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We investigated whether multiple food allergies could be safely prevented by simultaneously administering very small amounts of multiple foods.Infants 3-4 months old with atopic dermatitis from 14 primary care pediatric clinics in Japan were enrolled in this randomized, placebo-controlled trial. The infants were administered either mixed allergenic food powder (MP) containing egg, milk, wheat, soybean, buckwheat, and peanuts, or placebo powder (PP). The amount of powder was increased in a stepwise manner on weeks 2 and 4, and continued until week 12. The occurrence of food allergy episodes after powder intervention was assessed at 18 months old. This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (number UMIN000027837).A total of 163 participants were randomly allocated to either the MP group (n = 83) or the PP group (n = 80). The incidence of food allergy episodes by 18 months was significantly different between the MP and PP groups (7/83 vs. 19/80, respectively; risk ratio 0.301 [95% CI 0.116-0.784]; P = 0.0066). Egg allergies were reduced in the MP group. In addition, food allergy episodes from any of the other five foods were significantly reduced, although the reductions in those due to individual foods were not significant.Gradually increasing the intake of very small amounts of multiple foods in early infancy can safely reduce the incidence of egg allergies. Other foods may also suppress food allergies, but no definitive conclusions could be reached.

Background: There is controversy regarding the efficacy and side effects of proactive administration of allergenic foods in early infancy to prevent food allergies. This is the first trial involving the gradual introduction of trace amounts of multiple foods to infants. Methods: Infants under 4 months old with atopic dermatitis from 14 primary care pediatric clinics in Japan were enrolled in this randomized, double-blind, placebo-controlled trial. The infants were administered either mixed allergenic food powder (MP) containing eggs, milk, wheat, soybeans, buckwheat, and peanuts, or placebo powder (PP). The amount of powder was increased in a stepwise manner on weeks 2 and 4 and continued until week 12. Weaning food was started subsequently according to the Japanese guidelines for nursing/bottle feeding, and for baby food. The occurrence of food allergy episodes after powder intervention was assessed at 18 months old by the physician responsible for each participant. Findings: A total of 163 participants were randomly allocated to either the MP group (n = 83, 50.9%) or the PP group (n = 80, 49.1%). There was a significant difference in the incidence of food allergy episodes by 18 months between the MP and PP groups (7/83 vs. 19/80, respectively; risk ratio 0.301 [95% CI 0.116 – 0.784]; P = 0.008). No serious adverse events attributable to MP were observed. Interpretation: Gradually increasing the intake of trace amounts of multiple foods in early infancy can safely reduce the incidence of food allergies. Clinical Trial Registration Details: UMIN000027837. The protocol for this study and the subsequent changes are available on the UMIN-CTR Trial website. Funding Information: This study was self-funded and did not receive any other support. Declaration of Interests: The authors declare that no conflicts of interest exist. Ethics Approval Statement: Written informed consent was obtained from the parents of the participants at the time of enrollment. The study was approved by the institutional review board of Umezu Clinic.

特発性ネフローゼ症候群 (以下，ネ症) の中には緩徐な経過でネ症に至る症例や病初期にはネ症の診断基準を満たすが，経過観察のみで自然に軽快する非典型的な経過をとる症例がみられる。鳥取県では平成3年より鳥取県小児腎疾患患者登録を実施しており，平成3年～5年の3年間にネ症は25例登録された。その中に，非典型ネ症は4例含まれていた。ステロイド剤 (以下，ス剤) を3日間服用しただけで軽快した症例が1例，緩徐な経過の症例が1例，いったん自然に尿蛋白が消失した後に再燃した症例が2例であった。全例ス剤に感受性があり，1例のみ再発したが，すべて経過は順調である。非典型的ネ症は言い換えれば軽症のネ症と考えられ，ス剤長期投与の副作用を考慮すればネ症診断直後より早期にス剤を開始すべきではなく，一定期間の観察期間をおき，ス剤を必要としない症例を発見する努力が必要と考えられる。

腎疾患の治療の中で食事療法は重要な位置を占めているが，外来通院中の慢性腎疾患児の食事療法のコンプライアンスの確認をすることは難しく，適切な食事指導が行われていない症例に遭遇することがある。今回，私たちは小児慢性腎疾患に対する食事指導の重要性を再確認するため，鳥取大学医学部附属病院小児科外来通院中の慢性腎疾患児57例の味覚識別能を測定するとともに，その臨床検査成績との比較検討を行った。 腎不全患児は慢性腎炎患児に比べて，4味質とも有意に鈍化していた。血清尿素窒素，クレアチニンが高値なものほど4味質とも味覚識別能は鈍感であり，クロールは甘味と塩味，カリウムは甘味と有意な関係を認めた。さらに，慢性腎炎患児では蛋白尿および血尿の程度の強いものほど塩味の味覚識別能は鈍化している傾向にあった。小児慢性腎炎の悪化例では塩味を中心とした味覚識別能が鈍化している傾向にあるので，その生活管理の中で食生活に関する指導は重要であり，味覚検査はその際の有用な指標 となるであろう。

Immunoglobulin A (IgA) nephropathy progresses without apparent signs. The only available means of knowing the precise incidence of this disease in children is to analyze data from the school urinary screening system. Students between 6 and 15 years old with IgA nephropathy detected by school urinary screening from 1983 to 1999 in Yonago City, Japan, were examined. In addition, two hospitals with pediatric care units administered a questionnaire and patients with pediatric IgA nephropathy detected by means other than the school urinary screening program were recruited. Of 270,902 children examined by the school urinary screening system, 29 demonstrated suspected chronic nephritis on the basis of abnormal urinalysis and underwent renal biopsy procedures. Among the 29 children, 14 cases of IgA nephropathy were confirmed. During the same period, of the children examined by means other than the school screening program, 20 demonstrated suspected renal disease and underwent renal biopsies. Among these 20 children, 6 cases of IgA nephropathy were diagnosed. In all, 20 cases of pediatric IgA nephropathy were detected over the past 17 years. The incidence rate of pediatric IgA nephropathy was 4.5 cases/year per 100,000 children under 15 years. The incidence of pediatric IgA nephropathy is higher than that of idiopathic nephrotic syndrome.

A single intravenous injection of adriamycin (ADR) results in marked proteinuria and glomerular morphological changes that are similar to minimal-change disease in humans. We examined the effect of superoxide dismutase (SOD) on ADR-induced proteinuria. ADR in a dose of 7.5 mg/kg body weight significantly increased urinary protein by day 14; proteinuria rapidly increased thereafter. Concurrent administration of SOD (50 mg/kg) over 30 min prior to and 30 min following ADR injection markedly reduced proteinuria. Twenty-one days after the treatment with SOD, the amount of urinary protein was 108.6 +/- 43.1 mg/24 h in the experimental animals, while it was 221.6 +/- 102.9 mg/24 h in the ADR control group (p less than 0.05). There were also less severe glomerular morphologic changes in the SOD group versus ADR controls. The protective effects of SOD provide indirect evidence that oxygen free radicals are important mediators of ADR-induced proteinuria.

Change in the localization of the antigen recognized by the proteinuria-inducing monoclonal antibody (MA) 5-1-6 in experimental nephrosis was studied by indirect and biotin-avidin immunofluorescence, and immunoperoxidase at light and electron microscopical levels. The proteinuric state was induced by the administration of the aminonucleoside of puromycin (PAN) or adriamycin. The antigen decreased in quantity and/or its distribution changed with an increase in the amount of protein excreted in both experimental models. Recovery from the alterations observed during the development and proteinuria appeared to occur when PAN-induced proteinuria subsided. This antigenic molecule may thus be essential for maintaining the normal permselectivity of glomerular capillary walls.