This results were linked with structural changes occurred in sample. It has been shown that the highest weight loss of the sample at temperatures of about 320°C is associated with destruction of C-H bonds (FTIR). In addition, a large volume of gases and high amounts of compounds from the BTEX group are generated when liquid metal interacts with oil sand. The results show, that compared to other molding sands used in foundry, this material is characterized by the highest gaseous emissions and the highest harmfulness, because benzene emissions per kilogram of oil sand are more than 7 times higher than molding sand with furan and phenolic binders and green sand with bentonite and lustrous carbon carrier.

The effects of silica additive (Poraver) on selected properties of BioCo3 binder in form of an aqueous poly(sodium acrylate) and dextrin (PAANa/D) binder were determined. Based on the results of the thermoanalytical studies (TG-DTG, FTIR, Py-GC/MS), it was found that the silica additive results in the increase of the thermostability of the BioCo3 binder and its contribution does not affect the increase in the level of emissions of organic destruction products. Compounds from group of aromatic hydrocarbons are only generated in the third set temperature range (420-838°C). The addition of silicate into the moulding sand with BioCo3 causes also the formation of a hydrogen bonds network with its share in the microwave radiation field and they are mainly responsible for maintaining the cross-linked structures in the mineral matrix system. As a consequence, the microwave curing process in the presence of Poraver leads to improved strength properties of the moulding sand (Rum). The addition of Poraver's silica to moulding sand did not alter the permeability of the moulding sand samples, and consequently reduced their friability. Microstructure investigations (SEM) of microwave-cured samples have confirmed that heterogeneous sand grains are bonded to one another through a binder film (bridges).

Emission of gases under high temperature after pouring molten metal into moulds, which contain the organic binder or other additives (solvents or curing agent), may be an important factor influencing both on the quality of the produced castings, and on the state of environment. Therefore, a comprehensive study of the emitted gases would allow to determine restrictions on the use of the moulding sands in foundry technologies, eg. the probability of occurrence of casting defects, and identify the gaseous pollutants emitted to the environment. The aim of the research presented in this paper was to determine the amount of gases that are released at high temperatures from moulding sands bonded by biopolymer binder and the quantitative assessment of the emitted pollutants with particular emphasis on chemical compounds: benzene, toluene, ethylbenzene and xylenes (BTEX). The water-soluble modified potato starch as a sodium carboxymethyl starch with low (CMS-NaL) or high (CMS-NaH) degree of substitution was a binder in the tested moulding sands. A tests of gases emission level were conducted per the procedure developed at the Faculty of Foundry Engineering (AGH University of Science and Technology) involving gas chromatography method (GC). The obtained results of the determination of amount of BTEX compounds generated during the decomposition process of starch binders showed lower emission of aromatic hydrocarbons in comparison with binder based on resin Kaltharz U404 with the acidic curing agent commonly used in the foundries.

Out of moulding sands used in the foundry industry, sands with organic binders deserve a special attention. These binders are based on synthetic resins, which ensure obtaining the proper technological properties and sound castings, however, they negatively influence the environment. These resins in their initial state these resins are not very dangerous for people and for the environment, thus under an influence of high temperatures they generate very harmful products, being the result of their thermal decomposition. Depending on the kind of the applied resin, under an influence of a temperature such compounds as: furfuryl alcohol, formaldehyde, phenol, BTEX group (benzene, toluene, ethylbenzene, xylene), and also polycyclic aromatic hydrocarbons (PAHs) can be formed and released.

The article presents research results of physico-chemical and environmental issues for the dust generated during dedusting of the installation for the processing and preparation of moulding sand with bentonite. Particular attention was paid to the content of heavy metals and emission of gases from the BTEX group, which is one of the determinants of the moulding sands harmfulness for the environment. The analysis of heavy metals in the test samples indicate that there is an increase of the content of all metals in the dust compared to the initial mixture of bentonite. The most significant (almost double) increase observed for zinc is probably related to the adsorption of this element on the dust surface by contact with the liquid metal. The study showed, that dust contained more than 20% of the amount of montmorillonite and had a loss on ignition at a similar level. The addition of 1% of dust to the used moulding sand results in almost 30% increase in the total volume of gases generated in casting processes and nearly 30% increase of the benzene emission.

No-bake process refers to the use of chemical binders to bond the moulding sand. Sand is moved to the mould fill station in preparation for filling of the mould. A mixer is used to blend the sand with the chemical binder and activator. As the sand exits the mixer, the binder begins the chemical process of hardening. This paper presents the results of decomposition of the moulding sands with modified urea-furfuryl resin (with the low content of furfuryl alcohol below 25 % and different activators: organic and inorganic) on a quartz matrix, under semi-industrial conditions. Investigations of the gases emission in the test foundry plant were executed according to the method extended in the Faculty of Foundry Engineering (AGH University of Science and Technology). Article presents the results of the emitted chosen aromatic hydrocarbons and loss on ignition compared with the different activators used to harden this resin. On the bases of the data, it is possible to determine the content of the emitted dangerous substances from the moulding sand according to the content of loss on ignition.

The furan resin offers advantages such as high intensity, low viscosity, good humidity resistance and is suitable for cast different casting alloys: steel, cast iron and non-ferrous metal casting. For hardening furan resins are used different hardeners (acid catalysts). The acid catalysts have significant effects on the properties of the cured binder (e,g. binding strength and thermal stability) [1 - 3]. Investigations of the gases emission in the test foundry plant were performed according to the original method developed in the Faculty of Foundry Engineering, AGH UST. The analysis is carried out by the gas chromatography method with the application of the flame-ionising detector (FID) (TRACE GC Ultra THERMO SCIENTIFIC).

The harmfulness assessment of moulding sands with a geopolymer binder and a new hardener, in an aspect of the emission of substances from the BTEX group, was performed. Within the expedience project the new series of hardeners for the inorganic GEOPOL binder was developed. Before the introduction of the new system of moulding sands it was necessary to estimate their influence on the environment. To this aim the gasses emission from moulding sands subjected to the influence of liquid cast iron was tested with regard to the content of the gases from the BTEX group (benzene, toluene, ethylbenzene and xylenes). For the comparison the analogous investigations of the up to now applied moulding sands with the geopolymer binder, were performed. It was found that both systems of moulding sands binding emit similar amounts of gases, as well as similar amounts of substances from the BTEX group. Moulding sands with the GEOPOL binder are much more environmentally friendly than moulding sands with organic binders. The content of the BTEX group substances in gases emitted from moulding sands with the GEOPOL binder was approximately 10-times lower than in case of the moulding sands with organic binders.

The paper presents the results of an investigation of the gases emission of moulding sands with an inorganic (geopolymer) binder with a relaxation additive, whose main task is to reduce the final (residual) strength and improves knocking-out properties of moulding sand. The moulding sand without a relaxation additive was the reference point. The research was carried out using in accordance with the procedure developed at the Faculty of Foundry Engineering of AGH - University of Science and Technology, on the patented stand for determining gas emissions. Quantification of BTEX compounds was performed involving gas chromatography method (GC).The study showed that the introduction of relaxation additive has no negative impact on gas emissions - both in terms of the total amount of gases generated, as well as emissions of BTEX compounds. Among the BTEX compounds, only benzene is emitted from the tested moulding sands. Its emission is associated with the introduction a small amount of an organic hardener from the group of esters. [ABSTRACT FROM AUTHOR]

The problem of harmful casting resins has been present in foundries for many years. Manufacturers are introducing new products that contain in their composition environmentally and eco-friendly ingredients. Unfortunately, not all types of technology can be used, sometimes environmental benefits are disproportionate to the quality of castings and their price. In the foundry industry, the most popular binders are based on organic compounds (often carcinogenic) and other harmful substances. Due to strict legal regulations regarding environmental protection, as well as care for the foundry's workers' comfort - their occurrence should be reduce to a minimum. These compounds often behave also depending on the conditions of use (temperature, atmosphere). The application of various methods of thermal analysis and spectroscopic methods allows to verify the mechanism of resin decomposition process in relation to conditions in the form in both inert and oxidizing atmosphere. For analysis the resins from cold-box technology, were used TG-DTG-DSC, Py-GC/MS methods and specified the course of changes occurring in combination of different atmosphere. [ABSTRACT FROM AUTHOR]

This paper focuses on the thermal behavior of the starch-based binder (Albertine F/1 by Hüttenes-Albertus) used in foundry technology of molding sand. The analysis of the course of decomposition of the starch material under controlled heating in the temperature range of 25- 1100°C was conducted. Thermal analysis methods (TG-DTG-DSC), pyrolysis gas chromatography coupled with mass spectrometry (Py- GC/MS) and diffuse reflectance spectroscopy (DRIFT) were used. The application of various methods of thermal analysis and spectroscopic methods allows to verify the binder decomposition process in relation to conditions in the form in both inert and oxidizing atmosphere. It was confirmed that the binder decomposition is a complex multistage process. The identification of CO2 formation at set temperature range indicated the progressive process of decomposition. A qualitative evaluation of pyrolysis products was carried out and the course of structural changes occurring in the presence of oxygen was determined based on thermo-analytical investigations the temperature of the beginning of binder degradation in set condition was determined. It was noticed that, significant intensification of Albertine F/1 sample decomposition with formation of more degradation products took place at temperatures above 550°C. Aromatic hydrocarbons were identified at 1100°C. [ABSTRACT FROM AUTHOR]

In the foundry industry, many harmful compounds can be found, which as a result of gradual but long-term exposure to employees bring negative results. One of such compounds is phenol (aromatic organic compound), which its vapours are corrosive to the eyes, the skin, and the respiratory tract. Exposition to this compound also may cause harmful effects on the central nervous system and heart, resulting in dysrhythmia, seizures, and coma. Phenol is a component of many foundry resins, especially used in shell moulds in the form of resincoated sands. In order to identify it, the pyrolysis gas chromatography-mass spectrometry method (Py-GC/MS) was used. The tests were carried out in conditions close to real (shell mould process - temperature 300°C). During the measurement, attention was focused on the appropriate selection of chromatographic analysis conditions in order to best separate the compounds, as it is difficult to separate the phenol and its derivatives. The identification of compounds was based on own standards. [ABSTRACT FROM AUTHOR]

The organo-inorganic commercial binder Albertine F/1 (Hüttenes-Albertus) constituting the starch-aluminosilicate mixture was directed to structural studies. The paper presents a detailed structural analysis of the binder before and after exposure to physical curing agents (microwaves, high temperature) based on the results of infrared spectroscopy studies (FTIR). An analysis of structural changes taking place in the binder system with the quartz matrix was also carried out. Based on the course of the obtained IR spectra, it was found that during the exposure on physical agents there are structural changes within the hydroxyl groups in the polymeric starch chains and silanol groups derived from aluminosilicate as well as in the quartz matrix (SiO2). The curing of the molding sand takes place due to the evaporation of the solvent water and the formation of intramolecular and intermolecular cross-linking hydrogen bonds. Type and amount of hydrogen bonds presence in cured molding sand have an impact on selected properties of molding sand. Results indicates that for molding sand with Albertine F/1 during conventional heating a more extensive network of hydrogen bonds is created. [ABSTRACT FROM AUTHOR]

In many foundries, the requirements placed on castings production have risen mainly over the few years. Further trends in recent years have been the ever increasing level of automation and introduction of new alloys, especially composites. On the other hand, the foundry environment has become increasingly difficult because is used many organic binders. Environmental regulations will be further tightened up. These processes are pursued at national, European and global level. Conformity with emission limits is becoming increasingly difficult. The problem is emission of aromatic hydrocarbons, phenol, odours and other harmful compounds to environment. The main purpose of many companies is reduction of this toxins. The new cold-box systems (based on phenolic resins) try to reduce the emission by introducing into the resin structure silicate modifiers. Research presented of this article evaluate the effectiveness of these methods. The results show comparison of two resins ("without" and "with" silicate modifier) for assessment of emission of harmful aromatic hydrocarbons and phenol. [ABSTRACT FROM AUTHOR]

The article contains the results of emission BTEX (benzene, toluene, ethylobenzene and xylenes) during thermal destruction (500 - 1 300 °C) of moulding sand with furan resin. This furan resin is with a high content of free furfuryl alcohol (about 80 %). Knowledge of emissions of these compounds allows the assessment the harmfulness of a given moulding sand. Quantitative analysis of BTEX is highly complex and requires using of modern equipment (e.g. gas chromatography -- mass spectrometry). Therefore, an attempt to assess potential emissions of BTEX compounds from a given moulding sand based on measurements of total volatile organic compounds (VOC) emission and loss on ignition (LOI). These measurements are less time-consuming and do not require expensive equipment. [ABSTRACT FROM AUTHOR]

The casting production is considered of the main factors influencing the development of World economy. Actual capacity of the world's casting production, which is about 101 mln metric ton per year (2012), is strongly diversified. The last decade brought significant changes in the World map of the greatest casting producers. Globalization and transformation of economic systems is reflected by variations of foundry production in different countries, moreover the globalization of economy is regarded not only as a chance but also as a menace for European foundries. [ABSTRACT FROM AUTHOR]

Procedures have been developed to determine the volume, rate and composition (particularly BTEX: benzene, toluene, ethylbenzene and xylenes and PAHs (polycyclic aromatic hydrocarbons)) of gas evolution from moulds and cores prepared with various binders as a means of harmfulness of moulding sands. The rate of gas evolution from green sands with four different lustrous carbon carrier and BTEX content were determined. The gas evolution rates are highest in the range of about 20 to 30 s after contact with molten metal. In practice during the first 200-250 s the total emission of gases generated in investigated samples occurred. The main emitted component from the BTEX group was benzene. [ABSTRACT FROM AUTHOR]

In this paper, the results of decomposition of a moulding sand with furfuryl resin also on a quartz matrix and with additions of a reclaimed material, under industrial conditions, are presented. Investigations of the gases emission in the test foundry plant were performed according to the original method developed in the Faculty of Foundry Engineering, AGH UST. The dependence of the emitted PAHs and BTEX group substances and ignition losses on the reclaim fraction in a moulding sand are of a linear character of a very high correlation coefficient R². On the bases of the derived equations, it is possible to determine the amount of the emitted hazardous substances from the moulding sand containing the known fraction of the reclaim. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study focusing on the gas generation of 3D-printed cores fabricated using binder-jetting technology with furfuryl resin. The research aimed to compare gas emission levels, where the volume generated during the thermal degradation of the binder significantly impacts the propensity for gaseous defects in foundries. The study also investigated the influence of the binder type (conventional vs. 3D-printed dedicated binder) and core construction (shell core) on the quantity of gaseous products from the BTEX group formed during the pouring of liquid foundry metal into the cores. The results revealed that the emitted gas volume during the thermal decomposition of the organic binder depended on the core sand components and binder type. Cores produced using conventional methods emitted the least gases due to lower binder content. Increasing Kaltharz U404 resin to 1.5 parts by weight resulted in a 37% rise in gas volume and 27% higher benzene emission. Adopting shell cores reduced gas volume by over 20% (retaining sand with hardener) and 30% (removing sand with hardener), presenting an eco-friendly solution with reduced benzene emissions and core production costs. Shell cores facilitated the quicker removal of gaseous binder decomposition products, reducing the likelihood of casting defects. The disparity in benzene emissions between 3D-printed and vibratory-mixed solid cores is attributed to the sample preparation process, wherein 3D printing ensured greater uniformity.

A new type of organobentonite foundry binder composed of a composite of bentonite (SN) and poly(acrylic acid) (PAA) was analyzed using thermal analysis (TG-DTG-DSC) and pyrolysis gas chromatography mass spectrometry (Py-GC/MS). The temperature range in which the composite retains its binding properties was identified using thermal analysis of the composite and its components. Results showed that the thermal decomposition process is complex and involves physicochemical transformations that are mainly reversible at temperatures in the ranges of 20-100 °C (related to evaporation of solvent water) and 100-230 °C (related to intermolecular dehydration). The decomposition of PAA chains occurs between 230 and 300 °C, while complete decomposition of PAA and formation of organic decomposition products takes place at 300-500 °C. Dehydroxylation of montmorillonite (MMT) in bentonite begins at about 500 °C, which leads to a drastic structural transformation. An endothermic effect associated with the remodeling of the mineral structure was observed on the DSC curve in the range of 500-750 °C. The produced SN/PAA composite was found to be thermostable during degradation in both oxidative and inert atmosphere, similar to the starting bentonite, and even maintained over a relatively higher and wider temperature range compared to organic binding materials used. At the given temperatures of 300 °C and 800 °C, only CO 2 emissions occur from all the examined SN/PAA samples. There is no emission of compounds from the BTEX group. This means that the proposed binding material in the form of the MMT-PAA composite will not pose a threat to the environment and the workplace.

Casting cores produced in additive manufacturing are more often used in industrial practice, in particular in the case of the production of unit castings and castings with very complex geometry. The growing interest in the technology of 3D printing of cores and molds also brings emerging doubts related to their mechanical and technological properties. This article presents a comparison of the properties of cores made of sand with acid-curing furfuryl resin, made with 3D printing technology; the cores were prepared in a conventional way (mixing and compaction). The main purpose of this research was to determine the possibility of using shell cores as a substitute for solid cores, aimed at reducing the amount of binder in the core. The influence of the type of the binder and the size of the grain matrix fraction on the obtained mechanical and technological properties of the cores, with particular emphasis on abrasion and thermal deformation, as well as on the kinetics of their hardening, was demonstrated., Competing Interests: The authors declare no conflict of interest.

A series of studies related to the production of organobentonite, i.e., bentonite-poly(acrylic acid), and its use as a matrix grain-binding material in casting moulding sand is presented. In addition, a new carbon additive in the form of shungite was introduced into the composition of the moulding sand. Selected technological and strength properties of green sand bond with the obtained organobentonite with the addition of shungite as a new lustrous carbon carrier (Rcw, Rmw, Pw, Pw, PD) were determined. The introduction of shungite as a replacement for coal dust in the hydrocarbon resin system demonstrated the achievement of an optimum moulding sand composition for practical use in casting technology. Using chromatographic techniques (Py-GC/MS, GC), the positive effect of shungite on the quantity and quality of the gaseous products generated from the moulding sand during the thermal destruction of its components was noted, thus confirming the reduced environmental footprint of the new carbon additive compared to the commonly used lustrous carbon carriers. The test casting obtained in the mould of the organobentonite moulding sand and the shungite/hydrocarbon resin mixture showed a significantly better accuracy of the stepped model shape reproduction and surface smoothness compared to the casting obtained with the model moulding sand.

Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA) typically occurs in anti-neutrophil cytoplasmic autoantibody (ANCA)-positive cases presenting with rapidly progressive renal insufficiency and urinary abnormalities induced by primarily necrotizing crescentic glomerulonephritis (NCGN). Recently, ANCA-negative EGPA has also been reported to manifest with renal involvement, such as NCGN or non-NCGN, including membranous nephropathy (MN). Herein, we report a 70-year-old female who presented with purpura on the lower legs, upper limb numbness, renal dysfunction (eGFR, 20.5 ml/min/1.73 m 2 ), and eosinophilia (eosinophils, 37,570/ μ l). MPO-and PR3-ANCA were negative, and urinalysis revealed urine protein (0.63 g/day) but without red blood cells in the urine sediment. Thus, she was diagnosed with ANCA-negative EGPA with rapidly progressive renal dysfunction. A renal biopsy revealed vasculitis in the interlobular arteries without NCGN, with the vasculitis being complicated by MN. Micrograph findings on fluorescence immunostaining contained both primary and secondary characteristics of MN (dominance of IgG subclass 4 more than subclass 1 vs. negativity of PLA2R and THSD7A). After treatment with prednisolone, her eosinophil counts normalized, and renal dysfunction improved. Furthermore, urine protein did not increase above 1.0 g/day during the clinical course. This is a rare case of ANCA-negative EGPA presenting with acute renal dysfunction without NCGN and subclinical MN with unknown etiology. It is important to recognize that EGPA pathology varies widely throughout the disease course, and the clinical course of subclinical MN should be carefully assessed in further follow-ups., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2022 Eri Kasama et al.)

Background: We experienced a nosocomial outbreak of coronavirus disease 2019 (COVID-19) from November 2020 to February 2021, during the third wave of the pandemic in Japan., Methods: We retrospectively assessed the characteristics and data of 20 inpatients undergoing hemodialysis who were hospitalized for treatment of diseases other than COVID-19 during the COVID-19 nosocomial outbreak ("inpatient," IP), and of 10 outpatients undergoing hemodialysis who were hospitalized for the care of COVID-19 under outpatient visits ("outpatient," OP)., Results: Eleven patients in the IP group (55%) and one in the OP group (10%) died. Kaplan-Meier analysis showed that the IP group died more rapidly than the OP group ( p  = 0.02). Multivariate analysis among all hemodialysis patients showed that the IP group was not at risk of mortality independently; however, the activity of daily life (ADL) dependency was found to be an independent factor in increasing the risk of mortality (hazard ratio: 7.618)., Conclusion: Our findings show that the nosocomial infected group has a worse prognosis, although it is not an independent predictor for the risk of mortality. ADL dependency could predict the risk of mortality in all hemodialysis patients with COVID-19 during the third wave pandemic in Japan., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2022.)

Background: Preventing progression to end-stage renal disease (ESRD) in advanced IgA nephropathy (IgAN) patients with impaired renal function remains challenging. We analyzed the efficacy of tonsillectomy combined with steroid pulse therapy (TSP)., Methods: In this retrospective analysis, IgAN patients with proteinuria > 0.5 g/day and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 were divided into three groups: patients treated with TSP (TSP group; n = 23), oral prednisolone (oPSL group; n = 41), and conservative therapy (CONS group, n = 51). We analyzed the clinical and histological backgrounds, remission of urinary findings, and renal survival rate to a 25% decline in eGFR from baseline, and incidence of ESRD., Results: There were significant differences in the patients' backgrounds among the groups. Therefore, we adjusted the background using propensity score marching between TSP group and oPSL or CONS group. The 5-year remission rate of hematuria was significantly higher in the TSP group than in the oPSL group, and that of both hematuria and proteinuria was significantly higher in the TSP group than in the CONS group. The 10-year renal survival rate was significantly higher in the TSP group than in the oPSL and CONS groups. In a multivariate Cox regression analysis, TSP was found to be an independent factor for the 25% decline in eGFR in entire cohort. The adverse effect frequency in the TSP group was similar to the CONS group., Conclusions: TSP can effectively induce remission of urinary abnormality and improve the prognosis without frequent adverse effects in IgAN patients with impaired renal function.

Background: Global sclerosis has been reported as the risk factor of IgAN. In Oxford classification, global sclerosis was correlated with tubulointerstitial (T) lesions. Therefore, in patients with T lesions, renin-angiotensin system inhibitors (RASI) might be effective by decreasing glomerular hyperfiltration and hypertension. However, these beneficial effects of RASI have not been reported., Methods: In this retrospective cohort study, we divided 87 IgAN patients with T1/2 lesions into two groups: RASI group (n = 47, treated with RASI) and APA group (n = 40, treated with anti-platelet agents). We analyzed the background of each group, the serial changes of blood pressure and the amount of proteinuria (U-Prot), progression to end-stage renal disease, and the risk factors for progression., Results: After propensity score matching, 22 cases from each group were selected, and clinical and histological characteristics were similar. Serial changes of blood pressure had been significantly decreased in RASI group (p = 0.0029), but not in the APA group. Proteinuria was tended to decrease in RASI group, though it was not significant (1.14-0.47 g/gCre) and it was similar in APA group (0.95-0.85 g/gCre). 20 year renal survival rate was 59.5% in RASI group, whereas 21.3% in APA group (p = 0.0119). In multivariate Cox regression analysis, RASI was an independent factor to prevent from progression to ESRD (HR 5.91, p = 0.0039)., Conclusion: RASI has shown a significant beneficial effect on histologically advanced IgAN patients with T lesions. These results are compatible with the previous studies that reported the beneficial effects of RASI on clinically advanced IgAN patients.

Objective Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been reported to have beneficial effects in patients with IgA nephropathy (IgAN). Although DHA and EPA have different mechanisms of action, no study to date has assessed their individual actions in patients with IgAN. This study therefore analyzed the effects administering DHA in addition to EPA for the treatment of IgAN. Methods Twenty-one IgAN patients who were being treated with EPA (1,800 mg/day) were switched to EPA (1,860 mg/day) and DHA (1,500 mg/day). The changes in their clinical parameters from 6 months before to 6 months after switching treatment were analyzed. Results The triglyceride levels did not change during treatment with EPA alone, but tended to decrease-although not to a statistically significant extent-after the switch. The patients' low-density-lipoprotein cholesterol, blood pressure, proteinuria, and hematuria levels were similar before and after switching. The estimated glomerular filtration rate (eGFR) tended to decrease during EPA therapy, but became stable after switching and the median %⊿eGFR changed from -7.354% during EPA therapy to +1.26% during the 6 months after switching to EPA and DHA therapy (p=0.00132), and renal the function remained stable for another 6 months. Moreover, the median %⊿eGFR during the 6 months after switching was significantly higher in comparison to IgAN patients who were treated with EPA alone as a control (-3.26%, p=0.0361). No clinical parameters were independently associated with a stable renal function without switching to DHA/EPA. Conclusion The addition of DHA to EPA stabilized the renal function of IgAN patients, and it seemed that there were pleiotropic effects beyond the improvement of the clinical parameters.

A 71-year-old Japanese woman presented with progressive fatigue, lethargy, dysarthria and a gait disorder. Her laboratory data revealed hyponatremia (Na 101 mEq/L), and we started correcting her serum sodium level. Within a few days, she became comatose, bedridden, and was intubated. We diagnosed osmotic demyelination syndrome (ODS) and started performing plasma exchange (PE) on the 39th day of hospitalization. She fully recovered after starting PE, and was discharged on foot unassisted. PE can be a beneficial treatment in patients with chronic ODS.

We report a patient treated with rituximab for interstitial pneumonia (IP) associated with microscopic polyangiitis (MPA) and who was undergoing hemodialysis. A 59-year-old woman who had been treated with tacrolimus for 1 year for rheumatic arthritis was referred to the Department of Nephrology for fatigue, fever, weight loss, and rapidly developing renal dysfunction. On the first admission, severe renal dysfunction, proteinuria, hematuria, and an elevated titer of MPO-ANCA were observed, and the woman was diagnosed with rapidly progressive glomerulonephritis because of MPA. At that point, IP was found to be present but not active. Although steroid semipulse therapy following an initial prednisolone (PSL) administration of 40 mg/day, IVCY, and plasma exchange were administered, renal dysfunction did not recover, and the patient required maintenance hemodialysis. Upon discharge, a high titer of MPO-ANCA was continuously observed. Nine months after the initiation of hemodialysis, respiratory discomfort and desaturation developed. Interstitial shadow and ground glass opacity were seen on a CT scan, and the patient was diagnosed with exacerbation of interstitial pneumonia caused by MPA recurrence. At the second admission, acute findings identified by imaging techniques had improved. However, the high titer of MPO-ANCA continued in spite of the steroid semi-pulse therapy following PSL administration, and rituximab corresponding to 200 mg/weekly for 1 month was also administered. The dose of rituximab was decreased subsequently because the patient was judged to be compromised by the hemodialysis. At the same time, internal administration of sulfamethoxazole/trimethoprim was initiated. After the rituximab treatment, MPO-ANCA antibodies gradually decreased, and the respiratory condition improved. Five months after the rituximab treatment, respiratory dysfunction recurred. Based on the CT findings and a high level of β-D-glycan, the patient was diagnosed with ARDS due to pneumocystis pneumonia. In this case, rituximab was effective for IP due to MPA, but pneumocystis pneumonia could not be prevented in spite of prophylactic antibiotics. This case suggests that deliberative dose adjustments, careful patient observation, and prophylactic measures for infection are critical in rituximab treatment.