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Ishiyama K.,Japan Community Health Care Organization Sendai Hospital | Sato T.,Japan Community Health Care Organization Sendai Hospital | Yamaguchi T.,Tohoku University | Taguma Y.,Japan Community Health Care Organization Sendai Hospital
Clinical and Experimental Nephrology | Year: 2016

Background: Corticosteroids have been widely used in patients with cholesterol crystal embolism (CCE) and low-density lipoprotein apheresis (LDL-A) was reported to reduce the risk of end-stage renal disease in patients with CCE. This study was designed to evaluate the renoprotective effects of LDL-A in combination with corticosteroids in patients with CCE. Methods: Thirty-five patients with CCE who, between 2008 and 2013, had shown renal deterioration after vascular interventions were retrospectively evaluated. All patients received corticosteroids; of these, 24 also received LDL-A and 11 did not, designated LDL-A and control groups, respectively. Differences in eGFR (ΔeGFR), 3 months and 1 year after CCE diagnosis, were compared in the two groups. Results: The median estimated glomerular filtration rate (eGFR) in all patients was 38.9 [interquartile range (IQR) 31.9–49.4] ml/min/1.73 m2 at baseline (before vascular intervention). At diagnosis, it was 14.4 (IQR 11.3–21.8) ml/min/1.73 m2. The initial corticosteroid dose was 0.34 ± 0.10 mg/kg/day. The mean number of LDL-A treatment sessions in the LDL-A group was 4.3 ± 1.8. eGFR was increased significantly after LDL-A treatments, from 15.0 (IQR 12.3–20.1) to 19.6 (IQR 14.3–23.6) ml/min/1.73 m2 (P < 0.05). ΔeGFR tended to be higher in the LDL-A than in the control group at 3 months [median 6.5 (IQR 5.1–9.3) vs. 2.6 (IQR −0.6 to 6.3) ml/min/1.73 m2, P = 0.095] and was significantly higher at 1 year [median 7.5 (IQR 5.4–8.7) vs. 2.2 (IQR −3.8 to 5.1) ml/min/1.73 m2, P = 0.019]. Conclusions: LDL-A plus corticosteroids may restore deteriorated renal function better than corticosteroids alone in patients with CCE. © 2016 Japanese Society of Nephrology


Morozumi K.,Japan Community Health Care Organization Sendai Hospital | Namiki S.,Japan Community Health Care Organization Sendai Hospital | Nakamura Y.,Tohoku University
Acta Urologica Japonica | Year: 2016

A 39-year-old female visited our hospital because of a bladder tumor. Computed tomography and magnetic resonance imaging showed a retrovesical tumor in dome of the bladder. Cystoscopy showed edematous inflammatory changes of the mucosa of the bladder wall. We diagnosed her with urachal carcinoma from cystoscopy finding and image inspections. She received partial cystectomy with pelvic lymphadenectomy. Histopathological examination revealed inflammatory myofibroblastic tumor because these specimens presented positive for anaplastic lymphoma kinase in immunohistochemical studies. She has been followed up for 16 months without any evidence of local recurrence.


Ishiyama K.,Japan Community Health Care Organization Sendai Hospital | Sato T.,Japan Community Health Care Organization Sendai Hospital | Taguma Y.,Japan Community Health Care Organization Sendai Hospital
Therapeutic Apheresis and Dialysis | Year: 2015

Drugs such as corticosteroids and statins have been used to treat cholesterol crystal embolism (CCE), but the prognosis remains poor. This study evaluated the efficacy of low-density lipoprotein apheresis (LDL-A) in patients with CCE. Patients with CCE who showed renal deterioration after vascular interventions were studied retrospectively. Information on demographic variables, clinical measurements, and medication use was collected. The outcomes were incidence of maintenance dialysis and mortality at 24 weeks. A total of 49 patients with CCE were included, among whom 37 (76%) were diagnosed pathologically and the remainder were diagnosed clinically. The median estimated GFR at baseline and at diagnosis were 40.5 and 13.4mL/min per 1.73m2, respectively. Corticosteroids were used in 42 patients (86%), statins in 30 patients (61%), and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in 29 patients (59%). LDL-A was performed in 25 patients (LDL-A group), and not in 24 patients (control group). Smoking (100% vs. 72%, P=0.02), white blood cell count (8900/mm3 vs. 7000/mm3) and corticosteroid use (96% vs. 75%) were higher in the LDL-A group compared with the control group, but there were no differences in other demographic and clinical parameters between the groups. Patients in the LDL-A group had a lower incidence of maintenance dialysis (2/25 (8%) vs. 8/24 (33%), P<0.05), and a trend towards lower mortality (2/25 (8%) vs. 7/24 (29%), P=0.074). These results suggest that LDL-A decreases the risk of maintenance dialysis in severe renal CCE patients after vascular interventions. © 2015 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society of Dialysis Therapy.


PubMed | Tohoku University and Japan Community Health Care Organization Sendai Hospital
Type: | Journal: Clinical and experimental nephrology | Year: 2016

Corticosteroids have been widely used in patients with cholesterol crystal embolism (CCE) and low-density lipoprotein apheresis (LDL-A) was reported to reduce the risk of end-stage renal disease in patients with CCE. This study was designed to evaluate the renoprotective effects of LDL-A in combination with corticosteroids in patients with CCE.Thirty-five patients with CCE who, between 2008 and 2013, had shown renal deterioration after vascular interventions were retrospectively evaluated. All patients received corticosteroids; of these, 24 also received LDL-A and 11 did not, designated LDL-A and control groups, respectively. Differences in eGFR (eGFR), 3months and 1year after CCE diagnosis, were compared in the two groups.The median estimated glomerular filtration rate (eGFR) in all patients was 38.9 [interquartile range (IQR) 31.9-49.4] ml/min/1.73mLDL-A plus corticosteroids may restore deteriorated renal function better than corticosteroids alone in patients with CCE.


PubMed | Tohoku University and Japan Community Health Care Organization Sendai Hospital
Type: Journal Article | Journal: Clinical and experimental nephrology | Year: 2016

Anemia greatly affects the development of renal and cardiovascular outcomes in chronic kidney disease (CKD) patients. However, the impact based on CKD stage remains unclear.We prospectively followed 2,602 Japanese CKD patients under the care of nephrologists. CKD was defined according to cause, estimated glomerular filtration rate <60mL/min, and/or proteinuria. Patient outcomes [primary end-points: cardiovascular events (CVEs), all-cause mortality, and end-stage kidney disease (ESKD) requiring renal replacement therapy] were assessed in association with basal hemoglobin (Hb) levels (<10, 10-12 and 12g/dL), stratified by CKD stages.During follow-up, 123 patients developed CVEs, 41 died, and 220 progressed to ESKD. For stages G3, G4 and G5, ESKD frequencies were 2.8, 64.4, and 544.8 person-years, while CVEs and death were 25.6, 45.6, and 76.3 person-years, respectively. The combined endpoint rate was significantly higher in patients with Hb <10 versus Hb 10-12g/dL, but a higher risk for CVEs and death with Hb <10g/dL was found only in G3 [hazard ratio (HR) 4.49, (95% confidence interval (95%CI) 2.06-9.80)]. In contrast, risk for ESKD with Hb <10g/dL was found only in G4 [HR 3.08 (95% CI 1.40-6.79)] and G5 [HR 1.43 (95% CI 1.01-2.05)]. No increased risks with higher Hb levels were found.The impact of renal anemia of Hb <10g/dL on clinical outcomes differed by CKD stage, with a significantly high risk for CVEs and all-cause mortality in G3 and progression to ESKD in G4 and G5.


PubMed | Tohoku University and Japan Community Health Care Organization Sendai Hospital
Type: Journal Article | Journal: Journal of vascular surgery | Year: 2016

The number of hemodialysis patients with peripheral artery disease is increasing, and critical limb ischemia develops in some of these patients. The clinical outcomes in such patients after major amputation remain unclear. We therefore examined the mortality rates after major amputation in hemodialysis patients.The study enrolled 108 hemodialysis patients undergoing their first major amputation at Community Health Care Organization Sendai Hospital between January 2005 and December 2014 and monitored them until June 2015. All-cause mortality and additional amputation-free survival were evaluated by Kaplan-Meier analysis.The most dominant primary disease of renal failure was diabetes mellitus (77%), and the duration of hemodialysis was 8.5 6.8years. During the median follow-up period of 11.5months (20.3 22.6months), 80 patients (74%) died, and the survival rates were 83% at 30days, 56% at 1year, and 15% at 5years. The median time to death was 19.9months (95% confidence interval, 9.8-30.0months), and the causes of death were cardiac (45%), sepsis (29%), cerebrovascular (4%), and others (22%). Thirty-one patients underwent additional amputation, and the additional amputation-free survival rates were 39% at 1year and 9% at 5years. The median time between the first and second amputations was 2.5months (5.7 7.6months). Univariate analysis showed previous minor amputation (P= .04) and low hematocrit level (P= .04) were associated with the 30-day mortality rate, and age (P= .05) was associated with the 5-year mortality rate. On multivariate Cox proportional hazard analysis, only age was associated with mortality rate (hazard ratio, 1.02; 95% confidence interval, 0.99-1.02; P= .04). We also compared walking ability before and after major amputation among patients who survived >60days. The rate changed from 34% to 12% for of ambulatory patients, from 45% to 48% for wheelchair use, and from 21% to 40% for bedridden patients. Ambulatory patients had a significantly better survival rate than the others (P= .02).The mortality rate after major amputation in hemodialysis patients was high, and major amputation had a huge negative effect on patients walking ability.


PubMed | Tohoku University and Japan Community Health Care Organization Sendai Hospital
Type: | Journal: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi | Year: 2015

Blood cultures for patients suspected of having bacteremia are standard practice, although several studies demonstrate that blood cultures have limited utility because of a low true-positive rate and infrequent resultant changes in antibiotic treatment. However, most reports exclude immunocompromised patients such as transplant recipients. We assessed the utility of blood cultures in transplant recipients hospitalized for community-acquired infections and evaluated clinical characteristics to predict bacteremia.This retrospective study included 136 febrile cases in 97 kidney transplant recipients admitted to our hospital for whom blood cultures were performed between February 2001 and March 2013.Among the 136 cases, blood cultures were positive, contaminated, and negative in seven (5.1%) cases, 12 (8.8%) cases, and 117 cases (86.1%), respectively. All bacteria detected in the seven cases were sensitive to the initial empirical antibiotics. Antibiotic treatment was changed based on the blood culture results only in one case for which the coverage was narrowed. The white blood cell count and C-reactive protein level were significantly higher in the patients with bacteremia. The predictive model based on these two factors successfully identified the high-risk group with a sensitivity and specificity of 86% and 91%, respectively.Among the outpatient kidney transplant recipients, positive blood cultures were uncommon and scarcely affected antibiotic therapy, especially in patients with upper respiratory tract or urinary tract infections. Therefore, it may be reasonable to perform blood cultures only for patients with marked leukocytosis and high C-reactive protein level, even among transplant recipients.


PubMed | Tohoku University, Japan Community Health Care Organization Sendai Hospital and Dokkyo Medical University
Type: Journal Article | Journal: Pathology international | Year: 2015

Artifacts in the process of specimen preparation are frequent in ultrastructural evaluation of renal biopsy. We hypothesized that the common practice of wrapping kidney biopsy specimens in saline-soaked gauze to prevent the drying of the specimens could be the major factor of artifacts. In this study, whole kidneys from two male Sprague-Dawley rats were used. Before fixation, fresh small cubes of kidney tissue were macerated in saline (Saline group) or hypoelectrolytic isoosmotic solution for infusion (HISI group) (Sorita T3 or SOLDEM 3A) for 10 or 30min. Then, the specimens were processed by 1% OsO(4) in 0.1M phosphate buffer (pH7.4) and embedded by EPON 812 for ultramicroscopic analysis. In the Saline group, ultrastructural examination revealed swollen podocyte, swollen capillary protuberance of the mesangium into the glomerular capillary loop, tubular cells with swollen mitochondria and microvilli, and the smooth muscle cells in the arteriolar wall with marked vacuolar degeneration were detected after 10min maceration in saline and these findings become more pronounced after 30min maceration. However, in the HISI group, these artifacts were not identified or limited within 30min. It is postulated that HISI solution could prevent the artifacts, and be used for soaking and wrapping instead of physiologic saline solution.


PubMed | Osaki Citizen Hospital, Japan Community Health Care Organization Sendai Hospital and Tohoku University
Type: Journal Article | Journal: Case reports in oncology | Year: 2017

A 73-year-old male underwent transurethral resection of a bladder tumor in August 2010 and April 2011. Pathological examination revealed urothelial carcinoma. After the surgery, chemotherapy and intravesical Bacillus Calmette-Guerin instillation were performed. In September 2014, he once again underwent transurethral resection of the bladder tumor for recurrence, and was again diagnosed with urothelial carcinoma, pT2, by pathological examination. After neoadjuvant chemotherapy, radical cystectomy for tumor recurrence was performed. Pathological examination at this time revealed small cell carcinoma, pT3N0. It is rare for urothelial carcinoma to change to small cell carcinoma, and the mechanism and cause of this change are still unknown. In this case report, we discuss what causes small cell carcinoma of the urinary bladder and review the literature regarding its origin.


PubMed | Kawasaki Medical School, Tohoku University, Kyoto University, Iwate Prefectural Central Hospital and Japan Community Health Care Organization Sendai Hospital
Type: Journal Article | Journal: Clinical and experimental nephrology | Year: 2015

The aim of this study was to determine the efficacy of cyclophosphamide (CY) on anti-neutrophil cytoplasmic antibody (ANCA)-positive microscopic polyangiitis (MPA) with renal involvement in Japanese patients.Eighty-two patients with newly diagnosed ANCA-positive MPA were enrolled in this retrospective study. Patients were divided into two groups based on whether they received combination therapy with a corticosteroid (CS) plus CY (CY group) or CS alone or with other therapies (non-CY group). The primary outcome was defined as the combination of death and end-stage renal disease (ESRD).The CY and non-CY groups included 29 and 53 patients, respectively. In the non-CY group, 31 patients were treated with CS alone, and 22 with a combination of CS and other therapeutics. The percentage of males and mean Birmingham vasculitis activity scores were higher in the CY group than those in the non-CY group, but other factors such as age, serum creatinine, serum albumin, or CRP at baseline were equivalent in the two groups. No differences were observed in remission rates using induction therapy for the two groups. However, the survival rate 5 years after induction therapy was lower in the CY group than in the non-CY group (0.50 vs. 0.73; P=0.041), although the hazard ratio of CY for the primary outcome adjusted for all confounding factors was 1.321 [95% confidence interval (CI), 0.662-2.637; P=0.171].CY may not have an additive effect on induction therapy with CS for Japanese patients with renal vasculitis associated with ANCA-positive MPA.

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