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Search Results: 1 - 10 of 357 matches for " Yasuhiko Tomino "
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Transperitoneal Calcium Balance in Anuric Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients
Chieko Hamada,Yasuhiko Tomino
International Journal of Nephrology , 2013, DOI: 10.1155/2013/863791
Abstract: Backgrounds. Calcium (Ca) and bone metabolism in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients show a remarkable difference depending on dialysis modalities. The levels of serum Ca and phosphate (P) in HD patients fluctuate contributing to the intermittent and rapid removal of plasma solute unlike in CAPD. Characteristics of plasma solute transport in automated peritoneal dialysis (APD) patients are resembled with that in HD. The purpose of the present study was to examine the difference of transperitoneal Ca removal between APD and CAPD anuric patients. Subjects and Methods. Twenty-three APD anuric patients were enrolled in this study. Biochemical parameters responsible for transperitoneal Ca removal in 24-hour and 4-hour peritoneal effluents were analyzed on CAPD and APD. Results. Transperitoneal Ca removal on APD was smaller compared with that on CAPD. The Ca removal was related to the ultrafiltration during short-time dwell. Decrease of the Ca removal during NPD induced by short-time dialysate dwell caused negative or small Ca removal in APD patients. The levels of intact PTH were increased at the end of PET. Conclusion. It appears that short-time dwell and frequent dialysate exchanging might suppress the transperitoneal Ca removal in anuric APD patients. 1. Introduction Bone disease is one of the serious complications in chronic dialysis patients. Adynamic bone disease and secondary hyperparathyroidism are associated with not only viability and quality of life (QOL) but also mortality in long-term dialysis patients. It is generally considered that Ca and bone metabolism between peritoneal dialysis (PD) and hemodialysis (HD) patients provided remarkable differences according to dialysis modalities. Hemodialysis patients undergo rapid and intermittent removal of phosphate, uremic toxins and excess body fluid from sera, and influx or efflux of Ca influent in such metabolism [1–3]. Higher serum Ca levels and continuous glucose loading occur, which may lead to a higher incidence of adynamic bone in CAPD patients compared with that in HD patients [4, 5]. Patients with very low parathyroid hormone (PTH) level had a higher mortality rate after adjustment for age, gender, diabetes, and dialysis vintage [6]. The turnover of bone remodeling in PD patients is lower than that in HD patients [4, 5]. Using 3.5?mEq/L Ca dialysate in HD, Ca removal demonstrated a negative balance [7, 8]. It is recognized that Ca mass transport in CAPD patients depends on the following factors: Ca concentration in the dialysis fluid, starting plasma
Influence of the period between onset of IgA nephropathy and medical intervention on renal prognosis  [PDF]
Keiko Okazaki,, Yusuke Suzuki, Takashi Kobayashi, Fumiko Kodama, Satoshi Horikoshi, Yasuhiko Tomino
Health (Health) , 2011, DOI: 10.4236/health.2011.38086
Abstract: Background. The clinical course of IgA nephropathy (IgAN) is highly variable. In order to verify the necessity of early medical intervention in IgAN patients, the present study investigated the clinical impact of the duration between disease onset and first medical intervention on renal prognosis. Methods. We enrolled 57 patients diagnosed with IgAN on the basis of biopsy performed at our hospital. The medical records of these patients were traceable to the last 10 years, during which they had not undergone dialysis or treatment at any other hospital. On the basis of histological assessment of prognosis, these patients were classified according to the Japanese guidelines into the following groups: groups I, good prognosis; group II, relatively good prognosis; group III, relatively poor prognosis; and group IV, poor prognosis. We investigated the correlation between the duration of disease onset and the first consultation with a nephrologist and the rate of increase in serum creatinine over a 10 year period. In addition to the abovementioned patients, 6 patients with IgAN who underwent dialysis within the 10 years were separately evaluated. These patients came under the poor prognosis category; i.e., they belonged to group IV. Results. The duration between disease onset and medical consultation was significantly longer in younger patients or in those with asymptomatic proteinuria at onset when compared to that in older patients or in those with other urinary abnormalities. There was a significant correla tion between this duration and renal prognosis, particularly in group III patients. Although the duration between onset and consultation was not correlated to the serum creatinine level at the time of first medical intervention, urinary protein level among group IV patients at the time of first consultation was significantly higher in patients with dialysis than that in those without dialysis. Conclusions. Early medical intervention may lead to a better renal prognosis, particularly in group III patients, who form a major portion of the IgAN population. It therefore appears that early diagnostic screening and subsequent intervention are important for a good prognosis in IgAN patients.
Dimethylarginine Dimethylaminohydrolase 2 Gene Polymorphism and Its Association with Asymmetrical Dimethyl Arginine in Hemodialyzed Patients  [PDF]
Mochamad Yusuf, Mochammad Thaha, Raden Mohammad Yogiarto, Muhammad Aminuddin, Raden Mohammad Yogiantoro, Retno Handajani, Yasuhiko Tomino
Open Journal of Nephrology (OJNeph) , 2013, DOI: 10.4236/ojneph.2013.31013
Abstract: Introduction:Patients with CKD have elevated plasma levels of Asymmetrical Dimethyl Arginine (ADMA), impaired EDRF/NO responses in isolated resistance vessels, and a marked increase in the frequency of cardiovascular events that are predicated by plasma levels of ADMA. ADMA is considered as a risk factor for endothelial dysfunction, progression of chronic kidney disease and a marked increase in the frequency of cardiovascular events that are predicated by plasma levels of ADMA. Elevated ADMA in CKD have been related to a combination of a reduced renal ADMA excretion and a reduced catabolism of ADMA by dimethylarginine dimethylaminohydrolase (DDAH). The current study was undertaken to determine whether there is a correlation between ADMA and SNPs at -449 DDAH 2.Subjects and Methods :It was a cross sectional analytic study, 56 hemodialysis patients and 30 healthy individuals were enrolled. Based on its etiology, HD patients group was further divided in to hypertension (HT) subgroup and non-HT subgroup. Genotyping of the polymorphisms was performed using PCR-based SNP detection methods based on
Pathological Scenario with the Mannose-Binding Lectin in Patients with IgA Nephropathy
Isao Ohsawa,Masaya Ishii,Hiroyuki Ohi,Yasuhiko Tomino
Journal of Biomedicine and Biotechnology , 2012, DOI: 10.1155/2012/476739
Abstract: A deeper understanding of the mechanism of complement activation may help to elucidate the pathogenesis of IgA nephropathy (IgAN). Traditionally, the activation of an alternative pathway (AP) has been recognized as an enhancer mechanism of glomerular damage. This paper documents contemporary information concerning the possible pathological mechanisms of the lectin pathway (LP) in the circulation and in the glomerulus. The circulating initiator of LP activation is not fully understood. However, ligands for mannose-binding lectin (MBL) which are among the starter molecules of the LP are aberrant glycosylated molecules-containing immune complex. Recent reports have focused on N-glycans on secretory IgA as a candidate ligand. Mesangial deposits of MBL are seen in 25% of patients with IgAN. Mesangial deposits of MBL and C4 and/or C4 breakdown products are implicated as markers for disease progression of IgAN. On the other hand, patients with MBL deficiency tend to show better clinical presentation and lower levels of urinary protein and serum creatinine than MBL-sufficient patients. It is now recognized that involvement of AP and LP constitutes an additional mechanism for explaining the progression of IgAN.
Experimental Models of Type-2 Diabetic Nephropathy
Yasuhiko Tomino,Mark E. Cooper,Theodore W. Kurtz,Yoshio Shimizu
Experimental Diabetes Research , 2012, DOI: 10.1155/2012/218917
Association of the Cardioankle Vascular Index and Ankle-Brachial Index with Carotid Artery Intima Media Thickness in Hemodialysis Patients
Tomohito Gohda,Hiromichi Gotoh,Yoshikazu Gotoh,Saori Yamaguchi,Yasuhiko Tomino
International Journal of Nephrology , 2013, DOI: 10.1155/2013/401525
Abstract: The objectives of the present study are (1) to compare the cardioankle vascular index (CAVI), ankle-brachial index (ABI), and carotid artery intima-media thickness (CA-IMT) between HD patients with and without type 2 diabetes (T2D) or prevalence of cardiovascular (CV) disease and (2) also to evaluate the relationship of these indices with CA-IMT in these patients according to ABI levels. This study consisted of 132 HD patients with T2D and the same number of patients without T2D. The patients with diabetes or prevalence of CV disease had significantly higher CA-IMT and lower ABI values than those without diabetes or prevalence of CV disease, respectively. Although diabetic patients had higher CAVI than those without diabetes, CAVI did not differ between patients with or without prevalence of CV disease. In univariate analysis, CA-IMT was more strongly correlated with ABI than CAVI. However, the opposite was true in patients with an ABI value of more than 0.95. Both indices were significantly correlated with CA-IMT although ABI was a powerful determinant than CAVI. It appears that both indices are associated with CA-IMT in HD patients, especially with an ABI value of more than 0.95. 1. Introduction Cardiovascular (CV) diseases are major causes of death in patients with end-stage kidney disease (ESKD), especially for patients with type 2 diabetes (T2D). Carotid artery IMT (CA-IMT) is one of the most established predictors of death from CV disease independent of other classical risk factors in hemodialysis (HD) patients [1–3], although recent studies reported that the association between CA-IMT progression assessed from two ultrasound scans and CV disease remains unproven in general population [4, 5]. The ankle-brachial index (ABI) is used to diagnose peripheral artery occlusive disease (PAOD), and for patients, with an ABI value of less than 0.90, it is accepted as a reliable marker for PAOD [6]. A lower ABI value has also been shown to be significantly associated with CV diseases [7]. On the other hand, brachial-ankle pulse wave velocity (baPWV) is a useful marker for measuring arterial stiffness, one aspect of arteriosclerosis [8]. Several studies have demonstrated that both indices reflect the severity of carotid arteriosclerosis and predict all-cause and CV mortality in HD patients [9–12]. However, one drawback of baPWV is that it is affected by changes in blood pressure during measurements. Recently, a novel arterial stiffness parameter, the cardio-ankle vascular index (CAVI), was developed by measuring baPWV and blood pressure. Unlike baPWV, CAVI is
Usefulness of Change in Estimated Glomerular Filtration Rate as a Predicting Factor of Progression of Chronic Kidney Disease
Kunimi Maeda,Chieko Hamada,Satoshi Horikoshi,Yasuhiko Tomino
ISRN Nephrology , 2013, DOI: 10.5402/2013/351364
Abstract: Purpose. To explore factors contributing to chronic kidney disease (CKD) progression and change in estimated glomerular filtration rate over time (ΔeGFR) as a risk factor in predialysis patients under multidisciplinary managements. Methods. Among 113 CKD patients, eGFR, serum creatinine, total protein, albumin, urea nitrogen, uric acid, calcium, inorganic phosphate, total cholesterol, urinary creatinine, urinary protein (UP), hemoglobin A1c, hemoglobin, and hematocrit were analyzed. Results. ΔeGFR analysis in the first six months presented a positive slope (remission group) in 43 patients (38%) and a negative slope (no-remission group) in 70 patients (62%). Three-year dialysis-free rate was 89.4% in the remission group and 39.3% in the no-remission group, with a significant difference ( ). To explore factors contributing to dialysis initiation by stepwise Cox regression, baseline eGFR (HR 0.706, ) and ΔeGFR in the first six months of treatment (HR 0.075, ) were identified. To investigate factors affecting remission and no remission by stepwise logistic regression, age (odds ratio 1.06, ) and UP excretion (odds ratio 1.223, ) were identified. Conclusion. Monitoring of ΔeGFR and UP is not only useful in suppressing CKD 3 progression, but also in deciding strategies to achieve remission in individual patients. 1. Introduction In Japan, the number of patients with chronic kidney disease (CKD) shows a trend of annual increase and has reached 13.3 million as estimated by the Japanese Society of Nephrology. In other words, 1 in 9 adults is affected by CKD, showing a great impact of this disease on the population. In addition, the number of patients initiated on dialysis therapy continues to increase at a rate of 10,000 a year, reaching approximately 280,000 at the end of 2009 and has become an important medicoeconomic and social issue [1]. The Japanese Society of Nephrology tackled the establishment of standard treatment and dissemination of estimated glomerular filtration rate (eGFR) for the Japanese, which form the basis of CKD guidelines, and published the Clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease 2009 [2]. However, the current therapies cannot be regarded as optimal, and further studies of multidisciplinary treatment incorporating various modalities are required. With the previous background, further promotion of the use of eGFR as a simple indicator of the disease condition and practice of treatment based on evidence obtained from clinical studies are necessary. To investigate the relationship between the change in
Podocyte loss and albuminuria of KK-Ay mouse: A spontaneous animal model for human type 2 diabetic nephropathy  [PDF]
Yuji Ishikawa, Takamichi Ito, Mitsuo Tanimoto, Shinji Hagiwara, Masako Furukawa, Saori Yamaguchi, Keisuke Omote, Katsuhiko Asanuma, Tomohito Gohda, Yoshio Shimizu, Kazuhiko Funabiki, Satoshi Horikoshi, Yasuhiko Tomino
Journal of Diabetes Mellitus (JDM) , 2012, DOI: 10.4236/jdm.2012.23054
Abstract: Podocyte loss was well known in type 2 diabetic nephropathy patients. The objective of the present study was to determine the number of podocytes and the degree of albuminuria in diabetic KK-Ay/Ta (KK-Ay) mice which had been reported as diabetic nephropathy model. Diabetic KK-Ay mice, diabetic KK/Ta mice and non-diabetic BALB/cA Jcl (BALB/cA) mice were studied. We analyzed glomerular lesions in all mice by morphometric analysis and immunofluorescence to determine the number of podocytes. Level of urinary albumin was also measured. Glomerular enlargement and mesangial expansion were observed in KK-Ay mice. Mean number of podocytes per glomerulus (NG pod) in diabetic KK-Ay mice was significantly lower than that in non-diabetic BALB/cA mice. Mean NG pod/glomerular area (GA) per glomerulus was also significantly decreased in diabetic KK-Ay mice. The level of urinary albumin/creatinine ratio (ACR) in diabetic KK-Ay mice was significantly higher than that in non-diabetic BALB/cA mice. These data suggest that podocyte loss might induce albuminuria in KK-Ay mice. This finding confirmed our previous report that KK-Ay mice, especially in terms of histological findings, are a suitable animal model for glomerular injury in type 2 diabetic nephropathy.
Pathological Role of Tonsillar B Cells in IgA Nephropathy
Yusuke Suzuki,Hitoshi Suzuki,Junichiro Nakata,Daisuke Sato,Tadahiro Kajiyama,Tomonari Watanabe,Yasuhiko Tomino
Clinical and Developmental Immunology , 2011, DOI: 10.1155/2011/639074
Abstract: Although impaired immune regulation along the mucosa-bone marrow axis has been postulated to play an important role, the pathogenesis of IgA nephropathy (IgAN) is unknown; thus, no disease-specific therapy for this disease exists. The therapeutic efficacy of tonsillectomy or tonsillectomy in combination with steroid pulse therapy for IgAN has been discussed. Although randomized control trials for these therapies are ongoing in Japan, the scientific rationale for these therapies remains obscure. It is now widely accepted that abnormally glycosylated IgA1 and its related immune complex (IC) are probably key molecules for the pathogenesis, and are thus considered possible noninvasive biomarkers for this disease. Emerging evidence indicates that B cells in mucosal infections, particularly in tonsillitis, may produce the nephritogenic IgA. In this paper, we briefly summarize characteristics of the nephritogenic IgA/IgA IC, responsible B cells, and underlying mechanisms. This clinical and experimental information may provide important clues for a therapeutic rationale.
Different Pathological Roles of Toll-Like Receptor 9 on Mucosal B Cells and Dendritic Cells in Murine IgA Nephropathy
Tadahiro Kajiyama,Yusuke Suzuki,Masao Kihara,Hitoshi Suzuki,Satoshi Horikoshi,Yasuhiko Tomino
Clinical and Developmental Immunology , 2011, DOI: 10.1155/2011/819646
Abstract: Although pathogenesis of IgA nephropathy (IgAN) is still obscure, pathological contribution of mucosal immunity including production of nephritogenic IgA and IgA immune complex (IC) has been discussed. We have reported that mucosal toll-like receptor (TLR)-9 is involved in the pathogenesis of human and murine IgAN. However, cell-type expressing TLR9 in mucosa remains unclear. To address this, we nasally challenged cell-specific CpG DNA ((i): dendritic cell: (DC), (ii): B cell, (iii): both), known as ligand for TLR9, to IgAN prone mice and analyzed disease phenotype of each group. After 8 times of the weekly administration, every group showed deterioration of glomerular damage. However, CpG-A-group showed clear extension of mesangial proliferative lesions with increase of serum IgA-IgG2a IC and its glomerular depositions, while CpG-B-group showed extent of glomerular sclerotic lesions with increase of serum and glomerular IgA and M2 macrophage infiltration. Present results indicate that mucosal TLR9 on B cells and DC may differently contribute to the progression of this disease via induction of nephritogenic IgA or IgA-IgG IC, respectively. This picture is suggestive for the pathological difference between child and adult IgAN.
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