Shinichi Abe

Electrocardiographic abnormalities in patients receiving hemodialysis

We assessed standard 12-lead and Holter electrocardiographic (ECG) abnormalities in maintenance hemodialysis (HD) patients. Of 221 outpatients receiving HD, 143 (65%) had ECG abnormalities. Rates were higher in male, elderly, hypertensive, and diabetic patients than in female, younger, normotensive, and nondiabetic patients. The prevalence of ECG changes correlated inversely with HD duration. Serial ECGs were compared in 87 patients whose average HD duration was 7.5 ± 2.5 years. Thirty-four patients (39%) showed normal ECGs throughout, 27 (31%) relatively stable abnormalities, 22 (25%) worsening, and 4 (5%) reversion to normal. Age, hypertension, and diabetes are factors related to abnormal ECG findings. Among the 142 Holter recordings from 72 patients, 70 (97%) were basically in sinus rhythm, and 2 (3%) were in atrial fibrillation. The average frequency of supraventricular premature contractions (SVPCs) was 1597 ± 9725 per 24 hours, and that of ventricular premature contractions (VPCs), 556 ± 1415. VPCs were multifocal in 9%, in runs in 25%, and early in 1%. In 29 (40%) of recordings, VPCs appeared mainly during and for several hours after HD. ST-T changes were seen in 43 (60%). In 11, ST depression occurred during and a few hours after HD. Patients receiving HD showed diverse ECG abnormalities. Holter ECGs revealed a high incidence of arrhythmias and ST-T changes, which frequently appeared in relation to HD timing.

The influence of antecedent renal disease on pregnancy

The influence of antecedent renal disease on pregnancy was studied retrospectively in 72 women with various renal diseases that had been proved by biopsy. Among 105 pregnancies studied, normal deliveries were observed in 74 (71%), abnormal deliveries with live infants in 14 (13%), fetal or neonatal deaths in 11 (10%), and spontaneous abortions in six (6%). The incidence of normal delivery, as well as that of live births, was the highest in the cases of membranous glomerulonephritis, but there was no obvious difference in the incidence among IgA nephropathy and non-IgA proliferative glomerulonephritis. Cases in which there were tubulointerstitial changes of the cortical area or arteriosclerosis in biopsy specimens and cases that included hypertension (greater than 140/90 mm Hg) or decreased renal function (glomerular filtration rate, less than 70 ml/min) were clearly associated with an unfavorable outcome in delivery. It was concluded that assessment of the advisability of pregnancy in nephritic women should be made on the basis of a combination of the clinical and histologic parameters.

An Overview of Pregnancy in Women With Underlying Renal Disease

This is a report of a retrospective study of the effects of preexisting glomerular disease and pregnancy on each other. Two hundred forty pregnancies in 166 Japanese women who delivered between 1970 and 1988 were analyzed. There were 206 (86%) live births, 14 (6%) perinatal deaths, and 20 (8%) spontaneous abortions. Perinatal loss was greatest in women with hypertension and/or glomerular filtration rate (GFR) less than 70 mL/min before conception. Pregnancy did not appear to adversely affect the underlying glomerular disease if GFR was greater than 70 mL/min and blood pressure was below 140/90 mm Hg. However, with moderately impaired renal function (creatinine greater than 124 mumol/L [1.4 mg/dL] or GFR less than 50 mL/min), the long-term prognosis was poorer, despite generally favorable obstetrical outcomes. Gravidas with membranoproliferative glomerulonephritis had the highest rates of hypertension (29%) and decreased renal function (33%) at final follow-up, ie, the type and severity of glomerulonephritis had a major impact on clinical course.

Significance of Tubulointerstitial Lesions in Biopsy Specimens of Glomerulonephritic Patients

To evaluate the significance of tubulointerstitial lesions in the cortical area of renal biopsy specimens, clinicopathological studies were performed on 101 cases of IgA nephropathy, 31 cases of IgA-negative (non-IgA) proliferative glomerulonephritis and 75 cases of idiopathic membranous glomerulonephritis. The degree of tubulointerstitial lesions was assessed semiquantitatively by light microscopic observation and was correlated with the several histopathological and clinical parameters at biopsy, as well as with status at final follow-up (average follow-up period: 72 months). In these three types of glomerulonephritis, the degree of tubulointerstitial lesions in the cortical area was clearly correlated with the severity of glomerular injury, the prevalence of segmental sclerosis, global sclerosis, arteriolosclerosis, decreased renal function (GFR less than 70 ml/min) and hypertension (greater than 150/90 mm Hg) at the time of biopsy. The prevalence of stable renal function at final follow-up was statistically higher in the cases without tubulointerstitial lesions or with those whose lesions included less than 20% of the cortical area. From the above data, it was concluded that a semiquantitative evaluation of tubulointerstitial lesions in the cortex would reflect the severity of glomerular injury and also contribute to the assessment of prognosis in such primary glomerulonephritic patients.

Pregnancy in Glomerulonephritic Patients with Decreased Renal Function

Objective: A study was designed to evaluate fetal outcome of pregnancy and subsequent renal outcome in women with chronic glomerulonephritis who had moderately decreased renal function prior to conception.Methods: Data were analyzed from 15 pregnancies in 12 women whose glomerular filtration rate (GFR) was below 50 mL/min (GFR 42 ± 10 mL/min). The results were compared with those of 166 chronic glomerulonephritic patients whose average preconception GFR was 83 ± 13 mL/min. Renal functions during the 3-year follow-up period were compared between the 12 pregnant and 12 nonpregnant nephritic patients whose ages and GFRs were matched at the start of observation.Results-Obstetrical Outcomes: There were five normal deliveries, six complicated deliveries with a live infant, and four perinatal deaths. The average birth weight was 2115 ± 753 g. This compared poorly with the obstetrical outcomes in women with mild renal impairment, in which the rate of normal delivery was 66% (P < 0.01) and of perinatal death was 6...