Yoshitaka Koshino

Gouty Kidney Associated with Membranous Nephropathy: Participation of Renal Tubular Epithelial Antigen

Histological studies were performed on 3 patients with gout and proteinuria measured at 1.0 g a day or more. Light microscopy revealed diffuse thickening of the glomerular capillary walls accompanied by spike formation and bubble-like appearance as well as tophaceous granuloma in the interstitium, tubular atrophy and benign nephrosclerosis. Immunofluorescence technique showed fine granular deposits of IgG and C3 along the glomerular capillary walls together with the renal tubular epithelial antigen (RTE) in 1 patient. Subepithelial dense deposits were also observed by electron microscopy. These findings suggest that the association of membranous nephropathy should be considered in patients with gout having moderate to severe proteinuria and that RTE may be involved in the pathogenesis of subepithelial deposits in gouty membranous nephropathy.

Occult Hepatitis B Virus Infection With Increased Virus DNA Levels in a Chronic Hemodialysis Patient: Occult HBV Infection in a Hemodialysis Patient

Dear Editor, Controlling hepatitis B virus (HBV) infection is a serious issue in dialysis hospitals. Occult HBV infection (OBI) is defined as the presence of HBV genome in the serum or liver tissue without detectable hepatitis B surface antigen (HBsAg). A previous study reported OBI prevalence in Japanese chronic hemodialysis (HD) patients to be 0.3% (1). The patients in that study tested negative for anti‐ hepatitis B surface antibody (HBsAb) and positive for anti‐hepatitis B core antibody (anti‐HBc), and HBV DNA was detected in their sera with a quantitative sensitivity of 2.1 log copies/mL (20 IU/mL). Herein, we report an OBI patient with increased serum HBV DNA levels who was undergoing HD.