Shin-ichi Takeda

Successful ultrasonically guided percutaneous ethanol injection for secondary hyperparathyroidism.

Ultrasonically guided percutaneous ethanol injection to all of four enlarged parathyroid glands, which were confirmed by fine-needle aspiration biopsy, was successfully performed in a hemodialysis patient with secondary hyperparathyroidism. In addition to marked reduction of serum parathyroid hormone, the size of parathyroid glands was significantly decreased after the procedure. As an adverse effect, the patient experienced a transient self-limiting dysphonia due to right recurrent nerve palsy after the first injection. This procedure may be an effective alternative to surgical treatment or administration of high-dose 1,25(OH)2 vitamin D3 in uremic patients with sonographically verified multiple enlarged parathyroid glands.

Significance of IgA deposits on the glomerular capillary walls in IgA nephropathy.

Based on immunofluorescence findings, 232 patients with IgA nephropathy were classified into two groups; one consisted of 88 patients (38%) with IgA deposits in the glomerular capillary walls together with the mesangial deposits (capillary type), and the other consisted of 144 patients (62%) with deposits confined to the mesangium (mesangial type). Electron microscopic findings revealed dense deposits on the capillary walls (subepithelial, 50%; intramembranous, 65%; and subendothelial, 24%) in 37 of 46 patients with capillary type and six of 47 with mesangial type (P less than .001). Crescent formation observed in greater than or equal to 10% of glomeruli was more frequently found in patients with the capillary type (30/88, 34%) than those with the mesangial type (9/144, 6%) (P less than .01), especially higher in those with subepithelial deposits (15/26, 57%). The capillary type patients showed heavier proteinuria (1.7 +/- 0.2 g/d) than the mesangial type patients (0.6 +/- 0.1 g/d) (P less than .05). Thirteen of the 14 patients in an acute exacerbation phase, manifested by an abrupt increase in urinary protein and development of macroscopic hematuria, showed capillary type IgA deposits. The ratio of patients with normal renal function in the fifth year after apparent onset was lower in the capillary type (74.0%) than in the mesangial type patients (96.9%) (P less than .05). These findings suggest that capillary IgA deposition is closely related to clinical and histologic activities of IgA nephropathy and is considered to be an important factor responsible for the progression of the disease, possibly through crescent formation.

Iodine-Induced Hypothyroidism in Patients on Regular Dialysis Treatment

Hypothyroidism with a serum concentration of thyroid-stimulating hormone (TSH) above 40 microU/ml was noted in 3 (3.2%) of 93 patients on regular hemodialysis or continuous ambulatory peritoneal dialysis. These 3 patients had no history of thyroid disease and were receiving no medication known to influence thyroid function. They had habitually eaten iodine-rich foods and showed an enlarged thyroid gland with a preserved radioactive iodine uptake and a markedly elevated serum inorganic iodine (II) level. In all 3 patients, both thyroidal microsomal antibody and thyroglobulin antibody titers measured by hemagglutination methods were less than 100, and TSH-binding inhibitory immunoglobulin was negative. Moreover, histologically no lymphocytic infiltrations were observed. With only iodine restriction, serum TSH level markedly decreased from 44.6 to 3.6 microU/ml in case 1, from 90.6 to 3.2 microU/ml in case 2 and from 43.2 to 9.4 microU/ml in case 3 in parallel with decreases in the serum II level. These results suggest that at least in an area like Japan, where the daily intake of iodine is high, iodine-induced hypothyroidism may be induced in patients undergoing regular dialysis treatment even in the absence of apparent underlying thyroid disease.

Characteristics of Glomerular Lesions in Hepatitis B Virus Infection

In an attempt to clarify a participation of hepatitis B virus (HBV) in the development of hepatic glomerulopathy in adults, kidney specimens obtained from 151 patients with liver diseases were studied. Although mesangial proliferation was more severe in patients with chronic hepatitis or liver cirrhosis than in those with acute hepatitis, no significant difference was observed between 82 serum hepatitis B surface antigen (HBsAg)-positive (HBV-related group) and 69 negative patients (HBV-nonrelated group). However, double contours of the glomerular capillary walls were observed more often in the former group (18/82, P less than .01), especially in the HBeAg-positive subgroup (8/24, P less than .001), than in the latter (3/69). In addition, glomerular capillary spike formation or a bubblelike appearance was observed in seven patients of the former group. Of these, all five patients examined were HBeAg-positive in their serum. By electron microscopic studies, subendothelial dense deposits and mesangial interpositions were observed more frequently in the HBV-related group, and subepithelial deposits were found only in the HBeAg-positive subgroup. The immunofluorescence study revealed IgA-dominant mesangial deposition in both HBV-related and nonrelated groups. As for the capillary wall deposits, however, IgG was dominant in 13 of the HBV-related group, but only one of the nonrelated group (P less than .01). Furthermore, one patient in the HBV-related group showed capillary wall-dominant HBeAg combined with IgG deposition.(ABSTRACT TRUNCATED AT 250 WORDS)

Tubulointerstitial nephritis in a patient with eosinophilic fasciitis and IgA nephropathy.

We report a tubulointerstitial nephritis in a patient with eosinophilic fasciitis and IgA nephropathy. Urinalysis revealed mild proteinuria and microscopic hematuria, and renal biopsy disclosed diffuse interstitial infiltrations of lymphocytes and plasma cells with few eosinophils in spite of mild mesangial proliferation with IgA deposits, indistinguishable from those of primary tubulointerstitial nephritis. Immunohistochemical examination showed a predominance of helper/inducer T cells infiltrating the renal interstitium and the fascia. Corticosteroid treatment led to a decrease of infiltrating cells in both tissues. Therefore, eosinophilic fasciitis and tubulointerstitial nephritis in our patient seemed to be interdependent phenomena.

Nature of renal involvement in the acro-renal-ocular syndrome.

A 16-year-old female with acro-renal-ocular syndrome complicated by ventricular septal defect is described. Renal biopsy was performed for the first time in this syndrome, and the results suggested that proteinuria and renal dysfunction were caused by chronic pyelonephritis secondary to malrotation of the kidney and anomalous pelves. Chronic renal failure and hypoplasia of the optic papillae were also observed in the patients mother, suggesting a participation of heredity in the pathogenesis of the syndrome.

Ultrasonically Guided Percutaneous Ethanol Injection to Parathyroid Autografts for Recurrent Hyperparathyroidism

Shin-ichi Takeda. MD, Department of Internal Medicine, Kurobe City Hospital, 1108-1 Mikkaichi, Kurobe, Toyama 938 (Japan) S uj E § Fig. 1. The levels of serum albumin, Ca, phosphorus and PTH before and after ethanol injection. showed hyperplasia. After the excision, serum PTH-c, Ca and ALP transiently decreased to 2.4 ng/ml, 5.0mEq/l and 237 IU/l, respectively, but showed subsequent increases. On September 11, 1991, subtotal gastrectomy with Billroth II reconstruction was per-