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Background Prognosis of nephrotic syndrome has been evaluated based on pathological diagnosis, whereas its clinical course is monitored using objective items and the treatment strategy is largely the same. We examined whether the entire natural history of nephrotic syndrome could be evaluated using objective common clinical items. Methods Machine learning clustering was performed on 205 cases from the Japan Nephrotic Syndrome Cohort Study, whose clinical parameters, serum creatinine, serum albumin, dipstick hematuria, and proteinuria were traceable after kidney biopsy at 5 measured points up to 2 years. The clinical patterns of time-series data were learned using long short-term memory (LSTM)-encoder–decoder architecture, an unsupervised machine learning classifier. Clinical clusters were defined as Gaussian mixture distributions in a two-dimensional scatter plot based on the highest log-likelihood. Results Time-series data of nephrotic syndrome were classified into four clusters. Patients in the fourth cluster showed the increase in serum creatinine in the later part of the follow-up period. Patients in both the third and fourth clusters were initially high in both hematuria and proteinuria, whereas a lack of decline in the urinary protein level preceded the worsening of kidney function in fourth cluster. The original diseases of fourth cluster included all the disease studied in this cohort. Conclusions Four kinds of clinical courses were identified in nephrotic syndrome. This classified clinical course may help objectively grasp the actual condition or treatment resistance of individual patients with nephrotic syndrome.

Background Despite recent advances in immunosuppressive therapy for patients with primary nephrotic syndrome, its effectiveness and safety have not been fully studied in recent nationwide real-world clinical data in Japan. Methods A 5-year cohort study, the Japan Nephrotic Syndrome Cohort Study, enrolled 374 patients with primary nephrotic syndrome in 55 hospitals in Japan, including 155, 148, 38, and 33 patients with minimal change disease (MCD), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and other glomerulonephritides, respectively. The incidence rates of remission and relapse of proteinuria, 50% and 100% increases in serum creatinine, end-stage kidney disease (ESKD), all-cause mortality, and other major adverse outcomes were compared among glomerulonephritides using the Log-rank test. Incidence of hospitalization for infection, the most common cause of mortality, was compared using a multivariable-adjusted Cox proportional hazard model. Results Immunosuppressive therapy was administered in 339 (90.6%) patients. The cumulative probabilities of complete remission within 3 years of the baseline visit was ≥ 0.75 in patients with MCD, MN, and FSGS (0.95, 0.77, and 0.79, respectively). Diabetes was the most common adverse events associated with immunosuppressive therapy (incidence rate, 71.0 per 1000 person-years). All-cause mortality (15.6 per 1000 person-years), mainly infection-related mortality (47.8%), was more common than ESKD (8.9 per 1000 person-years), especially in patients with MCD and MN. MCD was significantly associated with hospitalization for infection than MN. Conclusions Patients with MCD and MN had a higher mortality, especially infection-related mortality, than ESKD. Nephrologists should pay more attention to infections in patients with primary nephrotic syndrome.

Minimal change disease (MCD) is characterized by a nephrotic syndrome usually steroid-sensitive and a high incidence of relapse of proteinuria. Previous cohort studies have reported conflicting results regarding the association between the time to remission and incidence of relapse.This multicenter prospective cohort study included 102 adult patients with steroid-sensitive MCD or focal segmental glomerulosclerosis from a 5-year cohort study of primary nephrotic syndrome, the Japan Nephrotic Syndrome Cohort Study, who achieved remission of proteinuria within 2 months of immunosuppressive therapy (IST). The association between the time to remission of proteinuria after immunosuppressive therapy and incidence of relapse was assessed using Cox proportional hazards models adjusted for clinically relevant factors.Remission was observed at 3-7, 8-14, 15-21, 22-28, and 30-56 days after initiation of immunosuppressive therapy in 17 (16.7%), 37 (36.3%), 21 (20.6%), 13 (12.7%), and 14 (13.7%) patients, respectively. During a median observation period of 2.3 years after the end of the 2nd month after initiation of immunosuppressive therapy, 46 (45.1%) patients relapsed. The time to remission was associated with the incidence of relapse in an inverse U-shaped pattern (multivariable-adjusted hazard ratios [95% confidence intervals] of the time to remission of 3-7, 8-14, 15-21, 22-28, 30-56 days: 1.00 [reference], 1.76 [0.56, 5.51], 6.06 [1.85, 19.80], 5.46 [1.44, 20.64], and 2.19 [0.52, 9.30], respectively).The time to remission was identified as a significant predictor of relapse in steroid-sensitive patients.

Background and Aims The numbers of elderly patients on dialysis are increasing rapidly around the world. The quality of life (QOL) should be emphasized rather than survival for such patients. Shared decision making (SDM) regarding dialysis treatment options is one way to increase patient satisfaction with treatment, which should result in a better QOL. Thus, we investigated whether SDM affects the lives of elderly patients after dialysis initiation. Method We retrospectively collected clinical information about patients aged ≥ 80 years who started dialysis at our hospital between January 2013 and December 2017. The experience of SDM was defined as whether patients participated in a multidisciplinary approach to decision making about dialysis treatment options. Mortality rates, length of hospital stay and place of death during 2 years after dialysis initiation were determined. Results Among 124 patients, 40 participated in SDM. Functional activity, dementia, and daily assistance did not differ between patients with and without SDM. Participants in SDM were more likely to select PD (SDM vs. non-SDM: 50.0% vs. 3.6%; p < 0.001). Mortality rates did not differ between patients with and without SDM, but the rate of hospitalization for > 240 days was higher among patients without SDM (with vs. without SDM: 0.0 vs. 15.5%; p = 0.009). Among 70 deceased patients within two years, 59 died in hospital. Patients without SDM died in hospital more frequently (with vs. without SDM: 66.7% vs. 91.8%; p = 0.006). Conclusion Shared decision making reduced long-term hospitalization and death in hospital, indicating that more desirable home care therapy should be available for elderly patients on dialysis.

Background and Aims Hypozincemia can arise in patients with advanced chronic kidney disease (CKD) due to low protein intake and urinary or dialytic loss. Several studies have confirmed an association between hypozincemia and infection. Because infections comprise a major complication in patients with advanced CKD, we investigated whether hypozincemia is associated with infection risk in incident patients on dialysis. Method We prospectively analyzed 380 consecutive patients aged 20 years old or more who started hemodialysis between January 2013 and December 2018. Six patients who were receiving zinc supplementation at the time of the study were excluded. Serum zinc values were obtained at the time of dialysis initiation. We followed up the remaining patients after enrollment. The endpoint was severe infection defined as infection-related death or bacteremia confirmed by the detection of microorganisms in two sets of culture bottles. The patients were equally divided into groups with low, middle or high serum zinc concentrations. Data were analyzed using Kaplan-Meier curves and Cox hazards models. The local ethics committee approved this research. Informed consent was obtained from each individual participant included in the study. Results The rate of severe infection events over a follow-up of one year was the highest in the group with low zinc (p = 0.030). Cox hazards models adjusted for age, sex, diabetes mellitus, serum albumin and serum zinc, selected hypozincemia as an independent risk factor for severe infection events (HR, 10.76; 95% CI, 1.28–90.41; p = 0.029). Conclusion Hypozincemia is associated with risk of subsequent severe infection in incident patients on dialysis.

Objective Zinc (Zn) plays an important role in immune function. Several studies have identified an association between a Zn deficiency and infection. Infectious diseases are major complications of chronic kidney disease (CKD). We investigated whether serum Zn concentrations are associated with risk of infection in patients with advanced CKD. Design and Methods We retrospectively analyzed data from 299 patients with CKD whose serum Zn values were measured to evaluate anemia between January 2013 and December 2016. Among them, 9 who were supplemented with Zn and 67 who had started urgent dialysis at the time of measurement were excluded. We analyzed infection events, length of infection-related hospitalization and infection-related and all-cause mortality in the remaining 223 patients during a median follow-up of 36 months. We assigned the patients to groups with low or high Zn values (≤50 and >50 μg/dL, respectively) based on a median value of 50 μg/dL. Data were analyzed using Kaplan-Meier curves and Cox hazards models. Results During a median follow-up of 36 months, 40 patients were hospitalized with infections. The rate of infection-related and long-term hospitalization (>10 days) due to infection was higher for patients with low, than high, Zn values (23.3% vs. 12.6%; P = .042 and 26.2% vs. 12.4%; P = .007, respectively). After adjustment in Cox hazards models, low serum Zn values remained an independent risk factor for infection-related hospitalization (Hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.01-3.71; P = .048), especially for patients on proton pump inhibitor (PPI) medications (HR, 2.66, 95%; CI, 1.22-5.81; P = .014). Conclusion Patients with advanced CKD accompanied by low serum Zn concentration, and particularly those medicated with PPI, are at high risk of infection-related hospitalization, which results in long-term hospitalization.

The aim of the present study was to clarify the prevalence of immunosuppressive drug use and outcomes in elderly and non-elderly patients with primary membranous nephropathy (MN) in nationwide real-world practice in Japan. Between 2009 and 2010, 374 patients with primary nephrotic syndrome were enrolled in the cohort study (The Japan Nephrotic Syndrome Cohort Study, JNSCS), including 126 adult patients with MN. Their clinical characteristics were compared with those of nephrotic patients with primary MN registered in a large nationwide registry (The Japan Renal Biopsy Registry, J-RBR). Outcomes and predictors in the elderly (≥ 65 years) and non-elderly groups were identified. Similar clinical characteristics were observed in JNSCS patients and J-RBR patients (n = 1808). At the early stage of 1 month, 84.1% of patients were treated with immunosuppressive therapies. No significant differences were observed in therapies between age groups. However, elderly patients achieved complete remission (CR) more frequently than non-elderly patients, particularly those treated with therapies that included corticosteroids. No significant differences were noted in serum creatinine (sCr) elevations at 50 or 100%, end-stage kidney disease, or all-cause mortality between age groups. Corticosteroids were identified as an independent predictor of CR (HR 2.749, 95%CI 1.593–4.745, p = 0.000) in the multivariate Cox’s model. sCr levels, hemoglobin levels, immunosuppressants, clinical remission, and relapse after CR were independent predictors of sCr × 1.5 or × 2.0. Early immunosuppressive therapy including corticosteroids for primary MN showed better remission rates in elderly patients in a nationwide cohort study.

Aim: We aimed to evaluate the anti‐albuminuric effects of topiroxostat in Japanese hyperuricaemic patients with diabetic nephropathy. Methods: In this 24‐week, multicentre, open‐label, randomized (1 : 1) trial, we assigned hyperuricaemic patients with diabetic nephropathy (estimated glomerular filtration rate ≥ 20 mL/min per 1.73m2) and overt proteinuria (0.3 ≤ urine protein to creatinine ratio (UPCR), ファイル公開：2019-11-01

Thrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly constitute TAFRO syndrome, a variant of Castleman disease. We describe a patient with TAFRO syndrome who underwent renal biopsy. A 79-year-old woman was referred to us with fever and leg edema. She also had thrombocytopenia, pleural effusion, ascites, and acute kidney injury, and was admitted to our hospital. Her response to initial therapy with corticosteroid and cyclosporine was poor. Therefore, she received 4 doses of rituximab per week, which resulted in clinical improvement, including recovery of thrombocytopenia. A kidney biopsy thereafter showed diffuse, global glomerular endothelial injury indicating thrombotic microangiopathy (TMA). These findings suggested that TMA is associated with the thrombocytopenia and renal insufficiency of TAFRO syndrome.

The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n = 33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [n = 25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.

The number of elderly dialysis patients in Japan is dramatically increasing. Receiving therapy with better satisfaction through home care is one of the important factors in their daily lives. Thus, the quality of life of elderly patients on hemodialysis (HD) or peritoneal dialysis (PD) was evaluated. Clinical information of patients aged ≥80 years who started dialysis at our hospital between January 2013 and December 2015 was retrospectively collected. The mortality rate, length of hospitalization, and place of death were identified to evaluate patient quality of life. In total, 56 patients (14 PD and 42 HD) were enrolled. The mean age of study subjects was 85.2 ± 4.0 years. The proportion of PD patients who lived with their family or have professional caregivers who could assist them in their daily life was higher than that of HD patients (100 vs. 76.2%, respectively; p = 0.044). Mortality rate was higher in PD patients than in HD patients (p = 0.003), but long-term hospitalization of >180 days was observed only in HD patients (PD vs. HD: 0.0 vs. 16.7%; p = 0.102). In patients with Barthel index scores

Background: Early withdrawal within 3 years after starting peritoneal dialysis (PD) and PD-related peritonitis have been major obstacles preventing increases in the population of PD patients. To address these problems, we implemented education programs for medical staff. This study analyzed the recent status and outcomes of PD therapy, focusing on findings such as the incidence and prognosis of peritonitis as of 5 years after our last study. Methods: We investigated background, laboratory data and status of PD therapy, reasons for withdrawal from PD and incidental statements on peritonitis from 2010 to 2012 (R2), and compared findings with those from our last study of 2005–2007 (R1). Results: Early PD therapy withdrawal in R2 clearly improved to 44.7 %, compared with 50.9 % in R1. Peritonitis incidence improved slightly from once per 42.8 months/patient in R1 to once per 47.3 months/patient in R2. Notably, PD-related peritonitis as a cause of mortality improved markedly in R2, but outcomes of PD-related peritonitis did not change significantly between R1 and R2. In contrast, social problems increased as a reason for withdrawal from PD therapy. Conclusion: Our efforts at education might have been useful for improving early withdrawal from PD and deaths attributable to PD-related peritonitis. However, since improvements to incidence of PD-related peritonitis were limited by education, further improvement in PD-related peritonitis incidence requires development of new sterilized connecting systems during PD-bag exchanges to decrease PD-related peritonitis opportunities. Construction of medical support systems to address social problems is required to maintain long-term PD therapy.

Reportedly, thiamine deficiency, resulting from malnutrition and long-term diuretic therapy, is observed in patients with chronic kidney disease (CKD). The risk of thiamine deficiency might be enhanced, especially in end-stage CKD patients. Here, we assessed thiamine status in incident dialysis patients. This study was a single-center cross-sectional study which included 288 consecutive patients initiated into dialysis between April 2013 and March 2017 at our hospital. Thiamine status was evaluated by high-performance liquid chromatography of whole blood samples. We evaluated the association between blood thiamine concentration and other clinical parameters. Of the 288 patients, 21 patients receiving thiamine supplementation at the time of dialysis initiation and 26 patients without blood thiamine measurements were excluded. In 30 patients (12.4%), blood thiamine concentration was lower than the lower limit of normal (21.3 ng/mL; dotted line). Blood thiamine concentration correlated with age, body mass index, and Barthel index (BI) score (p = 0.008, 0.012 and 0.009, respectively). Stepwise multivariate regression analysis indicated that BI scores were independent risk factors for thiamine deficiency (β coefficients = 0.169, p = 0.013). The proportion of end-stage CKD patients with low blood thiamine concentration is high. Low physical function (low BI score) is an independent risk factor of thiamine deficiency. Clinicians should be aware of thiamine deficiency in end-stage CKD patients, especially those with low physical function.

Pozzi et al. reported the effectiveness of steroid pulse therapy (Pozzi’s regimen) in IgA nephropathy (IgAN). The present study was performed to clarify the predictive factors for IgAN patients treated with Pozzi’s regimen. One hundred nine IgAN patients treated by Pozzi’s regimen were observed for up to 112.6 (median 39.7) months, and remission of proteinuria (PR) and disappearance of urinary abnormalities [complete remission (CR)] after Pozzi’s regimen were analyzed. Predictive factors for the glomerular filtration rate (GFR) slopes for up to 5 years were analyzed among 81 patients who were observed for at least 2 years. The outcome of a 50 % increase in sCr was compared between the CR and non-CR groups within 2 years. Cumulative PR and CR rates increased rapidly until 2 years (54.5 and 46.8 % at 2 years), and then slowly but steadily up to 6 years (72.8 and 66.4 % at 6 years). Baseline characteristics of the CR and non-CR groups within 2 years were similar except for proteinuria. GFR slope was steeper in the non-CR group than in the CR group (−2.44 ± 5.12 vs. −0.32 ± 3.34 ml/min/1.73 m2/year). On multivariate analysis, sex and CR within 2 years were associated with GFR slope. Kaplan-Meier analysis demonstrated a better survival rate in CR group patients without a 50 % increase in sCr (p = 0.024). Among IgAN patients treated with Pozzi’s regimen, CR within 2 years predicts a good prognosis.

ギラン・バレー症候群（以下GBS）は，急速に進行する四肢筋力低下を主症状とするニューロパチーである．一般的にGBSの治療については，単純全血漿交換（以下PE）や免疫グロブリン大量療法（以下IVIg，400mg/kg/日×5日間）が推奨されており，その効果は同等とされている．しかし，維持透析患者に合併する症例数は少なく治療方針についても一定の見解が得られていない．われわれは，GBSと診断された維持透析患者4症例を経験した．2症例に対しては，第一選択で施行したIVIgで効果がなく，PEを施行したところ，施行直後より筋力の改善を認めた．残りの2症例ではPEを第一選択とした．4症例ともにPE施行後順調な経過をたどった．維持透析患者のGBSの治療にはIVIgよりPEが有効であると考えられる．

血液透析患者における新規肝炎発生は院内感染として発生する可能性もあり, その予防は重要な問題である. しかし, 透析導入された患者は導入施設にとどまらずに通院が可能となるとサテライト透析施設へ転院することが多い. したがって, 肝炎予防対策が一つの施設で入念に行われても地域内で差があるようでは, 施設間移動の間に予防が無効になる可能性もある. 春日井市民病院は地域の基幹病院として, 透析導入・患者紹介・合併症時の緊急対応を市内の6施設と連携して行っている. そこで, これら7施設が協同して1年間の前向き調査を行う中で, 肝炎の新規発生調査を行った. 対象透析患者は634名であり, 1年間の新規導入患者は98名, 1年の間に転院した患者が105名, 1箇所の施設にとどまった患者は491名, 死亡患者は28名であった. 幸いにも新規肝炎の発生は1年間で0%であった. 短い期間での検討であるが, 職員への啓発活動と院内感染予防マニュアルの遵守により, 新規肝炎発生を抑制できる可能性が示唆された.

症例は50歳男性. 昭和50年より維持透析中であった. 平成13年10月31日職場での昼食中に意識消失発作を認めた. 意識消失の際に転倒し前頭部を打撲した. 意識は回復したが, 両上肢に激しい疼痛が出現したため維持透析施設を受診した. 維持透析施設にて完全房室ブロックを認めたため当院へ紹介入院となった. 両上肢の疼痛の原因は, 頸椎MRIにて中心性脊髄損傷によるものと診断された. 頸椎MRI施行後完全房室ブロックに対し全身麻酔下で永久的ペースメーカー挿入術を施行した. 中心性脊髄損傷の治療に関してはメチルプレドニゾロン大量静注療法の施行にて改善した.病理組織学的検索は行っていないが今回の一連のエピソードには透析アミロイドーシスが深く関わっていると推測された. 長期透析患者においては軽微な外傷でも頸髄損傷をきたす可能性があることを念頭に置くべきである.

血液透析患者に発生する破壊性脊椎関節症 (DSA) の危険因子を明らかにする目的で, 我々は314名の患者において断面的調査を行った. DSAは40例 (12.7%) の患者に認められ, 頸椎病変が最も多く第4-6頸椎の病変で全体の80%を占めた. DSAを有する患者群と有さない患者群との比較では, DSAを有する患者群の方が高年齢で, 透析期間も有意に長かった (61.2±1.5vs55.6±0.7歳, P=0.005, 119±10vs91±4か月, P=0.007). しかし, 透析導入後6年以内の短期例でもDSAを9例に認めた. DSA発症に関与すると推測される諸因子との単因子相関では, 骨嚢胞の存在と手根管症候群の合併例でDSAの発症頻度が有意に高かった (それぞれX2=35.2, P

インタクト副甲状腺ホルモン値 (i-PTH) が極端に低値 (

In Japan, the population of patients on peritoneal dialysis (PD) is4% of the total number of patients with end-stage renal disease. Few systemic analyses have examined why the number of PD patients has not increased in Japan. We organized a registry to analyze PD patients and retrospectively investigated 561 PD patients (about 5% of all Japanese PD patients) from 13 hospitals in the Tokai area for 3 years from 2005.We investigated background, physical status, laboratory data, status of PD therapy, and the occurrence of PD-related complications, and analyzed reasons for withdrawal from PD.Nutrition did not change significantly during our observation. Urinary volume showed continued decreases after the introduction period. In contrast, PD fluid demand and ultrafiltration volume were significantly increased. For calcium metabolism, multiple phosphate binders were required after the second year of PD therapy. Early drop-out within 3 years after starting PD therapy comprised 50.9% of total withdrawals, with PD-related peritonitis as the most common reason, mainly caused by Gram-positive organisms. Incidence of peritonitis was 42.8 months/patient. Culture-negative results were obtained for 32% of peritonitis cultures. Diabetes affects the prognosis of PD therapy, but not the incidence of peritonitis.We examined clinical status over 3 years in the Tokai area. The results suggest that the incidence of peritonitis needs to be decreased to prevent early withdrawal of PD patients. Education systems to decrease the incidence of peritonitis and techniques to decrease culture-negative results might be important for improving the prognosis of peritonitis.

We report a case of thrombotic thrombocytopenic purpura (TTP) with a positive Coombs' test. A 59-year-old female was admitted to our hospital in February, 1997 with symptoms of heart failure. Ultrasound cardiography showed moderate pericardiac effusion and she was diagnosed as having pericarditis. After admission she had anorexia and her urine volume was reduced. Laboratory tests showed anemia and thrombocytopenia. Her Coombs' test result was positive. Her renal function gradually worsened and her conscious level was reduced. We diagnosed her as TTP and judged that she needed hemodialysis. We performed plasma exchange and started steroid therapy. The renal biopsy was compatible with TTP. After treatment, her level of consciousness improved, but her renal function did not improve. On the 51st hospital day she fell into acute respiratory distress syndrome (ARDS) and entered ICU. We considered ARDS caused by infection and continued treatment, but she died of shock and lactate acidosis. Activity of von Willebrand factor-cleaving protease in our case was 15% before the first PE, and 25 % just before death. A case of TTP without collagen disease usually shows a negative Coombs' test result. We think that this was a rare case in which autoimmune hemolytic anemia was supervened with TTP.

interstitium have not been fully explored. The purposes of this study were to assess the role of selectins in the acute infiltration trated leukocytes, macrophages (Mo) are the main cause of Mo in rats with unilateral ureteral obstruction (UUO) and of induction and progression of interstitial damage and to evaluate the role of vasa recta, that is, whether they facilitate fibrosis through synthesis of several cytokines and matrix massive influx of Mo into the interstitium by functioning as proteins such as fibronectin and type I collagen. However, specialized vessels. it is not known how leukocytes migrate into the interstiMethods. To evaluate the role of selectins in Mo infiltration into tubulointerstitium, the expression of selectins and L-selec- tium. One possibility is that the interstitium is endowed tin ligands was examined by immunohistochemistry and im- with specialized vessels, similar to the high endothelial munoelectron microscopy. The functional role of P-selectin venules (HEV), which in the peripheral lymph nodes fain vasa recta was studied by Stamper-Woodruff assay, in vivo cilitate the large-scale influx of lymphocytes [5]. Regardp-Mo migration assay and in vivo blocking experiments with the monoclonal antibody (mAb) ARP2-4. less of the nature of the initial stimulus inducing tubuloResults. Selective expression of P-selectin was detected in interstitial nephritis, leukocytes migrate preferentially vasa recta as early as one hour after UUO, and the expression into the outer medulla compared to the cortex or the increased thereafter for 96 hours. In contrast, endothelial ex- inner medulla [6, 7]. This suggests the existence of spepression of L-selectin ligands and E-selectin were not detect- cialized venules in the outer medulla. Renal ascending able. In the Stamper-Woodruff assay on kidney sections of rats with UUO, the adhesion of isolated rat peritoneal Mo (p-Mo) vasa recta, which form vascular bundles in the medulla, to vasa recta was significantly inhibited by the mAb ARP2-4 seem to be good candidates, because they are well devel(P-selectin blocker; P 0.01), but not by mAb ARE-5 (E-selec- oped in the outer medulla and localized at post-capillary tin blocker) or rLECIg (rat L-selectin chimeric protein). In sites [8]. the in vivo transfer experiments with fluorescein-labeled p-Mo The endothelial cells (ECs) of HEV in the peripheral into rats 48 hours after UUO, labeled p-Mo had accumulated around vasa recta at three minutes and had infiltrated predomi- lymph nodes express abundant carbohydrate ligands for nantly into the outer medulla at 180 minutes. The number of L-selectin, such as glycosylation-dependent cell adhesion labeled p-Mo was reduced when the rats were pretreated with molecule 1 (GlyCAM-1), CD34, MAdCAM-1 [9] and 2H5 ARP2-4 (P 0.01). Finally, ARP2-4 (10 mg/kg), injected 15 antigen [10]. HEVs are located at post-capillary vascular minutes before UUO, reduced the number of infiltrated Mo sites where lymphocytes can attach to ECs by virtue of de(P 0.01). Conclusion. The results suggest that vasa recta, which express creased blood flow velocity. These characteristics faciliP-selectin, contribute to massive infiltration of Mo into the inter- tate massive lymphocyte recruitment into the peripheral stitium by functioning as specialized post-capillary venules. lymph nodes [5, 9]. Whether ECs of ascending vasa recta share the functional features of lymph node HEV is not known. Likewise, it is unknown whether the ECs of the

An intelligent stabilometer and a stepping test graphical analyzer were devised by the utilization of a microcomputer-powered stabilometer equipped with software for an automatic analysis of the basic stabilo-metry and of the stepping test. The instrument is able to communicate with any host computer through a telecommunication line. Thus, measured raw data can be transferred to the host, and stored in its magnetic storage devices and processed with its unique analyzing software.This means that achievement of the recommendations for stabilometry proposed by the Committee for Standardization of Equilibrium Examinations has easily come within the range of possibility.In the stepping test, measurements and recordings of stepping deviations are automatically performed with higher precision, and the time processes of step-by-step changing stepping deviations are objectively made evident. Furthermore, the possibility of measurement and analysis of body sway during stepping and of the rhythm of stepping is in view.