Hiromichi Suzuki

Successful prednisolone therapy in elderly patients with severe forms of henoch-schönlein purpura nephritis.

INTRODUCTION Recently, Henoch–Schönlein purpura (HSP) has been observed in elderly people, although it was believed to be uncommon in these subjects. The increased risks of developing end-stage renal disease (ESRD) in adults in comparison with children were highlighted by different studies; however, limited data are available on the treatment of HSP nephritis in adults. METHODS Between 2002 and 2008, five elderly Japanese patients (>65 years old) (mean age, 68 years, ranging from 65 to 72) with severe forms of HSP nephritis were entered into a prospective study to evaluate prednisolone therapy on the outcome of nephropathy in terms of clinical symptoms and histopathological changes. The patients were considered at risk of developing chronic renal failure when they presented with a nephrotic syndrome and crescentic glomeruli. RESULTS At the last follow-up, 4–10 years after initiation of the therapy, four patients had clinically recovered and one died of lung cancer. No patients developed ESRD. The clinical outcome seemed to be correlated with glomerular activity (massive proteinuria and crescent formation). In spite of a relatively large dose of prednisolone, a few adverse effects, such as insomnia and skin lesions, were observed. DISCUSSION Our preliminary small study suggests that renal outcome as well as survival of elderly patients with severe forms of HSP might be altered by aggressive prednisolone therapy.

Role of Pulse Wave Velocity in Patients with Chronic Kidney Disease Stages 3-5 on Long-Term Follow-Up

Background: The relationship between arterial stiffness and kidney function has not been clearly demonstrated although observations of higher arterial stiffness in patients with advanced stages of chronic kidney disease (CKD) were reported. In longitudinal analyses, there was no close association between basal arterial stiffness and progression of kidney function in the general population. In the present study, we assessed the relationship between arterial stiffness and progression of renal dysfunction in patients with CKD stages 3-5 using two types of measures of arterial stiffness, i.e., carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV), over a 10-year period. Methods: 110 patients with CKD stages 3-5 (aged 57.8 ± 10.6 years; female/male: 72/38) were followed for 10 years. Before and at the end of the 10-year period, cfPWV and baPWV were measured using form PWV/ABI (Omron Colin Co. Ltd.). Results: Throughout the study, systolic blood pressure was well-controlled in all patients. Twenty-nine patients (26%) received renal replacement therapy, 12 patients (11%) developed cardiovascular diseases (CVDs), 5 patients were found to have neoplasm, and 9 patients dropped out of the study during the 10-year observation period. In patients who developed end-stage renal disease, the baseline estimated glomerular filtration rate (eGFR) was significantly lower, and in patients who developed CVD, the basal value of baPWV was significantly higher (p < 0.05). Throughout the study, blood pressures were controlled (136.1/77.0 ± 15.6/7.1 to 137.5/77.6 ± 14.9/11.2), kidney function worsened (eGFR, 30.8 ± 16.5 to 22.9 ± 17.6 ml/min/1.73 m2; p < 0.01), and baPWV but not cfPWV showed a significant change [1,672.2 ± 209.6 vs. 1,753.1 ± 333.2 cm/s (p = 0.04) and 918.9 ± 153.2 vs. 939.4 ± 133.2 cm/s]. Moreover, the difference in PWV between the start and the end of the 10-year observation period was positively correlated with the difference in eGFR. Conclusion: With moderate progression of renal dysfunction and under well-controlled blood pressure, peripheral but not central arterial stiffness is possibly one of the strongest predictors of CVD in patients with CKD stages 3-5.

Combination of Echocardiography and Pulse Wave Velocity Provides Clues for the Differentiation between White Coat Hypertension and Hypertension in Postmenopausal Women.

Objective: To determine whether or not noninvasive assessment of the cardiovascular system can discriminate white coat hypertension and hypertension in postmenopausal women. The major reason is the high prevalence of white coat hypertension in these subjects and the uncertain associations of white coat hypertension with cardiovascular risk. Patients and Methods: Selected women were required to be naturally or surgically menopausal for at least 1 year but not more than 5 years past their menstrual period. White coat hypertension patients were defined as subjects who had office blood pressures >150/90 mm Hg but who had both systolic and diastolic ambulatory pressures <120/80 mm Hg. In total, 44 subjects with a mean age of 52 years were recruited from the outpatient clinic and examined. Office and home blood pressures were measured using the HEM 401C (Omron Life Science Co. Ltd., Tokyo, Japan), a semi-automatic device that operates on the cuff-oscillometric principle and generates a digital display of the systolic (SBP) and diastolic blood pressure as well as the pulse rate. The pulse wave velocity (PWV) was recorded, and the left ventricular (LV) diameter, septal wall thickness, and left posterior wall thickness were assessed by M-mode echocardiography after selecting the measurement section by B-mode echocardiography. Results: Twenty patients were diagnosed as having white coat hypertension based on the criteria in the trial. Pulse wave patterns were different between subjects with white coat hypertension and those with hypertension. PWV of subjects with white coat hypertension was 1.32 ± 0.33 m/s and that of patients with hypertension was 1.46 ± 0.37 m/s (p < 0.01). In addition to these findings, there was a significant association between the values of home SBP and PWV and the LV mass index. However, this association was not seen for office SBP. When the data of the LV mass index and PWV were combined, white coat hypertension could be easily differentiated from hypertension. Conclusions: The combination of blood pressure self-monitoring, echocardiographic data, and PWV can be a powerful indicator for the treatment of hypertension in postmenopausal women.

Decline of Renal Function and Progression of Left Ventricular Hypertrophy Are Independently Determined in Chronic Kidney Disease Stages 3-5

Invasive and noninvasive methods for evaluating the effects of hemodynamics on progression of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD) have been proposed. Central aortic pressure (CAP) has been reported to be the best among selected measures of hemodynamics for predicting LVH. However, there are few studies examining the relation between longitudinal changes in CAP and renal dysfunction in patients with CKD. Methods: Sixty-seven patients with CKD stages 3-5 (female/male ratio: 26/41, age: 61.5 ± 13.1 years) were followed for 5 years. Before and at the end of the 5-year period, CAP was recorded by an automated tonometric system (HEM-9000 AI; Omron Healthcare, Kyoto, Japan). Second systolic aortic blood pressure (SBP2) was employed as an index of CAP. Results: Throughout the study, systolic blood pressure (SBP) was well controlled. Renal function followed by estimated glomerular filtration rate (eGFR) gradually worsened as a whole. Ten patients had renal replacement therapy, 3 patients developed cardiovascular diseases and 2 patients were found to have a neoplasm during the 5-year observation period. SBP2 increased from 120 ± 19 to 125 ± 33 mm Hg and eGFR decreased from 38.2 ± 18.2 to 29.5 ± 16.3 ml/min/1.73 m2; however, these differences did not achieve significance. The left ventricular mass (LVM) index significantly increased from 115.5 ± 10.5 to 131.2 ± 11.7 g/m2 (p < 0.05). Although the changes in SBP2 and eGFR looked like a mirror image, there was no significant correlation between the two factors. Moreover, multivariate regression analysis did not reveal a close correlation between SBP2 and CKD progression. In contrast to the decline of renal function, the baseline value of SBP2 predicted an increase in the LVM index. Conclusion: Worsening of renal dysfunction is not solely dependent on hemodynamics. Other factors might be involved in a complex manner.

Front & Back Matter

of Review Articles: Should be divided into the following subsections: Background, Summary and Key Messages. The Background should provide a brief clinical context for the review and is followed by the Summary, which should include a concise description of the main topics covered in the text. The Key Messages encapsulate the main conclusions of the review. Submit the abstract on a separate page. The abstract should be less than 300 words. Abstracts of Original Papers: Each paper needs an abstract of up to 300 words. It should be structured as follows:s of Original Papers: Each paper needs an abstract of up to 300 words. It should be structured as follows: Background/Aims: What is the major problem that prompted the study? Methods: How was the study performed? Results: Most important findings? Conclusion: Implications, future directions

Contents Vol. 2, 2014

Walter Abhayaratna, Canberra, A.C.T. Fabio Angeli, Perugia Chen-Huan Chen, Taipei Julio Chirinos, Philadelphia, Pa. Olga Fedorova, Baltimore, Md. Jong-Won Ha, Seoul Berthold Hocher, Nuthetal Sae Young Jae, Seoul Xiongjing Jiang, Beijing Yuhei Kawano, Osaka Jae-Ryong Kim, Daegu Kee-Sik Kim, Daegu Kwang-il Kim, Seoul Carmen McEniery, Cambridge Abdul Rashid Rahman, Cyberjaya Ernst R. Rietzschel, Ghent Arno Schmidt-Trucksäss, Basel Jim Sharman, Hobart, Tas. Kohji Shirai, Sakura-shi Jun Tao, Guangzhou Hirofumi Tomiyama, Tokyo Raymond Townsend, Philadelphia, Pa. Hongyu Wang, Beijing Editor

Contents Vol. 1, 2014

35 The Pulse of Asia Seoul, Korea, April 19–20, 2013 Guest Editor: Park, J.B. (Seoul)