Masahiko Shikano

Usefulness of a Highly Sensitive Urinary and Serum IL-6 Assay in Patients with Diabetic Nephropathy

Background/Aim: Interleukin-6 (IL-6) promotes the growth of renal mesangial cells. IL-6 may play a major role in such mesangial proliferation, but there has been little research on IL-6 in relation to diabetic nephropathy because of the difficulty in measuring urinary and serum IL-6 levels. Using a newly developed, highly sensitive IL-6 assay, we studied the relationship between serum and urinary IL-6 and diabetic nephropathy. Methods: We investigated 72 patients with type 2 diabetes. Urinary and serum IL-6 concentrations were measured using a chemiluminescent enzyme immunoassay with a detection limit of 0.11 pg/ml. Results: There was a significant increase of the serum IL-6 level as diabetic nephropathy progressed, with the level being 1.4 ± 0.3 pg/ml in patients with normal albuminuria, rising to 2.4 ± 0.6 pg/ml in patients with microalbuminuria and then to 4.4 ± 0.8 pg/ml in those having proteinuria. The serum IL-6 level was also significantly correlated with fibrinogen and aortic pulse wave velocity. The urinary IL-6 level was also significantly increased in diabetic patients as nephropathy progressed. Both serum and urinary IL-6 levels were high in the group with nephropathy, but there was no correlation between the two. Conclusion: The urinary IL-6 level seems to be a good indicator of diabetic nephropathy, and atherosclerotic changes were related to the serum IL-6 level. The serum IL-6 may, therefore, be useful in the evaluation of atherosclerosis including nephropathy.

The Evaluation of Corticosteroid Therapy in Conjunction with Plasma Exchange in the Treatment of Renal Cholesterol Embolic Disease

In this report, we describe 5 patients with cholesterol atheroembolic renal failure. In 3 of the 5 patients, combined therapy with corticosteroids and plasma exchange was performed. These 3 patients survived, with 2 showing an improvement in renal function. The 2 remaining patients died of multifactorial causes. The literature on therapy for cholesterol atheroembolic renal failure is reviewed and the efficacy of combined therapy by use of corticosteroids and plasma exchange is evaluated.

C1Q complexes with beta-2-microglobulin and amyloid P-component in sera of patients with dialysis-associated amyloidosis.

We studied complexes composed of C1q and beta 2-microglobulin (C1q.beta 2M) or serum amyloid P-component (C1q.SAP) in the sera of 38 patients receiving hemodialysis (HD) and 20 healthy control subjects using an enzyme-linked immunoassay. We also compared complex levels in HD patients with and without symptoms of HD-associated amyloidosis (HA). Serum C1q-beta 2M levels were significantly higher in HD patients without HA than in healthy control subjects and significantly higher in HD patients with HA than in HD patients without HA. Serum C1q.SAP levels were significantly lower in patients with HA than in those without HA. These results suggest that C1q.beta 2M may contribute to HA.

Correlation between somatosensory evoked potentials and sensory disturbance in stroke patients.

Somatosensory evoked potentials (SEP) were recorded in 125 (n = 151) stroke patients more than 3 weeks after disease onset and in 55 healthy adults. The correlation between sensory disturbance, N20 amplitude ratio, and the central conduction time (CCT) was then investigated. N20 amplitude ratio was given by the amplitude of the affected side divided by that of the unaffected side and presented as a percentage, while CCT represents the time interval between N20 and N13. For the healthy subjects, normal values of CCT were 6.1 +/- 0.4 msec (20-59 years old) and 6.4 +/- 0.4 msec (over 60 years old). Normal amplitude ratios were left side/right side = 97.5 +/- 16.4% and right side/left side = 105.4 +/- 17.7% with the value at the second standard deviation, 64.7%, representing the normal range of the amplitude ratio. Of 98 stroke patients with an abnormal amplitude ratio and 23 with an abnormal CCT, 91.8% and 95.7%, respectively, had sensory disturbance. Conversely, 82.6% of those with sensory disturbance showed an abnormal amplitude ratio, while only 38.6% with sensory disturbance showed an abnormal CCT. There was a definite correlation between sensory disturbance and either CCT or amplitude ratio, however, there was none between CCT and amplitude ratio. On the basis of these results, we concluded that amplitude ratio would be more effective than CCT as a parameter for monitoring sensory disturbance in stroke patients.

Efficacy of Granulocytapheresis and Leukocytapheresis for the Treatment of Microscopic Polyangiitis

Abstract:  We evaluated the efficacy of granulocytaperesis and leukocytapheresis for the treatment of rapidly progressive glomerulonephritis (RPGN) and lung hemorrhage caused by microscopic polyangiitis. Three patients with RPGN were treated by granulocytapheresis (GCAP) and five patients with RPGN were treated by leukocytapheresis (LCAP). The prednisolone dose was 0.4 ± 0.2 g/kg/day (mean ± SD; range 0.2–0.8 g/kg/day). Pre‐treatment serum creatinine was 3.2 ± 1.4 mg/dL (1.4–5.1 mg/dL). The patients were followed for a mean period of 15 ± 6 months (6–23 months). Renal function improved in five of the eight RPGN patients. Three lung hemorrhage episodes in two different patients were treated with GCAP and one lung hemorrhage episode was treated with LCAP combined with various doses of corticosteroids. All four lung hemorrhage episodes were ameliorated. We concluded that combined therapy of GCAP or LCAP and corticosteroids is effective for the treatment of RPGN and lung hemorrhage due to microscopic polyangiitis.

Acute renal failure after exercise in a patient with renal hypouricemia

Abstract A 22-year-old man had recurrent exercise-induced acute renal failure (ARF). He was found to have isolated renal hypouricemia: serum uric acid level was 0.7–1.0 mg/dl and fractional excretion of uric acid (FEUA) was 37%–43%. He showed no suppression of FEUA following the the administration of pyrazinamide, and no increase of FEUA after benzbromarone, suggesting a subtotal defect. We investigated renal function, FEUA, and serum nitric oxide after a treadmill exercise test in our patient and two control subjects. On the day after the exercise test, plain and enhanced abdominal computed tomography (CT) scans were performed in our patient. During the arterial phase, early equilibration phase, equilibration phase, and 2, 6, and 24 h after the injection of contrast medium, renal CT scans were performed at the same slice level. Although ARF was not induced by this level of exercise, the CT scans showed patchy contrast enhancement 2, 6, and 24 h after contrast medium administration. This finding suggests that patchy renal vasoconstriction may occur in patients with renal hypouricemia after strenuous exercise, even in the setting of normal creatinine clearance.

Infrared thermography and diabetic foot

Summary form only given. The purpose of this study was to identify and quantify the neurovascular risk factors for diabetic foot using infrared thermography, compared with other unusual neurological examinations. The subjects were 504 Japanese patients with type II diabetes and 150 normal subjects. Among the diabetic patients 28 had a history of diabetic foot. We preformed the cold stress test using ice-cold water. We observed the time course of the hand temperature and calculated the recovery rate. The hand temperature at rest and recovery rate was significantly lower in the diabetic patients compared with the normal. The patients with diabetic foot had significantly lower temperature and lower recovery rate compared with the patients without diabetic foot. These differences (especially the recovery rate) were the most specific findings in patients with diabetic foot compared with other neurological examinations. The cold stress test using computer-assisted thermography provides much information about the microcirculation of the skin in patients with diabetic foot. It will be helpful to detect high-risk patients.

Focal segmental sclerotic lesions of the glomerulus in transplanted kidneys assessed using computerized image analysis

Abstract:  Mechanisms responsible for the development of focal segmental sclerotic lesions of the glomerulus (FSGS lesions) in transplanted kidneys were investigated by morphometric analysis. The mean glomerular area and the interstitial area were measured using computerized image analysis to compare implantation biopsies (so‐called 1‐h biopsies; 1Bx) with later biopsies (episode Bx; EBx) that had been taken for diagnostic purposes to identify the cause of deteriorating renal function. Groups of patients with (group A, n = 15) or without (group B, n = 10) FSGS lesions were compared. Twelve of 15 in group A and all in group B had lost graft function due to chronic allograft nephropathy. It was found that neither the mean glomerular area nor the interstitial area differed significantly between the two groups in either 1Bx or EBx. The interstitial area was significantly increased (P = 0.007) and the mean glomerular area tended to be increased (P = 0.085) in EBx compared with 1Bx in group A but not in group B. The serum creatinine level at the time of EBx in group A correlated with the interstitial area (P = 0.031) but not the mean glomerular area. However, there was no similar correlation in group B. In conclusion, factors for the development of FSGS lesions in transplanted kidneys may be the increase in interstitial area and possible glomerular hypertrophy following transplantation, rather than pre‐existing reduced renal mass of the donor kidneys.

The Use of Somatosensory Evoked Potentials in Patients with Stroke

ABSTRACT.Somatosensory evoked potentials (SEPs) were recorded in 125 (n = 151) stroke patients more than 3 weeks after the onset of the disease. The correlation between sensory disturbance, N20 amplitude ratio, and the central conduction time (CCT) was then investigated. The N20 amplitude ratio was calculated by dividing the amplitude of the affected side by that of the unaffected side and presented as a percentage. The CCT represents the time interval between N20 and N13.Of 98 stroke patients with an abnormal amplitude ratio and 23 with an abnormal CCT, 91.8% and 95.7% respectively, had sensory disturbances. Conversely, 82.6% of those with sensory disturbances showed an abnormal amplitude ratio, whereas only 38.6% of those with sensory disturbances showed an abnormal CCT. There were definite correlations between sensory disturbance and either the CCT or amplitude ratio, however, there were none between the CCT and amplitude ratio. On the basis of these results, we conclude that amplitude ratio is more ef...