Takayuki Inoue

Plasma 1,5-Anhydroglucitol Concentration in Patients with End-Stage Renal Disease with and without Diabetes Mellitus

The plasma concentration of 1,5-anhydroglucitol, a new clinical marker of glycemic control in diabetic patients, was evaluated as a marker of glycemia in 83 diabetic and nondiabetic patients with end-stage renal disease. Plasma 1,5-anhydroglucitol concentration decreased and correlated inversely with blood glucose, hemoglobin A1c, or fructosamine in 48 diabetic patients with normal renal function. In 13 nondiabetic patients with end-stage renal disease not on dialysis, plasma 1,5-anhydroglucitol concentrations were lower than in 23 healthy subjects (6.22 +/- 2.10 vs. 24.20 +/- 7.50 micrograms/ml, respectively). The plasma concentration of 1,5-anhydroglucitol concentration in nondiabetic patients with end-stage renal disease was inversely correlated to the urinary N-acetyl-beta-D-glucosaminidase activity (r = -0.634) but not to blood glucose, hemoglobin A1c, or fructosamine. Renal tubular damage may contribute to the low plasma concentration of 1,5-anhydroglucitol in this group. The plasma concentrations of this polyol decreased in both diabetic (4.63 +/- 1.08 micrograms/ml) and nondiabetic patients on hemodialysis (4.71 +/- 0.87 micrograms/ml). In these two groups, there was no correlation between plasma concentration of this polyol and blood glucose, hemoglobin A1c, or fructosamine. The plasma concentration of 1,5-anhydroglucitol decreased after a single hemodialysis session. The results showed that impaired renal function and removal of 1,5-anhydroglucitol by dialysis may contribute to its decreased concentration in patients with end-stage renal disease, but that glycemic control does not. Therefore, we should consider renal function when we use plasma 1,5-anhydroglucitol concentration as a marker of glycemic control in diabetic patients.

Abnormal Calcium Metabolism in Hemodialyzed Patients with Diabetic Nephropathy

Calcium metabolism was studied in hemodialyzed patients with diabetes mellitus nephropathy (HD/DM) and in hemodialyzed nondiabetic patients with chronic glomerulonephritis (HD/non-DM). Incidence of bone changes visible in X-ray films, assessed by changes in the lamina dura and trabecular patterns of mandibulae, was less in HD/DM than in HD/non-DM patients. Serum c-terminal parathyroid hormone was significantly lower in HD/DM than that in HD/non-DM. Serum calcitonin was higher in HD/DM than that in HD/non-DM. The lower level of c-terminal parathyroid hormone would be a reason that bone changes were less in HD/DM than in HD/non-DM patients.

Effects of the Nicotinic Acid Analogue Niceritrol on Lipoprotein Lp(a) and Coagulation-Fibrinolysis Status in Patients with Chronic Renal Failure on Hemodialysis

Effects of the Nicotinic Acid Analogue Niceritrol on Lipoprotein Lp(a) and Coagulation-Fibrinolysis Status in Patients with Chronic Renal Failure on Hemodialysis T. Tetsuo Shoji Y. Yoshiki Nishizawa K. Koichi Kawasaki T. Tsutomu Tabata Y. Yoshiki Matsushita T. Takashi Inoue H. Hirotoshi Moriia Second Department of Internal Medicine, Osaka City University Medical School, and Division of Internal Medicine, Inoue Hospital, Osaka, Japan

Acute Renal Failure in McArdle’s Disease

This is a report of a case of acute renal failure associated with McArdles disease. A 45-year-old man had acute renal failure that required dialysis. His case was subsequently diagnosed as rhabdomyolysis secondary to McArdles disease, a primary myopathy due to myophosphorylase deficiency. History-taking revealed nothing suspected to be responsible for precipitating the renal failure.

The role of secondary hyperparathyroidism in hypertriglyceridemia in patients with chronic renal failure

慢性腎不全にみられる高中性脂肪血症の成因における二次性副甲状腺機能亢進症の関与の可能性について検討を行った. 透析患者128名において高中性脂肪血症はこの48.2%を占めたのに比し高コレステロール血症はむしろ少数例にみられただけであった. カルシトニン等の投与既往のない30症例については透析導入後, 血中コレステロールの有意の低下を認めたのに比し, 血中中性脂肪は透析導入後も高値を維持し続けた. 同一時における各因子との相関関係では, alkaline phosphataseと中性脂肪, β-リポプロテインおよび燐脂質に正の相関関係を認めた (p<0.025).副甲状腺摘出術 (PTX) を行った5症例のうち高中性脂肪血症を呈していた2症例がPTX後に中性脂肪の正常化を示し, 手術後20から30ヵ月においても持続した. 5/6腎摘腎不全ラットにおいては血中中性脂肪が偽PTX群にて123±37mg/dlであるのに比して, PTX群にて76±6mg/dlと有意に (p<0.05) 低下を示した.以上のことより, 腎不全における高中性脂肪血症成立機序に二次性副甲状腺機能亢進症の病態が関与していることが示された.