Koji Kanahara

Immunohistochemical Studies of Extracellular Matrix Components and Integrins in IgA Nephropathy

Localization of adhesive glycoproteins as the extracellular matrix and their cell surface receptors (integrins) were studied in an attempt to clarify their roles in the progression and aggravation of IgA nephropathy. The relationship between their localization and factors associated with clinical progression was then investigated in 65 patients with IgA nephropathy. The indirect immunoperoxidase method was used to study the distribution of fibronectin (FN), vitronectin (VN), fibronectin receptor (FNR) and vitronectin receptor (VNR). In all cases, FN was present in the glomeruli, mainly confined to the mesangial region, and in some cases, it was observed along the glomerular capillary loops. An expanded mesangial region accompanied higher FN distribution. FNR was present in the mesangial region and glomerular capillary loops, and was higher in the expanded mesangial region. VN was positive in 51 of 65 cases. In all cases, VNR was present in the mesangium and glomerular capillary loops, and its distribution was more predominant in and along the capillary loops than in the mesangial region. The expanded mesangium accompanied higher VNR distribution. There was a significant correlation in distribution between all factors with the exception of VN and FNR. FN, FNR and VNR increased significantly as a degree of histological damage. However, VN was not significantly associated with the degree of histological damage in positive and negative groups. The distribution of FN, FNR and VNR was associated with clinical aggravation factors although the distribution of VN was not. In conclusion, the distribution and functional alteration of FN and integrins in the glomeruli appear to be involved in the progression and exacerbation of IgA nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum soluble interleukin-2 receptor in patients with glomerulonephritis

Serum soluble interleukin-2 receptor (IL-2R) concentrations were determined using the ELISA method in 55 cases of glomerulonephritis. These patients can be classified as 29 cases of IgA nephropathy, 10 cases of membranous glomerulonephritis and 16 cases of mesangial proliferative glomerulonephritis. Our results showed that serum soluble IL-2R concentrations in glomerulonephritis cases were significantly higher than those in healthy controls. Among the different types of glomerulonephritis cases, however, no significant differences in serum soluble IL-2R were observed. While we found a significant positive correlation of serum soluble IL-2R to BUN and creatinine, we also found a significant negative correlation between serum soluble IL-2R and creatinine clearance. These findings suggest that serum soluble IL-2R can serve as an indicator of exacerbation of glomerulonephritis.

Preliminary identification of prognostic factors from clinical outcome in 38 cases of rhabdomyolysis

BackgroundRhabdomyolysis is a systemic metabolic disorder caused by leakage of muscle cell constituents into the blood after necrosis of skeletal muscle due to traumatic and nontraumatic causes. This study was done to identify the significant prognostic factors for rhabdomyolysis.MethodsThe relationship between the outcomes and various clinical characteristics was investigated retrospectively from January 1991 to December 1996, in 38 patients with rhabdomyolysis (29 men and 9 women).ResultsAmong the 8 patients who died, old age, diabetes mellitus, acute renal failure, and disseminated intravascular coagulation were significantly more common than in the 30 survivors. The BUN, serum sodium, serum potassium, serum phosphorus, and blood glucose levels were also significantly higher in the patients who died. There was no significant correlation between the outcome and the patients sex, the serum levels of creatine phosphokinase and other enzymes leaking from muscle, the blood and urine pH, base excess, and blood pressure, or the use of hemodialysis.ConclusionsIn patients with rhabdomyolysis, advanced age, diabetes mellitus, acute renal failure, and disseminated intravascular coagulation were factors associated with a poor prognosis, and so require aggressive treatment.

Measurement of bone mass by microdensitometry in patients undergoing hemodialysis.

慢性血液透析患者 (HD患者) の腎性骨異栄養症 (ROD) の詳細を知る目的にて慢性血液透析患者88例 (男性59例, 女性29例), 健常者60例 (男性30例, 女性30例) においてmicrodensitometry法を用いて骨量を測定した. 更には得られた骨量と臨床的諸因子, 治療との関連性について多変量解析により検討した. その結果, 1. 40歳代のHD患者では同年代の健常者に比しMCIの有意な低下が認められた. 2. MCIの低下に寄与すると考えられる項目は, 年齢60歳以上, 透析期間61か月以上, オステオカルシン10.1ng/ml以上, 血清カルシウム5.0mEq/l以下, 抗リン剤としてアルミゲル, 炭酸カルシウム単独投与等であった. 3. 30-50歳代のHD患者では同年代の健常者に比しΣGS/Dの有意な低下が認められた. 4. ΣGS/Dの低下に寄与すると考えられる項目は, 透析期間61か月以上, 年齢40歳以上, 性別女性, フェリチン251ng/ml以上, オステオカルシン10.1ng/ml以上, C-PTH 3.1ng/ml以上等であった. 以上より, RODの進展防止にはMD法による骨量指標と共に各種臨床的諸因子を総合的に判断し, 少なくとも適切なる抗リン剤, ビタミンD3の投与が重要であると考えられた.