著者

Miwako Omori Yoshinobu Saito Yukiko Miura Toru Tanaka Takeru Kashiwada Kenichiro Atsumi Hiroki Hayashi Yuji Minegishi Kazue Fujita Arata Azuma Masahiro Seike Akihiko Gemma

出版者

The Medical Association of Nippon Medical School

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.86, no.5, pp.296-300, 2019-10-15 (Released:2019-12-03)

参考文献数

23

被引用文献数

1

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We report a case of pneumonitis with alveolar hemorrhage induced by herbal medicines in a 73-year-old woman who was admitted to our hospital because of dyspnea and an abnormal shadow on a chest radiograph. She had received treatment with numerous drugs, including the herbal medicines Seisin-renshi-in, Chotosan, Rikkunshi-to, and Shakuyakukannzo-to. Chest radiography revealed diffuse ground-glass shadows in both lungs, and bronchoalveolar lavage fluid was progressively hemorrhagic. A culture of the fluid showed no evidence of microorganisms. Moreover, there were no findings suggestive of rheumatic disease or vasculitides. On the basis of this evidence, we suspected drug-induced diffuse alveolar hemorrhage. She discontinued all medicines and started treatment with corticosteroids. Her respiratory condition and chest radiographic findings improved. The timing of administration and rechallenge with other drugs suggested that the herbal medicines were the causative drugs. The primary concern was Seisin-renshi-in, because it contains Ougon (skullcap; a known cause of pneumonitis) and because a drug lymphocyte stimulation test was positive for Seisin-renshi-in. This is the first report indicating that Seisin-renshi-in may cause diffuse alveolar hemorrhage. Diffuse alveolar hemorrhage due to herbal medicines is a rare but emergent disorder. Therefore, treating physicians should be aware that it may be caused by herbal medicines, including Seisin-renshi-in.

著者

Shoya Oyama Hiroshi Takahashi Hiroki Hayashi Shigehisa Koide Shigeru Nakai Kazuo Takahashi Daijo Inaguma Midori Hasegawa Junichi Ishii Yukio Yuzawa Naotake Tsuboi

出版者

Fujita Medical Society

雑誌

Fujita Medical Journal (ISSN:21897247)

巻号頁・発行日

pp.2022-004, (Released:2022-07-22)

参考文献数

28

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Objectives: Cardiovascular and renal diseases are closely related. Brain natriuretic peptide (BNP) and urinary albumin are established predictors for cardiac and renal morbidities, respectively. To date, no reports have investigated the combined predictive value of BNP and urinary albumin for long-term cardiovascular–renal events in patients with chronic kidney disease (CKD). The aim of this study was to investigate this theme.Methods: Four hundred eighty-three patients with CKD were enrolled into this study and followed-up for 10 years. The endpoint was cardiovascular–renal events.Results: During the median follow-up period of 109 months, 221 patients developed cardiovascular–renal events. Log-transformed BNP and urinary albumin were identified as independent predictors for cardiovascular–renal events, with a hazard ratio of 2.59 (95% confidence interval [CI], 1.81–3.72) and 2.27 (95% CI, 1.82–2.84) for BNP and urinary albumin, respectively. For the combined variables, the group with high BNP and urinary albumin had a markedly higher risk (12.41-times; 95% CI 5.23–29.42) of cardiovascular–renal events compared with that of the group with low BNP and urinary albumin. Adding both variables to a predictive model with basic risk factors improved the C-index (0.767, 0.728 to 0.814, p=0.009), net reclassification improvement (0.497, p<0.0001), and integrated discrimination improvement (0.071, p<0.0001) more than each of them alone.Conclusions: This is the first report to demonstrate that the combination of BNP and urinary albumin can stratify and improve the predictability of long-term cardiovascular–renal events in CKD patients.