Suzuki Y.,Juntendo University |
Matsuzaki K.,Juntendo University |
Suzuki H.,Juntendo University |
Sakamoto N.,National Health Research Institute |
And 4 more authors.
Clinical and Experimental Nephrology | Year: 2014
Background: The remission criteria of immunoglobulin A (IgA) nephropathy have varied depending on the clinical study. Therefore, nephrologists cannot make a uniform assessment of treatment outcomes and the standardization of explanations of the condition is difficult in patients with IgA nephropathy. This study aims to propose clinical remission criteria for IgA nephropathy based on a nationwide opinion survey in Japan regarding IgA nephropathy remission/relapse. Method: This nationwide survey was sent to 312 teaching facilities of the Japanese Society of Nephrology by Progressive Renal Disease Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan. Results: Valid answers were obtained from 193 facilities (61.9 %) (136 internal medicine facilities and 57 pediatric facilities), of which 134 (69.4 %) thought that both hematuria and proteinuria should be used in the remission standards. Approximately half of the survey respondents shared the opinion on standards of negative results for hematuria and proteinuria and the duration and frequency of these conditions. Conclusion: In this paper, we propose a standardized set of criteria for defining IgA nephropathy remission: three consecutive negative results over a 6-month period in urinary occult blood tests; urinary sediment red blood cell count of <5/high-power field (hematuria remission); and urinary protein of <0.3 g/day (g/g Cr; proteinuria remission). Clinical remission is defined as cases with both hematuria and proteinuria remission. These consensus-based remission criteria should be verified in future studies. In the meantime, they may be useful in predicting therapeutic outcome in cases of IgA nephropathy. © 2013 Japanese Society of Nephrology.
Takahara S.,Osaka University |
Takahashi K.,Niigata University |
Akiyama T.,Sakai Onshinkai Hospital |
Uchida K.,Red Cross |
And 3 more authors.
Clinical and Experimental Nephrology | Year: 2013
Background: Mizoribine (MZR) was approved in 1984 in Japan for the suppression of rejection in renal transplantation with an approved administration dosage of 1-3 mg/kg/day. The action of MZR resembles that of mycophenolate mofetil (MMF), but MZR dosing is markedly lower than that of MMF. To examine whether higher dosing of MZR could obtain efficacy similar to MMF in renal transplantation, we conducted a comparative study of MZR and MMF using a high daily dose of MZR. Methods: A prospective, randomized comparative study of MZR versus MMF using tacrolimus (FK) and steroids as the base was conducted in 35 patients who had undergone living-donor renal transplantation (ABO-incompatible patients were not included) at 8 institutions in Japan between July 2005 and June 2007. Starting doses were 12 mg/kg/day for MZR and 2 g/day for MMF. Dosages of FK and steroids were set according to the protocol of each institution. Results: Patient and graft survival rate at 1 year after transplantation was 100 % in each group, with no significant difference in rejection rate apparent between groups. Adverse events found in both groups were characteristic, frequently involving infection and digestive organ disorder in the MMF group and elevated uric acid levels in the MZR group. Conclusions: Based on these results, MZR and MMF are considered almost equivalent in terms of efficacy and safety. © 2013 Japanese Society of Nephrology.
Hotta O.,Sendai Shakaihoken Hospital
Advances in Oto-Rhino-Laryngology | Year: 2011
IgA nephropathy (IgAN), the most common form of primary glomerulonephritis progressing to end-stage renal disease (ESRD), has been regarded as an incurable disease. However, in recent years, it has been demonstrated that combined tonsillectomy with steroid pulse (TS) therapy, if administrated in the relatively early stage of the disease, can yield clinical remission in patients with IgAN. However, clinical remission is no longer obtained when the same treatment is administrated in cases with more advanced disease and/or a longer duration of nephropathy. Thus, the paradigm of managing IgAN patients is shifting in Japan from 'slowing the progression and the delaying the onset of ESRD' (by conventional therapy using a RAS inhibitor and/or corticosteroids at low doses in selected patients with advanced IgAN) to 'achieving remission' by the TS therapy in patients with early disease. In the new paradigm aimed at clinical remission, the principle for initiation of TS therapy should be 'the earlier, the better'. Copyright © 2011 S. Karger AG, Basel.
Ieiri N.,Sendai Shakaihoken Hospital |
Hotta O.,Sendai Shakaihoken Hospital |
Sato T.,Sendai Shakaihoken Hospital |
Taguma Y.,Sendai Shakaihoken Hospital
Clinical and Experimental Nephrology | Year: 2012
Background: Because of the well-established annual urinalysis screening system in Japan, the duration of nephropathy (DN) can be estimated in more than half of all patients with IgA nephropathy (IgAN). Treatment using a combination of tonsillectomy and steroid pulse (TSP) therapy has been reported as an effective method for obtaining clinical remission (CR), defined as negative hematuria and proteinuria, in IgAN patients. The present study aims to identify the correlation between DN and CR rate in IgAN patients treated by TSP therapy. Methods: We retrospectively investigated 830 IgAN patients who were followed up for 81.6 months after TSP therapy. DN could be estimated in 495 of the 830 patients. Results: The CR rate among patients with DN ≤36 months was 87.3% (295/338 patients). The CR rate among patients with DN of 37-84 months was 73.3% (63/86 patients), while that among patients with DN ≥85 months was 42.3% (30/71 patients). The CR rate among the remaining 335 patients in whom DN could not be estimated because of missing annual urinalysis results was 43.6% (146/335 patients). A multivariate Cox regression model using data from the former group of 495 patients showed that DN ≤36 months was a significant predictor of CR (hazard ratio 1.839; 95% confidence interval 1.410-2.398; P < 0.001). Conclusion: Shorter DN is associated with higher likelihood of clinical remission in IgAN patients treated by TSP therapy. © 2011 Japanese Society of Nephrology.
Tokodai K.,Sendai Shakaihoken Hospital |
Amada N.,Sendai Shakaihoken Hospital |
Haga I.,Sendai Shakaihoken Hospital |
Takayama T.,Sendai Shakaihoken Hospital |
Nakamura A.,Sendai Shakaihoken Hospital
Diabetes Research and Clinical Practice | Year: 2014
Aims: To evaluate the predictive power of the 5-time point oral glucose tolerance test (OGTT) for new-onset diabetes after kidney transplantation (NODAT). Methods: We performed a retrospective study of 145 patients without diabetes who received kidney transplantations at our hospital. The 5-time point OGTT was performed before transplantation. The area under a receiver-operating characteristic curve (aROC) was used for evaluating the predictive power of 5-time point OGTT values. Results: Seventeen patients developed NODAT within 1 year after transplantation. All postload plasma glucose (PPG) levels were higher in patients who developed NODAT than in those who did not; fasting plasma glucose levels were not different. The aROC for the area under the glucose concentration-time curve was significantly greater than that for fasting plasma glucose. Univariate and multivariate analyses showed that each PPG level was an independent risk factor for NODAT. Furthermore, patients with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) could be stratified with a 1-h plasma glucose (1h-PG) cut-off point of 8.4. mmol/L. The incidences of NODAT were 23.5%, 16.7%, 9.1%, and 0% for patients with IGT. +. 1h-PG ≥8.4. mmol/L,IGT. +. 1h-PG <8.4. mmol/L, NGT. +. 1h-PG ≥ 8.4. mmol/L, and NGT. +. 1h-PG. <. 8.4. mmol/L, respectively. Conclusions: The area under the glucose concentration-time curve and each PPG concentration during the 5-time point OGTT are strong predictors of NODAT. A 1h-PG cut-off point of 8.4. mmol/L plus NGT/IGT can be used to identify patients at intermediate and high risk of developing NODAT. © 2014 Elsevier Ireland Ltd.