Kazuo Ota

Therapeutic Effects of Oral Sorbent in Undialyzed Uremia

The present study was carried out to clarify whether an oral sorbent, AST-120 (Kureha Chemical Ind Co, Tokyo), may postpone the initiation of dialysis therapy. The subjects were randomly divided into two groups, control and AST. The AST group consisted of 27 undialyzed uremic patients. Serum creatine concentrations (SCr) were 4.3 to 8.1 mg/dL (5.8 +/- 1.1 mg/dL, mean +/- SD). The control group consisted of 24 uremic patients who were not given AST-120 during the conservative therapy period before the initiation of hemodialysis. AST-120 (3.2 to 7.2 g/d) was administered to the patients in the AST group for 2.4 to 30.1 months (13.2 +/- 7.4) before the initiation of hemodialysis. The slopes of reciprocal creatinine v time in the control group were -1,251 +/- 856 x 10(-5) dL/mg/month during the 6 to 12 months before the initiation of dialysis therapy, and in the AST group, they were -1,004 +/- 1,012 x 10(-5) dL/mg/month before administration, and -347 +/- 509 x 10(-5) dL/mg/month after administration of AST-120 (P less than 0.01). All 24 patients in the control group and 21 of 27 in the AST group were introduced to hemodialysis. SCr and serum urea nitrogen (SUN) at the initiation of hemodialysis did not differ between the control and AST group: 10.8 +/- 2.6 and 11.0 +/- 2.2 mg/dL and 92.7 +/- 22.2 and 94.1 +/- 21.6 mg/dL, respectively. The times to the 50% undialyzed level were 5.0 months in the control group, and 14.3 months in the AST group.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunohistochemical analysis of rat S‐adenosylmethionine synthetase isozymes in developmental liver

Mammalian S‐adenosylmethionine (AdoMet) synthetase exists as two isozymes, liver‐type and kidney(non‐hepatic)‐type enzymes. The developmental expression of these two isozyme proteins has been investigated in rat liver using immunohistochemical techniques. The liver‐type AdoMet synthetase is expressed only in adult liver, but not in fetal liver. On the other hand, the kidney‐type AdoMet synthetase is predominantly expressed in fetal liver and faintly detected in adult liver. It was also found that both isozymes were localized to the hepatocytes of rat liver. These results clearly show that AdoMet synthetase isozymes are developmentally regulated within hepatocytes. In addition, in rat kidney we have shown that the kidney‐type AdoMet synthetase is predominantly localized to the distal tubule.

Antitumor effects of human lymphoblastoid interferon on advanced renal cell carcinoma.

Human lymphoblastoid interferon alpha was administered intramuscularly at a dose of 3 times 10(6) units per day to 25 patients with advanced renal cell carcinoma. Six patients (24.0 per cent) showed objective responses, including 2 with complete regression of tumors. Nine patients (37.5 per cent) showed disease stabilization, while the disease progressed in 9 others (37.5 per cent). All tumor responses (2 complete, 4 partial and 2 mixed responses) were seen in lung, skin and liver metastases in patients whose primary tumors had been removed. Mean time to response was 87 +/- 74 days (range 28 to 240 days) and mean duration of response was 6.5 +/- 6.4 months (range 1 to greater than 20 months). Human lymphoblastoid interferon alpha was a potential active antitumor agent in patients with advanced renal cell carcinoma.

Relationship between Plasma Levels of Hyaluronic Acid and Amyloid-Associated Osteoarthropathy in Chronic Hemodialysis Patients

Plasma levels of hyaluronic acid (HA) and acute-phase reactants were determined in chronic hemodialysis patients with or without carpal tunnel syndrome (CTS) and/or shoulder pain, which are characteristic symptoms of amyloid-associated osteoarthropathy. While levels of acute-phase reactants tended to be higher in the patients with CTS and/or shoulder pain than in patients without these symptoms, the difference was not significant. However, plasma levels of HA were significantly higher in the patients with these symptoms. Analysis of plasma levels of HA in age-matched patients also demonstrated a significant correlation between elevated levels of HA and the presence of CTS and/or shoulder pain. Among the patients with CTS and/or shoulder pain, those patients with bone cysts in the carpal bone or humeral head had significantly higher plasma levels of HA than patients without bone cysts. Thus, there appears to be a relationship between elevated plasma HA and amyloid-associated osteoarthropathy in chronic hemodialysis patients that is more specific than any correlation with levels of acute-phase reactants.

Protein Components of Amyloid-Like Kidney Stones of Chronic Hemodialysis Patients

We have examined amyloid-like kidney stones, commonly found in patients on maintenance hemodialysis. Extraction of protein from the stones and Western blot analysis were performed. beta 2-Microglobulin (beta 2MG), serum amyloid P component (SAP), lysozyme and PAS-positive substance were identified in the stones. It is suggested that calcium-mediated association of beta 2MG, lysozyme, SAP and PAS-positive substance may have an important role in the process of the formation of kidney stones in chronic hemodialysis patients.

Modification of Serum Beta-2-Microglobulin in Chronic Hemodialysis Patients

Hisashi Ozasa, MD, Kidney Center, Tokyo Women’s Medical College, Kawada-cho, Shinjuku-ku, Tokyo 162 (Japan) Dear Sir, Recently, extrarenal amyloid deposition has been recognized in long-term maintenance hemodialysis patients [1]. ß2-Microglobulin (ß2M) has been identified as the precursor of dialysis-related amyloid recovered from carpal tunnel or bone cysts [2]. By the way, presence of modified serum ß2M which has α-mobility and low pi compared with native ß2M has been reported in malignant lymphoma [3], small-cell lung cancer [4], AIDS [5], and modified urine ß2M was found in the urine of patients with cadaveric renal transplant [6]. Nissen and Claësson [7] suggested that the modification of serum ß2M due to serine protease digestion might reflect early events in allospecific responder cell activation. More recently, Forbes et al. [8] reported that heterogeneity of serum ß2M between the above-mentioned diseases corresponded to the difference of converting activity, namely protease activity and no modified ß2M was detected in the freshly drawn serum of these patients. Nevertheless, we have found faint α-mobility ß2M in the freshly drawn serum of some patients on long-term maintenance hemodialysis (fig. la). However, after being kept at room temperature for 24 h, much α-mobility form was observed (fig. lb). Considering the converting activity as reported by Forbes et al. [8], careful examination of the modified form of serum ß2M should be performed also in chronic hemodialysis patients. References Kachel, H.G.; Altmeyer, P.; Baldamus, C.A.; Koch, K.M.: Deposition of amyloid-like substance as a possible complication of regular dialysis treatment. Contr. Nephrol., vol. 36, pp. 127–132 (Karger, Basel 1983). Gejyo, F.; Yamada, T.; Odani, S.; et al.: A new form of amyloid associated with chronic hemodialysis was identified as ß2-micro-globulin. Biochem. biophys. Res. Commun. 129:701– 706 (1985). 1 Anti-human ß2M rabbit serum was generously supplied by Iatron Laboratory Inc., Tokyo, Japan 2 1 2 ß2M_ a b Fig. 1. Immunoblot analysis of serum from chronic hemodialysis patients. The serum fractionated by nondenaturing polyacrylamide gel electrophoresis was transferred to the nitrocellulose membrane. Immunodetection using anti-human ß2M antibody was performed1. a

The Clinical Value of Active T-Rosette-Forming Cells in Urine After Renal Transplantation

We examined 960 urine specimens from 12 renal transplant patients for the presence of thymus-derived rosette-forming cells as a post-transplant study. Active T-rosette-forming cells appeared in the urine before or simultaneously with an increase in serum creatinine during all 14 acute rejection crises. Moreover, the active urinary T-rosette-forming cells disappeared promptly after pulse treatment with large doses of methylprednisolone in 11 rejection crises, which resolved completely, while in patients with continued detection of active T-rosette-forming cells in the urine rejection crises recurred within a few weeks. It is suggested that the test for active urinary T-rosette-forming cells is a simple and reliable method to diagnose acute renal allograft rejection.

Perioperative managenent of patients with end-stage renal failure undergoing cardiac surgery

1977年より1986年に東京女子医大で心臓・大血管手術を施行した37例の透析患者のうち, 開心術あるいはaortocoronary bypass graft (ACB) を施行した12例について術中, 術後の管理上の問題点を血液浄化法を中心に検討した.症例は不安定狭心症5例 (全例3枝病変でうち1例は腹部大動脈瘤を合併), 急性心筋梗塞および中隔穿孔1例, 肺動脈狭窄, 心房・心室中隔欠損, 僧帽弁閉鎖不全1例, 亜急性心内膜炎, 大動脈炎, 大動脈弁・僧帽弁閉鎖不全1例, 僧帽弁狭窄2例, 僧帽弁閉鎖不全1例, 心房中隔欠損1例であり, 施行した手術はACB (2枝バイパス) 5例 (うち1例は腹部大動脈瘤切除・人工血管移植術も施行), 心室瘤切除, 中隔穿孔閉鎖1例, 肺動脈拡張, 心房・心室中隔欠損閉鎖1例, 心房中隔欠損閉鎖1例, 大動脈弁・僧帽弁置換1例, 僧帽弁置換1例, 交連切開術2例であった.直死例は2例 (16.7%) で, 1例は原疾患の心内膜炎が術後敗血症に進展したもので, 他の1例は術直後の低拍出量症候群によるものであった.6例の虚血性心疾患のうち5例にACB (全例2枝バイパス) を施行し, 1例が術後51日目に出血性脳梗塞で死亡した. 術後は10例に腹膜灌流 (PD) を行い, 循環動態の安定, 出血性合併症の予防の点で有効であった. その後7例は血液透析 (HD) に変更したが, うち2例は変更直後に出血性合併症で死亡した. 術前よりcontinuous ambulatory peritoneal dialysis (CAPD) に導入し, 術後もcontinuous PDで維持した4症例は全例術後経過は良好であった. また8例において術中人工心肺にHD, 血液濾過を併用したが, 術中術後の水分管理, 電解質・酸塩基平衡の補正, 高窒素血症の予防に有効であった.透析患者の心臓手術については早期に手術を行うこと, 適切な血液浄化法を施行することによりその成績の改善が期待される.