- 著者
- Eikan Mishima Naohiko Anzai Mariko Miyazaki Takaaki Abe
- 出版者
- Tohoku University Medical Press
- 雑誌
- The Tohoku Journal of Experimental Medicine (ISSN:00408727)
- 巻号頁・発行日
- vol.251, no.2, pp.87-90, 2020 (Released:2020-06-12)
- 参考文献数
- 20
- 被引用文献数
- 47 60
In light of the recent pandemic, favipiravir (Avigan®), a purine nucleic acid analog and antiviral agent approved for use in influenza in Japan, is being studied for the treatment of coronavirus disease 2019 (COVID-19). Increase in blood uric acid level is a frequent side effect of favipiravir. Here, we discussed the mechanism of blood uric acid elevation during favipiravir treatment. Favipiravir is metabolized to an inactive metabolite M1 by aldehyde oxidase and xanthine oxidase, and excreted into urine. In the kidney, uric acid handling is regulated by the balance of reabsorption and tubular secretion in the proximal tubules. Favipiravir and M1 act as moderate inhibitors of organic anion transporter 1 and 3 (OAT1 and OAT3), which are involved in uric acid excretion in the kidney. In addition, M1 enhances uric acid reuptake via urate transporter 1 (URAT1) in the renal proximal tubules. Thus, favipiravir is thought to decrease uric acid excretion into urine, resulting in elevation of uric acid levels in blood. Elevated uric acid levels were returned to normal after discontinuation of favipiravir, and favipiravir is not used for long periods of time for the treatment of viral infection. Thus, the effect on blood uric acid levels was subclinical in most studies. Nevertheless, the adverse effect of favipiravir might be clinically important in patients with a history of gout, hyperuricemia, kidney function impairment (in which blood concentration of M1 increases), and where there is concomitant use of other drugs affecting blood uric acid elevation.
- 著者
- Yuri Sasaki Eikan Mishima Koichi Kikuchi Takafumi Toyohara Takehiro Suzuki Hideki Ota Kazumasa Seiji Mariko Miyazaki Hideo Harigae Sadayoshi Ito Kei Takase Takaaki Abe
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- pp.5290-20, (Released:2020-08-22)
- 参考文献数
- 27
- 被引用文献数
- 3
Angioplasty for cases of chronic total occlusion of renal artery with/without atrophic kidney is generally not recommended. We here report a 57-year-old man who presented with renin-mediated refractory hypertension caused by occlusion of a unilateral renal artery leading to kidney atrophy (length: 69 mm). Angioplasty favorably achieved blood pressure control with normalized renin secretion and enlargement of the atrophic kidney to 85 mm. Timely angioplasty can be beneficial in select patients, even with an atrophic kidney and total occlusion, especially in cases with deterioration of hypertension within six months and the presence of collateral perfusion to the affected kidney.
- 著者
- Yuki Chiba Kei Takahashi Rui Makino Mai Yoshida Yuji Oe Tasuku Nagasawa Hiroshi Sato Mariko Miyazaki Koji Okamoto
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- pp.8385-21, (Released:2021-12-28)
- 参考文献数
- 21
- 被引用文献数
- 1
We herein report a case of crescentic glomerulonephritis associated with infective endocarditis (IE). A 61-year-old-woman presented with a fever and renal dysfunction and was diagnosed with IE. The patient was positive for PR3-ANCA and anti-GBM antibodies. Renal biopsy findings showed crescentic glomerulonephritis with isolated deposition of C3c, a serum conversion product of complement C3. Given these clinical findings, the patient was diagnosed with IE-associated glomerulonephritis. Antibiotic therapy was continued without immunosuppressive agents. After the initiation of the antibiotics, the fever resolved, and the renal function gradually recovered. This case highlights the notion that laboratory findings should be carefully evaluated with reference to other findings.
- 著者
- Satoshi Kumakura Takashi Nakamichi Nonoka Suzuki Shu Yamakage Ayako Ishikawa Emi Fujikura Satoko Sato Takeshi Aoki Hiroaki Musha Katsuko Kikuchi Tasuku Nagasawa Hiroshi Sato Sadayoshi Ito Mariko Miyazaki
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- pp.2378-18, (Released:2019-02-01)
- 参考文献数
- 22
- 被引用文献数
- 4
A 66-year-old man was admitted to our hospital because of multiple refractory skin ulcers. Based on his severe systemic arterial calcification and severe calcium-phosphate imbalance due to severe kidney dysfunction, we initially considered calciphylaxis. However, a skin biopsy provided a diagnosis of cholesterol crystal embolization. Although we initiated hemodialysis, steroid treatment, and low-density lipoprotein-cholesterol apheresis, he died of multiple intestinal perforation. An autopsy showed cholesterol crystals occluding multiple organ arterioles. This case suggests that skin ulcers in patients with chronic kidney disease may be an important diagnostic hallmark and may be associated with several serious diseases.