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Biomedical subjects

K Onoyama

Publications and source records attributed to K Onoyama.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Nephrotic syndrome due to membranous glomerulopathy in hypocomplementemic urticarial vasculitis syndrome;--a case report].

We report a case of hypocomplementemic urticarial vasculitis syndrome (HUVS) with membranous glomerulopathy in a 62-year-old man who had a 2-month history of secondary iritis. He was transferred to our hospital because of uncontrollable edema and respiratory dysfunction. Physical examination revealed anasarca, pulmonary edema, hypertension and urticaria-like eruption on his arms. Urinalysis, blood chemistry and serological studies showed massive proteinuria (10.5g/day) with numerous granular casts, hypoalbuminemia (1.5g/dl), renal dysfunction (creatinine; 1.6mg/dl, BUN; 86mg/dl), hypercholesterolemia (total cholesterol; 455mg/dl), positive results for antinuclear factor, microsome test, thyroid test, lupus anticoaglant, antithyroglobulin test and rheumatoid factor, but LE cell or double-strand anti DNA antibody was negative. Serum complement levels were persistently low as CH50 of 13 U/ml and Clq of 6.0 micrograms/dl. The patient serum precipitated with normal human Clq by immunodiffusion analysis, indicating the presence of anti-Clq antibody. Renal biopsy revealed membranous glomerulopathy with prominent fine granular deposition of Clq along the glomerular basement membrane by immunofluorescent study and subepithelial dense deposit by electron microscopy. Corticosteroid treatment was ineffective for hypocomplementemia and nephrotic syndrome. Acute subendocardial infarction occurred on the 25th hospital day and he died of acute respiratory distress syndrome on the 45th hospital day. Autopsy revealed leucocytoclastic vasculitis in the alveolar wall. HUVS was confirmed by clinical symptoms, such as iritis and urticaria-like eruption, serum anti-Clq antibody, the absence of any specific autoantibody for systemic lupus erythematosus (SLE) and leucocytoclastic vasculitis in the alveolar wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗
PubMed1993

Spontaneous large intra-abdominal wall haematoma as a rare complication in a maintenance haemodialysis patient.

The incidence of spontaneous bleeding in various parts of the body has been reported to be high in patients receiving maintenance haemodialysis. We present a case of spontaneous large haematoma of the intra-abdominal wall which developed in a 71-year-old Japanese man with 9 years' maintenance haemodialysis. Due to the clinical symptoms and signs, ileus was suspected and an emergency operation was performed. In maintenance haemodialysis the possibility of spontaneous bleeding should always be considered whenever unexplained and unexpected symptoms and signs are apparent.

Abdominal Muscles↗
PubMed1993

Effects of anti-hyperlipidaemic agent or dietary protein restriction on progressive renal deterioration in adriamycin-induced nephropathy in rats.

Hyperlipidaemia is strongly suggested to contribute to the pathogenesis of glomerular sclerosis. This study intends to clarify the effects of either a lipid lowering agent, lovastatin (LO) or protein restriction (PR) on adriamycin (ADR)-induced progressive glomerular sclerosis in rats. During the study period both serum cholesterol and triglyceride were significantly reduced in ADR-injected rats with either lovastatin administration (ADR-LO) or protein restriction (ADR-PR) compared to those without such treatment (ADR-NP). At week 22, urinary protein excretion, serum creatinine, blood urea nitrogen, glomerular sclerosis and tubulointestinal alterations, which were marked in ADR-NP, were ameliorated in both ADR-LO and ADR-PR rats. ADR-LO resulted in a body weight similar to that in ADR-NP while ADR-PR induced a marked weight loss. An antihyperlipidaemic agent, such as lovastatin, seems to be a useful tool for the prevention of renal deterioration.

Animals↗
PubMed1993

[An autopsy case of severe portal hypertensive gastropathy associated with a large shunt from superior mesenteric to left renal vein in a patient with alcoholic liver cirrhosis].

We report an autopsy case of severe portal hypertensive gastropathy with a large shunt from the superior mesenteric to left renal vein in a patient with alcoholic liver cirrhosis. A 60-year-old man with alcoholic cirrhosis was admitted for tarry stool and ascites. Endoscopic finding revealed multiple red spots and hemorrhagic gastritis at prepylorus of the stomach. Angiography showed a large shunt vessel originating from the superior mesenteric to left renal vein. He died of hepatic failure and DIC following frequent gastrointestinal bleeding. At autopsy, the stomach showed marked congestion of the capillary vessels in the tunica propria mucosa. This finding showed that the gastropathy resulted in the congestion of the gastric veins connecting with the large shunt vessel.

Disseminated Intravascular Coagulation↗
PubMed1993

Lack of blood pressure increase with age in long-term hospitalised patients with the sequelae of acute carbon monoxide poisoning.

We investigated retrospectively age-related changes in BP and body composition in 44 men who had been hospitalised for up to 26 yrs as a result of carbon monoxide poisoning. The average age of the patients was 42.5 +/- 9.1 (SD) yrs on the first admission. The average period of hospitalisation was 19.5 +/- 5.9 yrs. The patients received mild salt restriction and daily exercise in the hospital. During the study period, nine patients developed hypertension and received antihypertensive treatment. The prevalence of hypertension in our study population was 205 per 1,000 and the incidence of hypertension (DBP > 95 mmHg) was 9.1 per 100 person years. Both prevalence and incidence appear to be lower than those in the general population. In the other 35 patients BP significantly decreased from 127.5 +/- 10.0 mmHg (SBP)/79.8 +/- 8.1 mmHg (DBP) at the time of the first examination to 120.8 +/- 16.3 mmHg/71.9 +/- 10.3 mmHg on the last examination. Body mass index did not change significantly during the study period. Hypertensive cardiovascular death was not observed throughout the study period. In conclusion, controlled diet, salt intake, physical exercise and isolation from the social stimuli achieved by a long-term hospitalisation may prevent increased BP and cardiovascular death.

Acute Disease↗
PubMed1992

Elevation of serum erythropoietin after subtotal parathyroidectomy in chronic haemodialysis patients.

After successful subtotal parathyroidectomy (PTX) in 10 chronic haemodialysis patients, significant elevation of Epo was observed, from 48.4 +/- 17.8 mU/ml(M +/- SEM) at preoperative state to 103.3 +/- 34.7 mU/ml at 6 h and 163.4 +/- 50.2 mU/ml at 12 h after PTX. Significant reductions in both PTH-m and ionized calcium (iCa) were confirmed. Since Epo did not increase in the cases with an inadequate PTX and ovariectomy, an abrupt reduction in PTH with a decrease in iCa may play some role in the elevation of Epo.

Adult↗
PubMed1992

Human erythropoietin in children undergoing continuous ambulatory peritoneal dialysis.

The effect of intravenous recombinant human erythropoietin (rHuEPO) by two different dosage regimes was evaluated in 12 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Eight patients (group A) were treated once a week at a mean dose of 89 U/kg for 24 weeks. The other four patients (group B) were treated three times a week at a mean dose of 260 U/kg for 8 weeks, and then once a week at a mean dose of 88 U/kg for the next 16 weeks. In group A, the hematocrit (Ht) increased gradually and significantly from 19.9 +/- 2.1% to 28.7 +/- 1.5% at the 24th week, while in group B, it rapidly increased from 17.9 +/- 2.5% to 30.2 +/- 4.3% at the 8th week, and thereafter was maintained at a level of approximately 30%. However, there was no significant difference in the Ht between the two groups. In two of the four patients in group B, blood pressure increased from 136/87 mmHg to 168/102 mmHg and from 106/70 mmHg to 132/92 mmHg, at the 4th and the 8th weeks respectively, related to a rapid rise of the Ht. Neither antibody to rHuEPO nor other sides effect were evident. Gradual improvement of anemia by once-a-week intravenous administration of rHuEPO is advantageous for the quality of life in children on CAPD.

Adolescent↗
PubMed1992

CBF and oxygen metabolism in hemodialysis patients: effects of anemia correction with recombinant human EPO.

To investigate the effects of anemia correction with recombinant human erythropoietin (rhEPO) on both cerebral blood flow and oxygen metabolism in hemodialysis (HD) patients, the regional cerebral blood flow (rCBF), oxygen extraction (rOEF), and metabolic rate for oxygen (rCMRO2) were measured by positron emission tomography in five HD patients, and the data were compared with eight nondemented controls who had neither anemia nor uremia. In the HD patients, 1,500 U of rhEPO were administered intravenously three times a week to achieve a 10% increase in hematocrit (Hct) as an absolute value. Before rhEPO administration, the hemispheric rCMRO2 in HD patients was 1.48 +/- 0.09 (SE) ml.min-1.100 ml-1, which was significantly lower than that of 2.18 +/- 0.10 in the controls (P less than 0.01). In contrast, both rCBF and rOEF were significantly greater in the HD patients than the control, being 40 +/- 3 vs. 32 +/- 3 ml.min-1.100 ml-1 for rCBF (P less than 0.02) and 49 +/- 1 vs. 38 +/- 1% for rOEF (P less than 0.001). After treatment with rhEPO, Hct rose significantly from 21 +/- 1 to 31 +/- 1% in HD patients (P less than 0.001). There were significant reductions in both the hemispheric rCBF to 32 +/- 1 ml.min-1.100 ml-1 (P less than 0.01) and rOEF to 42 +/- 1% (P less than 0.01). However, the hemispheric rCMRO2 remained low at 1.58 +/- 0.06 ml.min-1.100 ml-1 even after rhEPO treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Synthesis of fibronectin by isolated glomeruli from nephrectomized hypertensive rats.

The accumulation of extracellular matrix (ECM) is an important feature of most forms of progressive glomerular diseases. In order to examine the relationship between ECM synthesis and glomerulosclerosis, we evaluated fibronectin synthesis by glomeruli with the immunoprecipitation of conditioned media from isolated glomeruli in 5/6 nephrectomized spontaneously hypertensive rats (5/6N-SHR). There was no difference in blood pressure between 5/6N-SHR and control SHR throughout the experiment. Two weeks after the nephrectomy, most of the glomeruli were intact and no difference in the synthesis of fibronectin was observed between either groups. Twenty weeks after the nephrectomy, marked glomerulosclerosis associated with an increase in urinary protein was revealed in 5/6N-SHR but no glomerular lesions in control SHR. The synthesis of fibronectin by isolated glomeruli increased in 5/6N-SHR compared to control SHR. The administration of enalapril or hydralazine + reserpine + hydrochlorothiazide markedly attenuated the glomerular sclerosis and urinary protein excretion to a comparable degree, although the later therapy reduced blood pressure more effectively. These antihypertensive therapies also suppressed fibronectin synthesis in the 5/6N-SHR group at week 20. In conclusion, increased synthesis of glomerular fibronectin appeared to contribute to the glomerulosclerosis caused by subtotal nephrectomy and hypertension.

Animals↗
PubMed1992

Reversible primary hypothyroidism and elevated serum iodine level in patients with renal dysfunction.

Recovery of thyroid function in patients with both thyroid and renal dysfunction was studied. Among 245 patients with primary hypothyroidism (serum TSH greater than 10 mU/l), 36 had mild to severe renal dysfunction (serum urea nitrogen greater than 7.1 mmol/l and creatinine greater than 106 mumol/l). Of these 36 patients, recovery of the thyroid function after iodine restriction was observed in 30 (83%), in whom an elevated serum non-hormonal iodine level (median 236, range 67-15,591 micrograms/l, N = 19) and a high thyroidal radioactive iodine uptake (51.5 +/- 29.3% at 24 h, N = 26) were observed. The perchlorate discharge test was positive in 7 of 13 patients examined, suggesting an iodide organification defect rather than an atrophic or destructive change in the thyroid. Antithyroid antibodies were negative in 22 patients (73%) and an almost normal thyroid gland or colloid goitre was confirmed histologically in 8 of them. After a 13.2 mg potassium iodide loading test, 24 h urinary excretion of iodine was about 60% in normal controls, but only 10% in a different group of six euthyroid patients with renal dysfunction. These findings suggest that impaired renal handling of iodine rather than autoimmune mechanism may have a significant role in the pathogenesis of reversible hypothyroidism found in patients with renal dysfunction, probably through a prolonged Wolff-Chaikoff effect.

Adult↗
PubMed1992

Albuminuria is not an aggravating factor in experimental focal glomerulosclerosis and hyalinosis.

It is widely known that the severity of glomerular sclerosis is proportional to the degree and chronicity of proteinuria and that the degenerative changes of glomerular epithelial cells that are associated with overflow albuminuria can be experimentally induced by the injection of large quantities of heterologous albumin. Such evidence suggests that autologous albuminuria per se may have a harmful effect on the kidneys. To examine the cause and effect relationship between renal lesions and albuminuria, we produced Adriamycin-induced experimental focal glomerular sclerosis in Nagase analbuminemic (NA) rats and control Sprague-Dawley (SD) rats and observed both the renal functional and histologic changes for 20 weeks. At week 4 after injection of Adriamycin glomerular epithelial lesions including foot process fusion were similarly revealed by an electron microscopic study in both groups in spite of the presence of a large difference in the amount of proteinuria (SD rats: 491 +/- 84 mg/day, NA rats: 43 +/- 30 mg/day) and albuminuria (SD rats: 383 +/- 73 mg/day, NA rats: 2 +/- 1 mg/day). At week 20, a light microscopic study showed the same degree of glomerular sclerosis and hyalinosis and tubulointerstitial changes associated with a decrease in inulin clearance in both groups. The increased glomerular accumulation of immunoglobulin M or complement 3 and glomerular trapping of aggregated human immunoglobulin G were also similar between the SD and NA groups. In summary, renal destruction of Adriamycin-nephropathy was not dependent on the degree of albuminuria. These results suggest that albuminuria is not an aggravating factor in focal glomerulosclerosis.

Albumins↗
PubMed1991

Primary hyperoxaluria type I due to a point mutation of T to C in the coding region of the serine:pyruvate aminotransferase gene.

cDNA clones for serine:pyruvate aminotransferase (SPT, alternative name: alanine:glyoxylate aminotransferase) were obtained from a cDNA library constructed from the liver of a primary hyperoxaluria type I (PH1) case in which the SPT activity was approximately one-hundredth that in control liver. Six clones were isolated from 100,000 transformants and all of them contained an approximately 1.5 kbp insert which included the whole coding region for human SPT. Nucleotide sequence analysis revealed a point mutation of T to C at position 634 (relative to the 5'-end of the cDNA) encoding a Ser to Pro substitution at residue 205. The T to C conversion created a new SmaI site, which enabled us to demonstrate that the point mutation had occurred in the patient's SPT gene. SmaI digestion of genomic DNA may be useful for the diagnostic gene analysis of this type of PH1.

Adult↗
PubMed1991

Ocular histopathologic findings in a 46-year-old man with primary hyperoxaluria.

A 46-year-old Japanese man with familial primary hyperoxaluria had been suffering from urolithiasis since the age of 6 years and had been treated by hemodialysis for 8 years before his death. The alpha-ketoglutarate glyoxylate carboligase and serine pyruvate transoxylase activities in the patient's liver had markedly decreased, indicating type I primary hyperoxaluria. Ocular tissues obtained at autopsy were studied immunohistochemically and histochemically. The ocular alterations were characterized by an unusual distribution of oxalate deposits, mainly located in the outer plexiform layer and the nuclear layer but not in the retinal pigment epithelium or in the vascularized layer of the sensory retina. These distributions of the oxalate deposits were determined to be unrelated to the blood vessels.

Blood Chemical Analysis↗
PubMed1991

Chronic tubulointerstitial changes induced by germanium dioxide in comparison with carboxyethylgermanium sesquioxide.

Chronic nephrotoxicity was investigated in rats orally administered germanium dioxide (GeO2) and carboxyethylgermanium sesquioxide (Ge-132) for 24 weeks. Increased BUN and serum phosphate as well as decreased creatinine clearance, weight loss, anemia and liver dysfunction were apparent at week 24 only in the GeO2 treated group. Vacuolar degeneration and granular depositions were observed by light microscope in the degenerated renal distal tubules in the rats of this group, with the semiquantitative scores of tubular degeneration being 95 +/- 9% in the GeO2 group, 3 +/- 1% in the Ge-132 group and 1 +/- 1% in the control group, respectively. Electron microscopy revealed electron-dense inclusions in the swollen mitochondrial matrix of the distal tubular epithelium in the GeO2 group. Although systemic toxicities were reduced after GeO2 was discontinued at week 24, renal tubulointerstitial fibrosis became prominent even at week 40 (16 weeks after discontinuation). A Ge.K alpha X-ray spectrum was clearly demonstrated in the mitochondrial matrix of the distal tubular epithelium in the GeO2 group with the help of electron probe X-ray microanalysis. On the other hand, neither toxic effects nor renal histological abnormalities were manifested in either the Ge-132 or the control group. The renal tissue content of germanium was high at weeks 24 and 40 in the GeO2 group. From these results, it is concluded that GeO2 causes characteristic nephropathy while Ge-132 does not. In addition, it appears that residual GeO2 remains for a considerably long time even after the cessation of GeO2 intake.

Animals↗
PubMed1991

Advantage of early initiation of aluminum hydroxide administration for the prevention of experimental progressive renal disease.

Aluminium hydroxide, a phosphate binder, is regarded as a strong candidate to halt the progression of chronic renal disease. In order to determine the most effective time to start treatment, aluminium hydroxide was administered either immediately (ADR-0w), or at 8 weeks (ADR-8w) or 16 weeks (ADR-16w) after repeated injection of Adriamycin (ADR) inducing glomerular sclerosis. In the aluminium hydroxide-untreated group the survival rate at the end of the experiment was 50%, while the early initiation of aluminium hydroxide (ADR-0w) resulted in a greater survival rate of 90%. Serum phosphate concentration and serum calcium-phosphate product were significantly less in the aluminium hydroxide groups (ADR-0w, 8w, 16w) than in the untreated group after week 20. Urinary protein excretion was significantly less in the ADR-0w and ADR-8w groups at week 12 or 16 compared to the aluminium hydroxide-untreated group. Blood urea nitrogen in the aluminium hydroxide groups was significantly less than that in the untreated group at week 34. Histological examination revealed that glomerular sclerosis was less severe in the ADR-0w and ADR-8w groups than in the aluminium hydroxide-untreated group, and glomerular hypertrophy was significantly decreased in the ADR-0w group. We conclude that early treatment with aluminium hydroxide was effective in preventing renal deterioration in focal glomerular sclerosis induced by Adriamycin.

Aluminum Hydroxide↗
PubMed1991

Haemodynamic effect of recombinant human erythropoietin on hypotensive haemodialysis patients.

The haemodynamic effects of recombinant human erythropoietin (rHuEpo) on anaemic haemodialysis patients suffering from chronic hypotension were examined. rHuEpo increased the haematocrit to around 30% and increased diastolic blood pressure by 12.4%, statistically significant. Correspondingly, the total peripheral resistance index increased 42.3% while the cardiac index decreased 24.4% (P less than 0.05) respectively. Blood volume, plasma renin activity and plasma noradrenaline did not change significantly. The extent of blood pressure elevation and haemodynamic alteration did not differ from our previous report on anaemic haemodialysis patients without hypotension. The incidence of hypotensive episodes and fluid supplementation did not change significantly after rHuEpo treatment. In conclusion, by using rHuEpo, approximately a 10% increase of blood pressure can be expected. However no substantial improvement in hypotensive episodes can be expected in chronic haemodialysis patients suffering from hypotension.

Adult↗
PubMed1991

Efficacy of once weekly erythropoietin therapy in children on continuous ambulatory peritoneal dialysis.

The efficacy of recombinant human erythropoietin (rHuEPO) on 10 anemic children undergoing continuous ambulatory peritoneal dialysis (CAPD) was evaluated. A mean dose of 93 U/kg of rHuEPO was given once a week for 24 weeks, either intravenously to 5 children or subcutaneously to the other 5. Anemia improved in all children by this therapy. The mean hemoglobin and hematocrit levels increased gradually but significantly from 6.9 g/dl and 20.2% to 9.4 g/dl and 30.1%, respectively, at the end of the study. Elevation of blood pressure or other side effects were not noted in any patient. The present study indicates that the once-a-week injection of rHuEPO by the intravenous or subcutaneous route is effective in children undergoing CAPD.

Adolescent↗