Yoshiyuki Takano

Progressively Decreasing Incidence of Membranoproliferative Glomerulonephritis in Spanish Adult Population

Spanish Society of Nephrology, Hospital Ramón y Cajal, Carretera de Colmenar, Km. 9,100, E-28034 Madrid (Spain) Dear Sir, 35η Several recent reports have called attention to the progressively decreasing incidence of membranoproliferative glomerulonephritis (MPGN) in the last decade [1–7]. In order to test this observation, we reviewed 8,545 renal biopsies in adult patients with primary glomerulonephritis (GN) examined at 33 nephrology units in Spain from January 1970 to December 1986. The study was entirely retrospective. The diagnosis was established on the basis of a kidney biopsy studied by light microscopy and immunofluorescence. Patients less than 14 years of age were excluded. MPGN was classified as type I (subendothelial deposits) or type II (dense intram-embranous deposits). A variance analysis was made to test the ‘null hypothesis’, that is to say two variables are independent. A marked reduction in the annual incidence of MPGN, expressed as a percentage of the total number of GN, was observed after 1976 (fig. 1). Thus, we compared the mean annual incidence of the various types of GN during three periods: period I (1970–1976), period II (1977–1981) and period III (1982–1986). As shown in table 1, in spite of the increased total number of patients submitted to biopsy, the incidence of MPGN (26.4,14.7 and 11.9% for the three periods, respectively) was significantly lower for each of the periods when compared with the preceding period (p < 0.001 for periods I vs. II; p < O.Ol for II vs. III). This reduced incidence was observed only in patients with type I MPGN (table 2), whereas the incidence of type II MPGN and its contribution to the total number of patients with primary GN (1.8,1.9 and 2% for the three periods, respectively) did not significatively vary (data from 23 hospitals). In addition, except for idiopathic nephrotic syndrome whose frequency remained unchanged, we observed variations in the incidence of three other primary GN. The incidence of crescentic GN between period I (4.8%) and period III (7.3%; p < O.Ol), membranous nephropathy in period I (8.1%) versus period III (11.6%; p < 0.01) and IgA 30–25–20–15–10–5Year: 1970 -71 -72–73–74–75–76 -77–78–79–80–81 -82–83 -84–85–86 6–7–8-12–15–17–19– 23–27–27–32–33–33–33–33–33–33 Number of hospitals Fig. 1. Annual incidence of MPGN in the Spanish adult population expressed as the percentage of the total number of GN throughout the 17-year study period. nephropathy (10.9, 19.9 and 22.3% for the three periods, respectively, p < 0.01) was found to increase significantly with time (table 1). The incidence of crescentic GN in period III was similar to that of the Milan study [4] and the increased frequency has also been previously reported [3].

Magnetic Resonance Imaging of Pseudotumors of the Craniovertebral Junction in Long-Term Hemodialysis Patients

Background/Aims: Pseudotumors of the craniovertebral junction (PTCVJ) are observed in long-term hemodialysis (HD) patients. There are neither criteria for diagnosis nor guidelines for screening. We attempted to determine magnetic resonance imaging (MRI) findings that could be used to detect PTCVJ, to determine the prevalence of PTCVJ, and to evaluate whether destructive spondyloarthropathy (DSA) might be a yardstick for selection of patients for MRI examination for PTCVJ. Methods: MRI were examined in 19 DSA patients (8 males, 11 females, age 61.4 ± 7.3 years, HD duration 17.0 ± 4.4 years) and in 20 sex-, age-, and HD-duration-matched non-DSA patients (9 males, 11 females, age 57.5 ± 6.6 years, HD duration 17.7 ± 4.9 years). We evaluated MRI characteristics of PTCVJ according those which occur due to rheumatoid arthritis. Results: PTCVJ were characterized as follows: disappearance of fat pads in the upper region (supradental PTCVJ), intensity change of the ‘predental triangle’ in the anterior region (predental PTCVJ), and thickening of cruciform ligaments (retrodental PTCVJ). The prevalence of PTCVJ among patients undergoing HD more than 10 years was high (26 out of 39; 66.7%). The prevalence of PTCVJ was not different between DSA and non-DSA groups. Conclusion: We verified that the above MRI findings might be helpful in the detection of PTCVJ. These findings were observed frequently and independently also in patients with DSA.

Urinary excretion rate of guanidinoacetic acid as a new marker in hypertensive renal damage.

This study was undertaken to evaluate the relation between the urinary excretion of guanidinoacetic acid (GAA) and other substances in hypertensive patients (6 with borderline hypertension and 29 with hypertension) and 12 normal controls. In 10 of the hypertensive patients, GAA was measured before and after 4 weeks of treatment with calcium entry blocker. In hypertensive patients the rate of GAA urinary excretion was 43.5 +/- 17-4 micrograms/min, which was much lower than in the controls (77.2 +/- 35.9 micrograms/min) (p less than 0.01). There was no significant difference among these groups in creatinine clearance (CCr), serum creatinine (Cr), beta 2-microglobulin (BMG) or in the urinary excretion of BMG, N-acetyl-D-glucosaminidase (NAG) or radiosensitive microalbumin (mAlb). The urinary excretion rate of GAA was positively correlated with CCr (r = 0.62; p less than 0.01), and negatively correlated with mean blood pressure (r = -0.49; p less than 0.01). Finally, the GAA excretion was significantly correlated with urinary NAG (r = 0.24; p less than 0.05) and serum BMG (r = -0.31; p less than 0.05), but not with urinary mAlb (r = 0.12; p less than 0.05). Ten hypertensive patients followed for 4 weeks attained their ultimate mean blood pressure reduction after treatment (from 119.3 +/- 8.0 to 101.7 +/- 13.5 mm Hg; p less than 0.001), but the GAA/Cr ratio in the urinary excretion was significantly elevated (from 0.054 +/- 0.016 to 0.070 +/- 0.02; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Alpha human atrial natriuretic peptide and catecholamines in hemodialysis patients

慢性腎不全における心房性ナトリウム利尿ホルモンの循環動態におよぼす影響を検討するため, 維持透析患者29名, 健康成人20名の心房性ナトリウム利尿ホルモン, 血漿カテコラミン, 血漿レニン活性, アルドステロンを測定した.心房性ナトリウム利尿ホルモンは, 維持透析患者群で著明にたかく, カテコラミンも有意な高値を示した (P<0.02). さらに, 両者の間には有意な正の相関を認めた (r=0.55, P<0.01). また, 心房性ナトリウム利尿ホルモンは, 収縮期血圧と有意な正の相関を示した (r=0.53, P<0.01).維持透析患者群では, 透析間の体重増加率が心房性ナトリウム利尿ホルモンと有意な正の相関を示した (r=0.62, P<0.01).以上より, 維持透析患者における高カテコラミン血症には心房性ナトリウム利尿ホルモンの関与が考えられ, 腎不全時の細胞外液の過剰が両者に影響していることが示唆された.

Clinical problems in chronic hemodialysis patients due to renal amyloidosis

腎不全のため血液透析を行った全身性アミロイドーシス12例 (骨髄腫随伴1例, 原発性4例, 続発性7例) について検討した. 続発性症例の原疾患は, RA 3例, 慢性腸炎1例, 中耳炎1例, 結核1例, ベーチェット病1例であった.初診時主訴は, 蛋白尿が7例と最も多く, 下痢3例, 巨舌1例, しびれ感1例であった. ネフローゼ症候群は8例に認められ, 治療抵抗性であった. 心アミロイドーシスが認められた症例は高窒素血症は軽度であったが, 肺浮腫のため早期の透析導入を余儀なくされたが, いずれも早期に死亡した. 心アミロイドーシスが認められない症例でも, 肺浮腫や全身浮腫のため早期の透析導入が行われた. 臨床的に心アミロイドーシスと診断されない例でも, 心エコー図, 心電図に異常所見が多く, 治療に抵抗性で, 心へのアミロイド物質と沈着が強く疑われた. また, 透析導入後新たに心アミロイドーシスが認められ, 心伝導障害のため死亡した症例もあり心アミロイドーシスは本症透析例の予後を左右する重要な因子と考えられた.腎, 心以外の障害としては, 透析中の血圧低下, 内シャント障害, 下痢, 腹痛などの消化器障害, 皮膚掻痒感, 甲状腺機能低下などが認められた. いずれも難治性であったが, 皮膚掻痒感に対してHDF, 甲状腺機能低下に対して甲状腺ホルモン薬が有効であった.