Biomedical subjects

Yume Nagaoka

Publications and source records attributed to Yume Nagaoka.

9 recordsLinked to original sources

PubMed2006

[A pregnant woman with nephrotic syndrome and focal segmental lesions].

A 32-year-old woman was admitted at 36 weeks' gestation because of increasing proteinuria and generalized edema. At the time of admission, serum creatinine was 1.3 mg/dl, and urinalysis demonstrated 4+ protein and 2+ occult blood. During her pregnancy, her blood pressure had been in the normal range. A normal healthy female neonate was delivered by caesarean section at 38 weeks' gestation. After delivery, the woman's 24-hour urine protein excretion was 11 g/day and serum albumin was 1.4 g/dl , hence nephrotic syndrome was diagnosed. Eleven days after delivery, a renal biopsy showed focal segmental lesions with glomerular epithelial cell injury. She was given 50 mg/day prednisolone and after a month, her 24-hour urinary protein excretion decreased to 2 g/day. One year later, she achieved complete remission. Although she had a relapse of nephrotic syndrome after twenty-one months, steroid therapy again achieved a good response.

Adult↗

PubMed2005

Insulin resistance contributes to obesity-related proteinuria.

OBJECTIVE: Proteinuria is a recognized complication of obesity, but the pathogenesis remains unclear. We undertook the present study to clarify the factors contributing to proteinuria associated with obesity. METHODS: We studied 12 obese patients with proteinuria. Twenty-seven age-matched obese subjects without proteinuria served as controls. A glucose tolerance test and renal biopsy were performed in all patients. Fasting serum insulin and homeostasis model assessment-insulin resistance (HOMA-IR) were regarded as reflecting insulin resistance. To delineate the relation between insulin resistance and proteinuria, troglitazone, which acts an insulin sensitizer was given to 6 of 12 patients with a regular diet for 8 weeks. The 6 others were observed without receiving troglitazone. RESULTS: The 12 patients showed the presence of a cluster of insulin resistance factors: higher blood pressure, higher body mass index, higher fasting plasma glucose, higher fasting serum insulin, and higher HOMA-IR than controls. The renal biopsy specimens exhibited no histological abnormalities in 7, focal segmental glomerulosclerosis in 3 and benign nephrosclerosis in 2. Troglitazone attenuated HOMA-IR and ameliorated proteinuria, but did not affect body weight, creatinine clearance, or blood pressure. In contrast, the parameters in the patients not given troglitazone did not change. CONCLUSION: Insulin resistance is a factor contributing to obesity-related proteinuria. The role of insulin resistance as a factor reducing proteinuria remains to be clarified.

Adult↗

PubMed2004

Favorable outcome of low-dose cyclosporine after pulse methylprednisolone in Japanese adult minimal-change nephrotic syndrome.

OBJECTIVE: There have been few studies on cyclosporine (CsA) monotherapy in adult minimal change nephrotic syndrome (MCNS). To delineate CsA therapy as new treatment options for MCNS, we conducted a prospective single-center study. METHODS: We assessed the efficacy of 3 different regimens in 36 patients, consisting of 26 first attacks or 10 relapses, of adult-onset MCNS. In 12 patients, CsA alone was given orally at a dose of 2-3 mg/kg/d, and in 12 patients, CsA after intravenous pulse methylprednisolone therapy (CsA/PMT) was given at the same dose. CsA was given for 12 months, tapered slowly, then stopped. The other 12 patients were treated with oral prednisolone (PSL, 40-60 mg/d) alone for 4 to 6 weeks, followed by daily PSL, with slowly tapering doses. RESULTS: Complete remission (CR) was obtained in 75% with CsA alone, 100% with CsA/PMT and 92% with PSL alone (p = 0.0379). The days required for CR were shortest in the CsA/PMT group (40.9 +/- 35.5 days with CsA alone vs. 11.0 +/- 5.6 with CsA/PMT vs. 21.5 +/- 15.8 with PSL alone). The cumulative rates of CR were significantly different among the 3 groups (p < 0.0001). The real numbers of the relapse were smallest in the CsA/PMT group, however, the cumulative rates of sustained remission among the 3 treatment arms were not statistically different. Renal function was well preserved with each treatment period. CsA-associated adverse effects were minimal but one patient developed new-onset hypertension and gingival hyperplasia. However, the adverse effects of PSL alone were serious in 3 cases: bleeding from gastric ulcer, diabetes mellitus, and aseptic necrosis. Many patients with PSL but few with CsA experienced cosmetic problems. CONCLUSIONS: CsA/PMT may be the most advantageous when the clinical efficacy of each treatment for MCNS is integrated.

Adult↗

PubMed2004

[Nephrotic syndrome and malignancy].

The patients with nephrotic syndrome frequently associate with solid tumors as well as hematologic malignancies, although the presence of nephrotic syndrome in patients with malignancy is rare. The association cannot be explained by chance alone, because it occurs at a rate. Theoretically, malignancy-associated glomerulopathy should be explained by at least two clinical criteria. First, a remission of proteinuria achieves after surgical removal of tumor or disappearance of tumor by chemotherapy. Second, relapse of proteinuria occurs after recurrence of malignancy. However, pathophysiologic link which is the third important criteria has not been established between the two diseases.

Hodgkin Disease↗

PubMed2003

Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status.

BACKGROUND: Recommended protein intake for dialysis patients is much higher compared with allowance for normal adults. The authors tried to make a consideration on balancing among nutrient intake, dialysis dose, and nutritional status in maintenance dialysis patients. METHODS: In 57 patients, 13 on hemodialysis (HD) and 44 on continuous ambulatory peritoneal dialysis (CAPD), serum urea nitrogen (SUN), albumin, weekly creatinine clearance of CAPD, and body protein mass by multifrequency bioelectrical impedance analysis were measured. Energy intake was examined from the patients' food diary by a registered dietitian, and protein intake was estimated by both the patients' food diary and calculation of protein equivalent nitrogen appearance. RESULTS: In HD patients, predialysis SUN levels significantly correlated with the amounts of protein intake (r = 0.893; P < 0.001), and there was no correlation between post- and next predialysis SUN levels. In CAPD patients, SUN levels significantly correlated with the amounts of protein intake (r = 0.645; P < 0.001), and there was no correlation between SUN levels and weekly Ccr. The amounts of protein intake were significantly correlated with body protein mass (r = 0.365; P = 0.014), and there were significantly positive relationships between the amounts of protein intake and energy intake in both HD (r = 0.798; P < 0.001) and CAPD patients (r = 0.631; P = 0.006). CONCLUSION: Whereas higher intake of protein requires higher doses of dialysis, lower intake of protein with sufficient energy intake requires lower doses of dialysis, and both could give the same effects on nutritional status.

Adult↗

PubMed2003

[Henoch-Schönlein purpura nephritis in a patient infected with the human immunodeficiency virus].

There are various forms of renal lesions in patients with human immunodeficiency virus(HIV), however reported cases of immune-complex glomerulonephritis are scarce. Here we describe an HIV-positive patient with Henoch-Schönlein purpura nephritis(HSPN), which presented as nephrotic syndrome. In addition to therapy combined with glucocorticosteroid and inhibition of the renin-angiotesin system(RAS), plasmapheresis and antiretroviral therapy produced a favorable outcome. A 26-year-old HIV positive man was admitted for purpura on both lower limbs. Despite glucocorticosteroid treatment, purpura recurred and urinary protein increased to 5-10 g daily. HSPN was diagnosed based on the skin and renal biopsies. During 2 months of treatment with combined glucocorticosteroid and RAS inhibition, nephrotic syndrome persisted. He received double filtration plasmapheresis(DFPP). Soon after, urine protein decreased to 2-3 g daily and macrohematuria decreased. The second renal biopsy showed a decrease in IgA deposition and improvement of acute inflammatory changes. In addition, highly active antiretroviral therapy was started to reduce the high viral load. After 3 weeks, HIV-1-RNA rapidly decreased and urine protein decreased to 1 g daily. After a year, urinary protein was negative, but mild microhematuria persisted. We speculate that the refractory nephrotic syndrome in this patient might be associated with the abnormal immunological condition due to HIV infection.

AIDS-Associated Nephropathy↗

PubMed2003

[Quadritherapy with cyclosporine for membranous lupus nephropathy].

The therapeutic approach to patients with membranous lupus nephropathy (MLN) remains controversial. We have attempted combination therapy for MLN. Five patients with MLN (WHO class Va and Vb) and nephrotic syndrome were treated with 1 g methylprednisolone intravenously for 3 consecutive days followed by daily prednisolone at the dose of 30-40 mg plus cyclosporine at the dose of 100-200 mg and angiotensin receptor blocker(40 mg of valsartan). Initial dosage prednisolone was given for 1 month, and then tapered gradually in terms of dosage and interval. These patients were followed up for a minimum of 12 months. Complete remission was obtained in 4 patients after a mean of 7.3 +/- 2.1 months, and partial remission was obtained in the remaining patient. Daily prednisolone dosage significantly decreased from a baseline mean of 0.69 +/- 0.11 mg/kg to a mean of 0.10 +/- 0.02 mg/kg at the last follow-up. Lupus activity, as measured by SLE disease activity index, significantly decreased in all patients. Serum creatinine level and blood pressure remained stable. It was concluded that quadritherapy, including intravenous methylprednisolone, prednisolone, cyclosporine, and angiotensin receptor blocker, was beneficial in inducing remission of nephrotic syndrome, reducing lupus activity, and sparing prednisolone dosage with an acceptably low risk for side effects.

Adult↗

PubMed2002

[Serum albumin levels and prognosis after commencing chronic dialysis in diabetic patients with end-stage renal failure].

We investigated 1) the association between serum albumin levels(Alb) at the initiation of dialysis and survival after a mean follow-up period of 30.1 +/- 23.1 months following the commencement of chronic dialysis, and 2) the factors associated with hypoalbuminemia at the initiation of dialysis in diabetic patients with end-stage renal failure(ESRF). A hundred and thirty diabetic patients who were initiated on chronic dialysis in our department between January 1992 and November 2000 were studied. Alb and some variables were collected at 12, 6, 3, and 1 month before the initiation of dialysis(-12, -6, -3, -1 M), at the initiation of dialysis(0 M), and 1, 6, and 12 months after commencing chronic dialysis(1, 6, 12 M). Multivariate logistic regression analysis showed that hypoalbuminemia(less than 3 g/d/) at 0 M was significantly associated with an increase in urinary protein excretion per 1 g/day during -12 M and -1 M and total blindness due to diabetic retinopathy(Odds ratio 1.41, 8.83, p = 0.01, 0.03). Cox's proportional-hazard model demonstrated that a decrease in Alb per 1 g/dl at 0 M was significantly associated with survival(Hazard ratio 3.69, p = 0.03, adjusted age, sex, mode of dialysis, and urinary protein excretion during -12 M and -1 M). In addition, a decrease in Alb between -1 M and 0 M was significantly associated with elevated C-reactive protein at 0 M and a decrease in hematocrit between -1 M and 0 M. In conclusion, hypoalbuminemia at the initiation of dialysis, from any cause other than proteinuria, was associated with a poor prognosis after commencing chronic dialysis in diabetic ESRF patients.

Adult↗

PubMed2002

[Fluctuation of the rate of renal function decline associated with fluctuation of compliance with a low protein diet in patients with diabetic renal failure].

We investigated fluctuation of compliance with a low protein diet and the influence on the rate of decline in renal function. Twenty-seven patients with diabetic renal failure who were prescribed a low protein diet of 0.6 g/kg/day were followed during a period of 12 months. Dietary compliance was evaluated based on a 4-day dietary diary, interview with patients and calculation of the protein catabolic rate from 24-hour urea excretion at every hospital visit. They were judged on a 4-rank system, A(adhered over 75% of the days), B(74-50%), C(49-25%), D(less than 24%). During the twelve months, 55.5% of the patients showed fluctuation of their compliance with the diet. In 17 patients whose compliance fluctuated between rank A and B, their rate of GFR decline(ml/min/month) was significantly faster(-2.40 +/- 2.59 vs 0.99 +/- 1.41, p < 0.01), their rate of serum creatinine elevation(mg/dl/month) was significantly higher(0.90 +/- 0.79 vs -0.42 +/- 0.45, p < 0.01) and their rate of serum urea nitrogen increase(mg/dl/month) was significantly larger(15.3 +/- 12.4 vs -10.0 +/- 12.9, p < 0.01) during the period of rank B than rank A. There were no significant differences in the rates of changes in serum levels of albumin, transffering, HbA1c and body weight between the two periods. In conclusion, fluctuation of compliance with a low protein diet affects the rate of renal function decline synchronizedly in patients with diabetic renal failure.

Aged↗