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抄録Background: Infection is an important factor in the development of renal diseases. We investigated the relationship between infection trends and the disease trends in renal biopsies.Methods: The frequency of renal biopsy diseases in our department over the past 25 years was plotted annually and monthly and compared with the trends of sentinel observation of infectious diseases.Results: IgA nephropathy increased in a cycle of 3 to 7 years, but its peak gradually decreases. IgA nephropathy showed a weak correlation with group A hemolytic streptococcus and drug-resistant Pseudomonas aeruginosa. On the other hand, in Henoch-Schönlein purpura showed a significant positive correlation with the secular variation of MRSA (r = 0.57, p < 0.01), influenza (r = 0.46, p < 0.05), and genital herpes (r = 0.45, p < 0.05) and condyloma (r = 0.43, p < 0.05). The frequency of ANCA nephritis was significantly correlated with the infection trends of adenovirus pharyngoconjunctival fever (r = 0.48, p < 0.05), hand-foot-mouth disease (r = 0.48, p < 0.05), influenza (r = 0.41, p < 0.05). It also showed a weak correlation with the secular and seasonal trends of group A hemolytic streptococcus. Minimal change nephrotic syndrome increased in a cycle of 4-5 years, and significantly correlated with group A hemolytic streptococcus (r = 0.561, p < 0.01), and the seasonal variation was associated with mycoplasma pneumonia, infectious erythema. Focal segmental glomerulosclerosis showed a significant correlation with the infectious trend of drug-resistant Pseudomonas aeruginosa (r = 0.62, p < 0.01), MRSA (r = 0.53, p < 0.05), Roseola (r = 0.53, p < 0.01), whooping cough (r = 0.42, p < 0.05).Conclusion: Renal diseases diagnosed by renal biopsy have cyclical variations associated with seasonal and secular variations in infectious disease epidemics.

A 70-year-old woman with complaints of edema, general malaise, and hypotension was diagnosed with renal amyloidosis, and laser microdissection mass spectrometry revealed her amyloidosis to predominantly comprise the apolipoprotein A-IV type. The M-protein turned from negative to positive during the course, and a bone marrow biopsy showed smoldering myeloma. Treatment with bortezomib and dexamethasone failed to save her from heart failure six months after the onset. Western blotting of urine samples at the time of the renal biopsy showed that amyloid light-chain κ amyloidosis had been present since the onset. Unlike the myeloma, Congo red staining was positive in the plasma cells of the bone marrow.

More than few patients on maintenance hemodialysis present with hyperuricemia, and the control of serum uric acid level is an important issue in the long-term management. In addition to allopurinol, febuxostat can be used as a xanthine oxidase inhibitor in hemodialysis patients. In this study, the clinical effects of febuxostat were compared with allopurinol in chronic hemodialysis patients. Eligible hemodialysis patients taking allopurinol were randomly assigned to take 100 mg allopurinol（n＝26）or 20 mg febuxostat（n＝23）for 12 weeks. Serum uric acid was markedly lowered in the febuxostat group（0-week 6.7 mg/dL, 12-week 4.3 mg/dL, p＜0.001）as compared with the allopurinol group（0-week 6.0 mg/dL, 12-week 5.8 mg/dL）and systolic blood pressure was lowered by 5 mmHg（p＝0.036）at 4-week in the febuxostat group while blood pressure was not significantly changed in the allopurinol group throughout the study period. In addition, the dose of erythropoiesis stimulating agent was reduced（0-week 22.2 μg/wk, 12-week, 17.1 μg/wk, p＝0.012）and serum phosphate level was lowered（0-week 5.9 mg/dL, 12-week 5.1 mg/dL, p＝0.027）in the febuxostat group but not in the allopurinol group. It is concluded that febuxostat is more effective in lowering serum uric acid than allopurinol in hemodialysis patients. In addition, it is suggested that febuxostat has an advantage in the management of renal anemia and hyperphosphatemia as well as hyperuricemia.

Leadless pacemakers have many advantages for some patients in preventing lead- and pocket-related complications. The traveling of the femoral vein is important in the context of normal approach site choice for leadless pacemakers. In this case, the leadless pacemaker could be successfully implanted without disrupting the inferior vena cava filter by using intravascular ultrasound in a hemodialysis patient with complete atrioventricular block and atrial fibrillation who had obstruction of the bilateral subclavian and right femoral veins, and travel abnormality of the left common iliac vein.

Multiple large-scale clinical trials have indicated that sodium glucose cotransporter 2（SGLT2）inhibitors reduce the incidence of cardiovascular events, deterioration of renal function and mortality. However, the therapeutic effects of SGLT2 inhibitors are supposed to be limited in patients with reduced renal function considering the mechanism of their action. In this study, a SGLT2 inhibitor, ipragliflozin was given to 30 type 2 diabetic patients with nephropathy whose estimated glomerular filtration rate（eGFR）was not lower than 30 mL/min/1.73 m2. After 12 to 16 weeks, hemoglobin A1c decreased by 0.6％（p＜0.001）, body weight was reduced by 1.8 kg（p＜0.01）and blood pressure was lowered by －10/－6 mmHg（p＜0.001/p ＜0.001）. This was accompanied by reductions in serum uric acid（－0.7 mg/dL, p＜0.001）, triglycerides （－25 mg/dL, p＝0.028）and g-glutamyl transferase（－8 U/L, p＝0.001）. On the other hand, plasma B-type natriuretic peptide also decreased by 12％（p＝0.020）and urinary albumin excretion was reduced by 23％ （p＝0.018）although the eGFR was not significantly changed. It is concluded that ipragliflozin is effective in lowering blood glucose even in patients with diabetic kidney disease and is beneficial in improving theaccompanying obesity and hypertension. In addition, ipragliflozin is thought to have favorable influences on the metabolisms of uric acid and lipids. These properties of ipragliflozin is expected to bring about protective effects against the progression of nephropathy and the development of cardiovascular disease resulting in the improvement of prognosis in diabetic patients with mild to moderate chronic kidney disease.

We compared treatment with a high-dose angiotensin II receptor blocker(ARB)and combination of ARB with a thiazide diuretic in 17 patients with hypertension. A randomized crossover study was performed giving 80 mg telmisartan or fixed-dose combination of 40 mg telmisartan and 12.5 mg hydrochlorothiazide for 16 weeks each. Although the clinic blood pressure was comparable between the high-dose ARB period(134/81 mmHg)and the combination period(134/82 mmHg), the morning home blood pressure was lower in the combination period than in the high-dose ARB period(138/82 vs. 151/88 mmHg, p=0.026/0.013). No significant difference was observed in urinary albumin excretion, but estimated glomerular filtration rate was lower in the combination than in the high-dose ARB period(58.9 vs. 62.1 mL/min/1.73 m^2, p=0.039). Serum uric acid was higher in the combination than in the high-dose ARB period(6.7 vs. 5.9 mg/dL p=0.022). The indices of glucose metabolism, serum lipids, oxidative stress, inflammation and adipocytokine did not significantly differ between the two periods. There was no significant difference in the measurement of endothelium-dependent vasodilation between the two periods. It is suggested that the addition of thiazide diuretic to medium-dose ARB is more effective in lengthening the hypotensive effect than high-dose ARB, however, care should be taken for the elevation of serum uric acid and the decrease in renal function.

Background: Forestry and field workers who work outdoors are at high risk for Hymenoptera stings and may develop occupation-related allergies from being stung. However, clinical and immunological surveys of Hymenoptera stings in the occupational setting have rarely been reported. We surveyed the natural history of Hymenoptera stings in Japanese forestry workers (FWs) and electrical facility field workers (EFFWs), and we assessed the utility of measuring specific (s)IgE Ab to Hymenptera venom. Methods: Questionnaires on hornet and paper wasp stings were completed by 999 FWs, 354 EFFWs, and 365 office workers as controls between July and November 2009. Sera from these participants were tested for sIgE Ab levels to Hymenptera venom with a CAP system using a fluoroenzyme immunoassay. Results: Of the participants who had experienced Hymenoptera stings, 914 (91.5%) were FWs, 293 (82.8%) were EFFWs, and 295 (80.8%) were controls. Of the participants who had experienced systemic reactions, 210 (21.0%) were FWs, 51 (14.4%) were EFFWs, and 39 (10.7%) were controls. sIgE Ab in response to hornet and wasp venom was positive (≥ class 2) in 42.4% and 41.4% of FWs, 30.1% and 31.4% of EFFWs, and 15.1% and 18.1% of controls, respectively. The likelihood of being sIgE-positive to wasp and hornet venom was significantly higher in FWs and EFFWs than in controls (P Conclusions: 21% of FWs and 14% of EFFWs had experienced systemic reactions to Hymenoptera stings with a higher frequency compared with office workers in the same area. 40% of FWs and 30% of EFFWs had sera that were sIgE positive to Hymenoptera venom.

We have succsessfully developed blue-violet laser diodes having the world's highest output power of 450mW by introducing a novel facet coating structure, reducing the internal loss in devices, and making a cavity length long.