[Renal infarction: Pathogenesis, pathophysiology, and therapy].
Explore the source record for details and available documents.
Diagnostic Imaging↗
Biomedical subjects
Tetsuro Kusaba
Publications and source records attributed to Tetsuro Kusaba.
Sarcoid granulomatous interstitial nephritis and sarcoid abdominal aortic aneurysms.
Explore the source record for details and available documents.
Aortic Aneurysm, Abdominal↗
Efficacy of biventricular pacing for dialysis-related hypotension due to idiopathic dilated cardiomyopathy.
A 45-year-old man who had been undergoing maintenance hemodialysis for end-stage renal failure, caused by chronic glomerulonephritis 4 years before, was admitted to our hospital for biventricular pacemaker implantation (BVP). Ten years ago, he was diagnosed with idiopathic dilated cardiomyopathy, and had been suffering from dialysis-related hypotension (DRH) due to low cardiac function over the past year. An electrocardiogram revealed complete left bundle branch block with a QRS duration of 180 ms, and echocardiography showed moderate hypokinesis of the left ventricular wall and systolic asynchronized motion of the septum and free wall. After BVP, the left ventricular ejection fraction had increased from 29% to 40%, and the transmitral rapid left ventricular filling (E wave) and atrial contraction (A wave) ratio (E/A) had improved from 1.3 to 1.0. Before and after BVP, we measured hemodynamic parameters during hemodialysis by successive echocardiography. Before BVP, systemic vascular resistance had decreased, cardiac output had not changed, and hypotension was noted. In contrast, after BVP, cardiac output had increased and systemic vascular resistance had not changed, which caused an increase in blood pressure. We conclude that BVP improved the cardiac function which resulted in an improvement in dialysis-related hypotension (DRH).
Blood Pressure Determination↗
More stable and reliable pharmacokinetics with preprandial administration of cyclosporine compared with postprandial administration in patients with refractory nephrotic syndrome.
STUDY OBJECTIVE: To compare the absorption profile of cyclosporine after preprandial administration with that after postprandial administration, and to determine which administration time resulted in a more stable absorption profile and the timing of the drug concentration that was the most reliable marker for monitoring drug absorption. DESIGN: Prospective analysis. SETTING: University teaching hospital in Japan. PATIENTS: Sixteen patients with refractory nephrotic syndrome. INTERVENTION: Thirteen patients received cyclosporine after breakfast (postprandial group) and eight received the drug 30 minutes before breakfast (preprandial group). MEASUREMENTS AND MAIN RESULTS: Blood cyclosporine concentration was measured 5 times serially: before administration (C 0 ) and at 1-hour intervals until 4 hours after administration of cyclosporine (C 1 -C 4 ). Also, area under the concentration-time curve from 0-4 hours (AUC 0-4 ) was calculated. Of the 13 patients in the postprandial group, six (46%) showed fair absorption and exhibited a peak concentration at C 1 or C 2 (high-absorption pattern); seven (54%) showed poor absorption and did not reach the peak concentration within the 4-hour period (low-absorption pattern). Five of the seven patients with the low-absorption pattern were switched from postprandial to preprandial administration. All patients in the preprandial administration group showed a high-absorption pattern and reached the peak cyclosporine concentration at C 1 . The C 2 value showed the best correlation with AUC 0-4 in both groups, and the C 0 parameter did not correlate with AUC 0-4 in either group. CONCLUSION: Preprandial administration provided a more stable absorption profile of cyclosporine compared with postprandial administration. From the correlation with AUC 0-4 , we concluded that C 2 , and not C 0 , is a reliable marker for monitoring cyclosporine exposure.
Absorption↗
HMG-CoA reductase inhibitors up-regulate anti-aging klotho mRNA via RhoA inactivation in IMCD3 cells.
OBJECTIVE: Klotho is thought to play a critical role in the development of age-related disorders including arteriosclerosis. Statins may exert vascular protective effects, independent of the lowering of plasma cholesterol levels. We investigated the impact of statins on mRNA expression of the age-suppressor gene, klotho in mIMCD3 cells. METHODS AND RESULTS: Klotho mRNA levels were evaluated with real-time RT-PCR. Atorvastatin and pitavastatin increased the expression of klotho mRNA in a dose-dependent manner. This stimulatory effect was abolished by the addition of mevalonate, GGPP and FPP, essential molecules for isoprenylation of the small GTPase Rho. As was the case with the statin treatment, inhibition of Rho-kinase by Y27632 up-regulated klotho mRNA. In contrast to the statin treatment, stimulation with angiotensin II down-regulated klotho mRNA expression without obvious morphological changes. Furthermore, pretreatment with atorvastatin blunted the angiotensin II-induced response and ameliorated the decrease in klotho mRNA expression towards basal levels. RhoA activity was further evaluated by detection of its translocation. Angiotensin II activated RhoA, whereas statins potently inactivated RhoA and blocked RhoA activation by angiotensin II. CONCLUSION: Statins inactivate the RhoA pathway, resulting in over-expression of klotho mRNA, which may contribute to the novel pleiotropic effects of statins towards vascular protection.
Amides↗
[Fulminant myocarditis treated with percutaneous cardiopulmonary support and long-term complications: three case reports].
A 16-year-old female underwent percutaneous cardiopulmonary support (PCPS) for treatment-resistant ventricular tachycardia, but she could not be weaned from PCPS early without complications. A 44-year-old female underwent PCPS for low cardiac output syndrome with mainly heparin used for anticoagulation. With long-term PCPS, the activated clotting time became unstable, and she died due to fatal hemorrhagic complications in the acute stage. A 71-year-old female underwent PCPS for low cardiac output syndrome with mainly nafamostat mesilate used for anticoagulation. Despite long-term extracorporeal circulation, she was weaned from PCPS without hemorrhagic complications. However, she died of multiple organ failure and systemic cytomegalovirus infection in the chronic stage. Myocardial recovery was delayed in Cases 2 and 3, so long-term PCPS was required, which resulted in severe complications. To prevent hemorrhagic complications, nafamostat mesilate should be given and activated clotting time should be measured frequently. To prevent multiple organ failure, the appropriate initial PCPS flow should be established after the evaluation of urinary output, saturation of venous oxygen, and splanchnic circulation such as arterial ketone body ratio and gastric acid secretion.
Acute Disease↗
[Case of non-Hodgkin lymphoma with acute renal failure successfully treated with chemotherapy].
We report a case of non-Hodgkin lymphoma (NHL) with acute renal failure. A 62-year-old man was admitted to our hospital on March 8, 2002 with leg edema and dyspnea on effort. About 3 weeks before admission, he was found to have slightly high serum creatinine (Cr) and high lactate dehydrogenase (LDH) levels by another home doctor. Physical examination revealed anemic conjunctivae and leg edema, but the urinary volume was preserved. Blood examination showed high BUN (64 mg/dl) and Cr levels (3.91 mg/dl). Urinary analysis showed proteinuria (1.05 g/day) and high BMG (14,434/microg/day) and NAG (4.55 U/day) levels, suggesting severe tubulointerstitial injury. On ultrasonography of the kidney, the bilateral kidneys showed marked swelling without hydronephrosis. To investigate the genesis of renal failure, we performed a renal biopsy. The specimen showed normal glomeruli, but a large number of cells infiltrated in the tubulointerstitial area with normal tubulointerstitial structure. The cells stained positively with anti-leukocyte antigen and L26 (B cell marker), and negatively with cytokeratin and UCHL-1 (T cell marker). These findings indicate that the interstitial cells were non-Hodgkin lymphoma with B cell diffuse large cells. Chemotherapy was performed with VAD (vincristine sulfate, doxorubicin hydrochloride, dexamethasone) considering his renal dysfunction. To avoid tumor lysis syndrome after chemotherapy, hemodialysis was performed on days 1-4 after the initiation of chemotherapy. After a series of chemotherapy, the urinary volume increased and serum Cr levels decreased to 2 mg/dl. After additional therapy with 4 courses of CHOP, he improved and was discharged on day 180 after admission.
Acute Kidney Injury↗
[Takotsubo cardiomyopathy thought to be induced by MRSA meningitis and cervical epidural abscess in a maintenance-hemodialysis patient: case report].
A 65-year-old man was admitted to our hospital for high fever and severe left shoulder pain. He was initiated on maintenance hemodialysis for end-stage renal failure caused by diabetic nephropathy 9 years previously. On admission, the serum CRP level was 29.3 mg/d/l and the white blood cell count was 29,000/mm3. Bacterial examination of blood and spinal fluid revealed MRSA colonization. On the 6th hospital day, a giant negative T wave in the V2-6 leads of an electrocardiogram asymptomatically appeared. Ultracardiogram revealed apical systolic paradoxical centrifugal motion. None of the cardiogenic enzymes, such as creatine kinase, lactate dehydrogenase and glutamic oxaloacetic transaminase was elevated. Cardiac thallium-201-chloride (201Tl-Cl) and I-123 beta-metyl iodophenyl-pentadecanoic acid (123I-BMIPP) scintigraphy revealed a decreased accumulation of isotopes in the apex. From these findings, we diagnosed Takotsubo cardiomyopathy induced by MRSA meningitis. Vancomycin was administrated and the inflammatory signs decreased. On the 46th hospital day, tetraplegia and respiratory suppression occurred. A cervical spinal magnetic resonance image revealed cervical spondylodiscitis and cervical epidural abscess, which compressed the medulla oblongata. Surgical spinal decompression and drainage of the abscess were performed. The giant negative T wave in the electrocardiogram improved after the operation. Two months after the operation, cardiac 201Tl-Cl scintigraphy revealed improvement in the accumulation of isotopes in the apex. Takotsubo cardiomyopathy is secondary cardiomyopathy presenting with apical systolic paradoxical centrifugal motion without coronary stenotic disease. It has been reported to be induced by severe mental stress or intracranial disease. In the present patient, it was predicted that stress on the central nerve system caused by the MRSA meningitis and the cervical epidural abscess induced the Takotsubo cardiomyopathy.
Cardiomyopathies↗
[Intravascular ultrasound imaging of the renal artery in patients with renovascular hypertension caused by neurofibromatosis 1].
A 26-year-old woman with neurofibromatosis 1 was admitted to our hospital for investigation of prolonged hypertension after toxemia of pregnancy. Plasma renin activity was elevated. From the renogram, stenosis of right renal artery was suspected and we performed renal arteriography, which revealed proximal right renal artery stenosis. The intravascular ultrasound (IVUS) image showed concentric stenosis with intimal and medial hypertrophy, which was iso-echoic and partly high echoic. Percutaneous transluminal renal angioplasty was performed and the lesion was well dilated. After angioplasty, blood pressure normalized in a week. From the clinical course and the IVUS image, we suspected that renal artery stenosis was due to neurofibromatosis 1.
Adult↗