著者

Hiroki Mizuno Naoki Sawa Akinari Sekine Noriko Inoue Yuki Oba Daisuke Ikuma Masayuki Yamanouchi Eiko Hasegawa Tatsuya Suwabe Hisanori Suzuki Junichi Hoshino Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9624-22, (Released:2022-05-31)

参考文献数

12

被引用文献数

1

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A 79-year-old man was admitted with a compression fracture of the first lumbar vertebra. His alkaline phosphatase (ALP) level was 35 IU/L, and his dual energy X-ray absorptiometry T score was -3.7 standard deviations, indicating osteoporosis. A genetic analysis showed a mutation of the alkaline phosphatase biomineralization-associated gene encoding tissue-nonspecific alkaline phosphatase. Hypophosphatasia-related osteoporosis was diagnosed. Alendronate, teriparatide, and minodronate were administered in that order. The ALP level increased during teriparatide use. A bone biopsy performed after three years of teriparatide treatment showed that cancellous bone was adynamic. In cortical bone, tetracycline double-labeling indicates enhanced bone formation. Teriparatide may thus be a viable treatment option even in patients with hypophosphatasia.

著者

Makoto Fukuda Naoki Sawa Daisuke Ikuma Yuki Oba Hiroki Mizuno Masayuki Yamanouchi Akinari Sekine Eiko Hasegawa Tatsuya Suwabe Junichi Hoshino Kei Kono Keiichi Kinowaki Kenichi Ohashi Hiromichi Tamaki Motoaki Miyazono Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.62, no.1, pp.81-85, 2023-01-01 (Released:2023-01-01)

参考文献数

9

被引用文献数

2 3

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A 43-year-old Japanese woman with rheumatoid arthritis treated by infliximab and methotrexate for 11 years was admitted for proteinuria and purpura. A kidney biopsy revealed endothelial damage-dominant nephritis with IgA deposition. Infliximab and methotrexate were discontinued, and tocilizumab was started; however, proteinuria persisted. Therefore, tocilizumab was discontinued, and oral prednisolone and methylprednisolone pulse therapy were administered. After 6 months, urinary protein was less than 0.1 g/day, and purpura subsided. To our knowledge, this is the first case of endothelial damage-dominant nephritis related to IgA vasculitis involving the skin and kidney after long-term use of infliximab and methotrexate.

著者

Atsuhiko Suenaga Naoki Sawa Daisuke Ikuma Yuki Oba Akinari Sekine Masayuki Yamanouchi Eiko Hasegawa Hiroki Mizuno Tatsuya Suwabe Kei Kono Yukako Shintani-Domoto Keiichi Kinowaki Kenichi Ohashi Yoshiyuki Suzuki Motoaki Miyazono Tamiko Takemura Yutaka Yamaguchi Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1121-22, (Released:2023-02-01)

参考文献数

8

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We performed 3 kidney biopsies in a 71-year-old man. At the first biopsy, we made the diagnosis of immunoglobulin G4 (IgG4)-related interstitial nephritis characterized by the simultaneous presence of IgG4-positive plasma cells and characteristic fibrosis with a bird's-eye pattern. At the second biopsy, rather than finding fibrosis as a post-inflammatory scar, we noted that steroid treatment had caused the simultaneous disappearance of IgG4-positive plasma cells and fibrosis and had restored the normal tubular structure. The third biopsy showed the recurrence of the disease with inflammatory cells accompanied by fibrosis. These findings suggest that IgG4-positive plasma cells and fibrosis occur simultaneously.

著者

Atsuhiko Suenaga Naoki Sawa Katsuyuki Miki Takayoshi Yokoyama Yasuo Ishii Hiroki Mizuno Daisuke Ikuma Yuki Oba Akinari Sekine Masayuki Yamanouchi Eiko Hasegawa Tatsuya Suwabe Kei Kono Keiichi Kinowaki Kenichi Ohashi Kazuho Honda Motoaki Miyazono Yuki Nakamura Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0813-22, (Released:2023-02-01)

参考文献数

16

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We experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.

著者

Toshiharu Ueno Koichi Kikuchi Ryo Hazue Koki Mise Keiichi Sumida Noriko Hayami Tatsuya Suwabe Junichi Hoshino Naoki Sawa Kenji Arizono Shigeko Hara Kenmei Takaichi Takeshi Fujii Kenichi Ohashi Yoshifumi Ubara

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.20, pp.2993-2999, 2016-10-15 (Released:2016-10-15)

参考文献数

13

被引用文献数

1 3

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A 58-year-old man was referred to our institution for an evaluation of nephrotic range proteinuria. Renal biopsy showed a marked expansion of the mesangial matrix and thickening of glomerular basement membrane (GBM) in periodic acid-silver methenamine (PAM). Immunofluorescence (IF) revealed strong staining for the monoclonal kappa light chain. EM demonstrated massive subendothelial and mesangial dense deposits. As a result, light chain deposition disease (LCDD) was diagnosed. Melphalan and prednisolone (MP) therapy was started, which was continued for 10 years with minimal complications. Serial evaluations of renal histology revealed the resolution of nodular lesions and the glomeruli became nearly normal. MP therapy can therefore be an effective therapeutic option for LCDD if it is continued over the long term.

著者

Motonori Nagasawa Yoshifumi Ubara Tatsuya Suwabe Masayuki Yamanouchi Noriko Hayami Keiichi Sumida Yoshinari Hattori Maki Tsukamoto Eriko Hiramatsu Eiko Hasegawa Junichi Hoshino Naoki Sawa Yuji Marui Michio Nakamura Shinji Tomikawa Kennmei Takaichi

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.24, pp.3401-3404, 2012 (Released:2012-12-15)

参考文献数

13

被引用文献数

2 5

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We herein report an unusual case of spontaneous parathyroid gland rupture. A man was admitted with respiratory distress in September 2010. He had been receiving hemodialysis since 1995. He was diagnosed secondary hyperparathyroidism in 2006 and began receiving cinacalcet therapy in 2009. His intact parathyroid hormone (iPTH) level decreased, and massive traumatic bleeding occurred, following which rupture of the parathyroid gland was detected during surgery. The ruptured gland showed nodular hyperplasia. Previous reports have indicated that parathyroid bleeding is associated with glandular hypertrophy. This is the first report of parathyroid apoplexy occurring after suppression of elevated parathyroid function caused by cinacalcet therapy.