著者

中尾 俊之 佐中 孜 椿原 美冶 服部 元史 本田 雅敬 水入 苑生 渡邊 有三 金澤 良枝 菅野 丈夫

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.49, no.8, pp.871-878, 2007-11-25 (Released:2010-05-18)

参考文献数

18

被引用文献数

13

著者

長沢 俊彦

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.20, no.12, pp.1251, 1978-12-25 (Released:2010-07-05)

著者

小西 憲子 武下 清隆

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.40, no.1, pp.22-26, 1998 (Released:2011-03-01)

参考文献数

11

---

A 41-year-old woman took an overdose of sedatives on the, and remained a sleep in the straight sitting position until she was woken up on the 15th. The next day she consulted our hospital complaining of pain and swelling of her right leg. X-ray examination with contrast medium revealed obstruction of the deep vein of her right leg by a thrombus. On, her serum urea nitrogen was 75.9 mg/dl and creatinine was 5.4 mg/dl accompanied by oliguria. The myoglobin value was 27, 000ng/ml in serum and 88, 000 ng/ml in urine. She was diagnosed as acute renal failure caused by rhabdomyolysis and hemodialysis therapy was started. She was released from hemodialysis on the . The swelling of her right leg disappeared at the end of February. However, her right foot was affected paralysis of the fibular nerve. Electromyogram of her right anterotibial muscle and the test of conduction velocity of right tibial nerve revealed that the neurological disturbance of her right leg was caused by thrombosis of the deep vein. Generally speaking, the swelling of the extremities resulting from rhabdomyolysis caused by crush syndrome is due to a massive shift of body-fluid into the crushed muscles. We believe that when the extremities are compressed (and/or crushed) for a long time, venous thrombosis of the extremities occurs due to compression, there by causing swelling of the compressed extremities, as in this case.

著者

小林 孝彰

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.47, no.2, pp.83-93, 2005-02-25 (Released:2010-05-18)

参考文献数

33

著者

今井 圓裕 堀尾 勝

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.48, no.8, pp.703-710, 2006-11-25 (Released:2010-05-18)

参考文献数

12

被引用文献数

2

著者

副島 昭典 北本 清 長沢 俊彦

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.24, no.11, pp.1289-1298, 1982-11-25 (Released:2011-07-04)

参考文献数

18

---

During two year periods between 1979 and 1981, we have experienced 28 cases of acute renal failure (ARF) with various causes. Among them 7 cases were thought to be originated from myoglobinuric ARF due to rhabdomyolysis. The causes of rhabdomyolysis were burns in one case, crush injury in one case, marathon running in one case, hypoxygenation from acute adrenal insufficiency in 2 cases and drugs in 2 cases. The serum and/or urinary level of myoglobin (Mb) detected by radioimmunoassy were moderately or highly elevated at the initial phase of ARF in these 7 cases. Also, there were hematest positive dark urine and dehydration of various degrees. There were no constant tendency in the serum level of uric acid, calcium, potassium in our cases with myoglobinuric acute renal failure (Mb-ARF), althought these parameters were fairly abnormal in Mb-ARF in the previous reports. Five cases received hemodialysis and two cases were treated conservatively. Six cases recovered completely from ARF and one case due to haloperidol induced Mb-ARF died, although frequent hemodialysis were performed. It was concluded that (1) Mb-ARF might be a considerably common cause of ARF, (2) measure-ment of serum and/or urine Mb might be very sensitive diagnostic tool for the differentiation of etiology of ARF. (3) However, Mb-ARF must be carefully differentiated from the acute exacerbation of chronic renal failure (CRF), since in patients with CRF the serum level of Mb were considerably high due to the disturbance of urinary excretion of Mb, (4) The outcome of Mb-ARF was relatively good.

著者

田中 敬雄 新開 五月 糟野 健司 前田 康司 村田 雅弘 瀬田 公一 奥田 譲治 菅原 照 吉田 壽幸 西田 律夫 桑原 隆

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.39, no.4, pp.438-440, 1997 (Released:2010-07-05)

参考文献数

10

被引用文献数

1

---

In 1993, Vanherweghem and his associates reported cases of rapidly progressive renal interstitial fibrosis in young women who were administered a slimming regimen including Chinese herbs. Subsequently, similar cases have been reported. In Japan, especially in the Kansai area, several cases of Chinese herbs nephropathy have already been reported. We experienced a patient suffering from Chinese herbs nephropathy(CHN), and further detected aristolochic acids from the Chinese herbs taken by the patient. Aristolochic acids are known to be causative agents of CHN. The danger of CHN should be noted as soon as possible and drugs containing aristolochic acids should be prohibited.

著者

藤井 隆 小嶋 俊一 大江 透 今西 政仁 木村 玄次郎 唐川 真二 飯田 達能 平田 結喜緒 倉持 衛夫 下村 克朗 伊藤 敬一 尾前 照雄

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.30, no.4, pp.347-353, 1988-04-25 (Released:2011-07-04)

参考文献数

25

---

The mechanism of polyuria associated with paroxysmal supraventicular tachycardia (SVT) was investigated in 8 patients whose SVT was provoked artificially by esophageal pacing. SVT was sustained for 60 minutes. Blood and urine samples were collected every 30 minutes from one hour before provocation to one hour after termination of SVT. Urine volume increasd in all patients more than two fold (on average 2.5 fold) of the control volume. Urine osmolality decreased from 546±66 (S. E.)mOsm/kg at the control period to 197±32 mOsm/kg at the peak of urine volume. Urinary Na excretion increased significantly (p<0.01) about 1.5 fold for 30 minutes after termination of SVT. Urinary antidiuretic hormone (u-ADH) was suppressed to one third of control period during SVT (from 30±11 pg/min to 8±2 pg/min), then increased significantly (p<0.05) to 74±15 pg/min after termination. Although plasma ADH level did not change during SVT, it tended to increased after termination. Plasma concentration of atrial natriuretic polypeptide (p-ANP) increased to 5 fold on average at termination of SVT and maximally attained value was 400 pg/ml. Urinary prostaglandin E2(u-PGE2) excretion increased after termination of SVT and percent changes of u-PGE2 had a positive correlation with those of urinary Na excretion (r=0.64, p<0.001, n=5). Positive correlation was also found between percent changes of u-PGE2 excretion and those of u-ADH excretion (r=0.72, p<0.001, n=5). The findings suggest the following conclusions: 1) The polyuria during SVT period was attributed mainly to the inhibition of ADH secretion, 2) Natriuresis after SVT period was due to i) the increase of p-ANP and ii) the release of renal PGE2 associated with the increased ADH secretion.

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.39, no.1, pp.1-37, 1997-02-25 (Released:2010-07-05)

被引用文献数

4

著者

山本 駿一 家里 憲二 長谷川 茂 塚原 常道 近藤 洋一郎 吉田 弘道 寺野 隆

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.42, no.7, pp.597-602, 2000-10-25 (Released:2010-07-05)

参考文献数

17

---

A 38-year-old woman was admitted to our hospital on for evaluation of thirst, bilateral backache and a feeling of abdominal fullness. She had hypokalemia, normotension, hyperreninemia, hyperaldostronism and hyperplasia of the juxtaglomerular apparatus on renal iopsy. Ultrasonography, intravenous pyelography and computed tomography showed marked bilateral renal calcification. Considering her history of persistent soft stool caused by chronic laxative abuse for 15 to 16 years and past diuretic abuse for several years since 1986, we diagnosed her as pseudo-Bartter's syndrome with nephrocarcinosis. The value of urinary Ca excretion was in the normal range, and acidification disturbance in NH4C1 loading test was revealed. In addition, she had taken analgesics for 2 to 3 years and interstitial nephritis on renal biopsy was seen. It is thus suggested that the cause of nephrocarcinosis in this case was the reduction of Ca solubility in the tubular cavity induced by incomplete renal tubular acidosis associated with analgesic nephropathy or interstitial nephritis caused by hypokalemia.

著者

豊田 雅夫 鈴木 大輔 上原 吾郎 梅園 朋也 堀木 照美 谷亀 光則 遠藤 正之 黒川 清 堺 秀人

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.43, no.1, pp.44-48, 2001-01-25 (Released:2010-07-05)

参考文献数

14

---

We experienced two cases of limb edema of unknown pathogenesis. No evidence was found concerning involvement of the kidneys, heart of other visceral organs. Case I was 22-year-old woman. Her white blood cell count increased to 13, 100/μl with 65.0 % eosinophils. Case 2 was a 27-year-old woman. Her white blood cell count increased to 23, 300/μl with 67.0 % eosinophils. In these cases, extensive diagnostic evaluations revealed no evidence of atopy, neoplasms, collagen vascular disease, or parasitic infestation. We diagnosed these cases as episodic angioedema with eosinophilia. In both cases, the angioedema improved gradually in parallel with a decrease in the white blood cell count. This disorder is very rare, but it is very important to consider it in differential diagnosis especially for nephrologists.

著者

張 達聰

出版者

Japanese Society of Nephrology

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.11, no.6, pp.731-754, 1969

---

The administrations of glucocorticoid in normal rabbits for 6 weeks produced exudative lesions in the renal glomeruli. In the animals, in which the injection of heparin was started after, just at the time of, or even before the glucocorticoid treatment, a higher frequency of the occurence of those lesions was observed. In the animals, which were given warfarin simultaneously with corticosteroid, the occurence of those lesions were markedly inhibited. In the rabbits treated with heparin or warfarin alone, no such lesions were found. The concentration of NEFA in plasma rose up to abnormal high level. It was markedly higher in the animals treated with both glucocorticoid and heparin than in those treated with glucocorticoid alone. No increase of NEFA was noted in the rabbits treated with both glucocorticoid and warfarin. It is assumed from these results that the steroid nephropathy in the rabbit may be caused by an in-creased mobilization of NEFA, followed by the acceleration of blood coagulation process as secondary phenomen. The renal lesions seen 4 weeks after the injection of glucocorticoid has gradually regressed, if the injection was discontinued at that time.

著者

山縣 邦弘 小山 哲夫 小林 正貴 成田 光陽

出版者

Japanese Society of Nephrology

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.32, no.10, pp.1045-1052, 1990

---

This study was undertaken to analyze the mechanisms of immune complex formation in Heymann nephritis. We isolated two different RTE antigens by gel filtration and prepared rabbit antisera against these antigens. By the indirect immunoflurescence method using normal rat renal tissues, the 65, 000 molecular weight antigen (=β) was observed not only in RTE, but also in the glomerular epithelium, epithelium of the small intestine, liver and spleen. On the other hand, the 35, 000 molecular weight antigen (=γ) existed in RTE and epithelium of the small intestine. When rats were injected intravenously with rabbit antiserum against β, glomerular depositions were observed within two hours. In rats injected with rabbit antiserum against r, no glomerular deposition was seen with-in 2 days, but fine granular depositions were observed after 6 days. When rat kidneys were perfused with rabbit antiserum against γ in saline by a single pass method, no glomerular deposition was seen. However, in rat kidneys perfused with preformed soluble γ-anti γ IC, fine granular depositions along the capillary walls were seen soon after the perfusion. Further the antigen which was reacted with anti γ antiserum was isolated from normal rat serum by immuno-affinity chromatography. These facts suggest that the mechanisms of IC formation may be due to not only in situ immune complex formation but also circulating immune complex deposition in Heymann nephritis.

著者

渡辺 有三

出版者

日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.24, no.6, pp.p655-663, 1982-06

著者

前田 益孝 椎貝 達夫

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.47, no.7, pp.821-827, 2005-10-25 (Released:2010-05-18)

参考文献数

18

---

Blood ionized calcium (iCa) fraction is affected by the serum albumin (Alb) level, even though this effect might not be appropriately estimated by the formulae proposed previously. To clarify a reasonable regimen for predicting iCa from serum total Ca (tCa), we investigated the relationship of blood iCa, tCa, and serum Alb levels through 124 samples from 116 non-dialysis patients requiring iCa measurement at the Nephrology Section of Toride Kyodo General Hospital. The patients comprised 61 males and 55 females with the mean age of 66.9±1.4 years, including 9 cases of hypercalcemia, 110 of normocalcemia, and 5 of hypocalcemia based on their iCa levels. Their background diseases were 25 cases of chronic glomerulonephritis, 17 of nephrotic syndrome, 40 of diabetes mellitus, 4 of collagen diseases, and 30 of others. Their mean serum Cr was 2.44±0.21mg/dl, and 77 patients showed elevated Cr levels.Four adjustment formulae: one derived from Payne's, two from the proposal of K/DOQI Clinical Practice Guidelines, and a theoretical one based on the previous in vitro experiments, were compared with the non-adjusted value (tCa itself) with respect to their suitability for estimating iCa. The correlation coefficient of tCa with iCa was higher than the values adjusted by the above four formulae. The difference of iCa from tCa divided by eight, which concisely predicted iCa based on the assumption that half the serum Ca is bound to protein, was less than 1/8th of the other adjusted Ca levels. Hence none of the adjusted Ca by the above formulae was superior to non-adjusted tCa from the point of estimating the iCa level. Moreover, the sensitivity for predicting hypocalcemia was the highest in tCa, even though its specificity was lower than the other adjusted values.In conclusion, no adjustment formula is required to predict ionized Ca from tCa, and to screen hypo-or hypercalcemia.

著者

伊藤 陽子 鶴見 裕子 木村 寿宏 竹下 康代 常田 康夫 戸谷 義幸 梅村 敏

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.49, no.4, pp.446-451, 2007-05-25 (Released:2010-05-18)

参考文献数

13

---

テオフィリン投与に関連したと考えられる高Ca血症の症例を経験したため報告する。症例は51歳女性, 気管支喘息のためテオフィリンを約5年間内服していた。2003年3月血清Ca濃度15.2mg/dLと著明な高Ca血症と腎機能障害のため当科を紹介受診した。過去の検査結果より, 2001年より高Ca血症が認められていた。高Ca血症の原因について精査を行ったが, 初診時には内分泌検査などの異常所見は認められなかった。そのため, 薬剤性の高Ca血症を疑った。内服中であったテオフィリンを中止したところ血清Ca濃度は低下し, 3カ月後には完全に正常値となった。過去に有効血中濃度を超えたテオフィリン投与によって高Ca血症が誘発されたという報告を認めたが, 有効血中濃度範囲内での高Ca血症の報告は認められない。本症例のテオフィリン濃度は有効血中濃度以下で保たれていた。また, 初診時では正常値であったがその後の測定で甲状腺機能亢進症が認められ, 精査の結果橋本病の合併が考えられた。甲状腺機能亢進症もしばしば高Ca血症の原因となりうる。初診時には甲状腺機能は正常であったことより, 甲状腺機能亢進症のみが高Ca血症の原因となった可能性は否定的であるが, テオフィリン, 甲状腺機能亢進症に伴う高Ca血症は, ともにアドレナリン受容体を介し高Ca血症を誘発すると考えられており, 両者の合併による増強作用が考えられた。また, これに加え本症例では高Ca血症にもかかわらず尿中Ca排泄量の増加を認めなかった。非顕性であった低Ca尿症がテオフィリン投与, 橋本病合併によってPTH作用が増強し, 高Ca血症を引き起こしたと考えられた。これらの病態が合併することにより, テオフィリンが有効血中濃度以下でも高Ca血症が誘発された可能性が疑われ, 非常に稀な症例と考えられた。

著者

山田 剛 中西 健 鵜山 治 飯田 竜也 杉田 實

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.33, no.6, pp.581-586, 1991 (Released:2010-07-05)

参考文献数

19

---

We described a patient with the milk-alkali syndrome induced by the ingestion of small amount of milk (200 ml/day) and ice cream (145 g/day) and the administration of small dose of absorbable alkali (magnesium oxide 2.0 g/day) for the treatment of chronic constipation. The present case shows not only triads, i, e., hypercalcemia (s-Ca 14.3 mg/dl), metabolic alkalosis (s-HCO3- 37.4 mEq/L), and renal insufficiency (s-Cre 2.3 mg/dl) but also hypernatremia (s-Na 161 mEq/L) and hypertonic dehydration after the frequent episodes of elevated body temperature. The milk-alkali syndrome has been defined as the hypercalcemia with a metabolic alkalosis from a high amount of calcium intake and long term administration of absorbable alkali in any form, usually as calcium carbonate for the treatment of peptic ulcer. As the present case could be distinguished from any other cases previously reported with regard to the amount of calcium (0.4 g/day) and alkali (36 mEq/day) intake and the clinical situations that induced the syndrome, we compared the present case with the previous reports, calculating the amount of calcium and alkali intake from milk and absorbable alkali. After the introduction of the H2 blockers for peptic ulceration, the most cases with milk-alkali syndrome had provoked by the smaller amount of calcium than previously reported, which were associated with the treatment of relatively large amount of alkali (50-150 mEq/day), suggesting the role of sustained metabolic alkalosis for the development. In the present case the metabolic alkalosis induced by hypertonic dehydration and enhanced by absorbable alkali intake also could cause an increase of renal tubular reabsorption of calcium and a decrease of ionized calcium which might produce increased secretion of parathyroid hormone followed by vitamin D3 activation and increased Ca absorption from the gut. The metabolic alkalosis might be essential to the development of the milk-alkali syndrome without a high calcium and absorbable alkali intake.

著者

今村 陽一 久保 明義 松原 渉 熊谷 晴光 原田 篤実 松本 勲 竹中 正治 白石 恒雄

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.28, no.4, pp.439-445, 1986 (Released:2010-07-05)

参考文献数

19

---

In order to evaluate the role of renin-angiotensin system and sympathetic nerve system to maitain the blood pressure during regular hemodialysis (HD), we examined the level of plasma renin activity (PRA), plasma norepinephrine (PNE) and plasma epinephrine (PE) before and after regular HD in 17 patients. The cardiac performance of them was also examined before and after HD by echocardiographic examination. 10 patients (group 1) exhibited stable blood perssure during HD, while 7 patients (group 2) exhibited a fall (≥10 mmHg) in blood pressure during HD. PNE significantly increased after HD in group 1 (217±119 to 317±141 pg/ml, mean±SD, p<0.01), unchanged in group 2 (443±387 to 538±391 pg/ml). PE did not change after HD in both groups: 25.6±17.7 to 25.6±19.8 pg/ml in group 1, 39.7±33. 5 to 34.9 ±24.1 pg/ml in group 2, PRA significantly increased after HD in both groups : 4.01±2.95 to 7.43±4.95 ngAI/ml/hr in group 1, 5.13±6.76 to 8.33±8.97 ngAI/ml/hr in group 2, p<0, 05, for each. There was not significant difference between both groups in the changes of cardiac performance before and after HD. These data suggest that sympathetic nerve system may play a important role on the maintenance of blood pressure during HD.

著者

高橋 伯夫 松沢 誠 池垣 岩夫 西村 眞人 増井 一郎 山田 親久 乾 修然 吉村 学

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.32, no.1, pp.53-64, 1990 (Released:2011-07-04)

参考文献数

30

---

We assessed the role of circulating digitalislike substance (s) on the blood pressure regulation in patients with essential hypertension, cardiac diseases, diabetes mellites and renal diseases by measuring digoxin-like immunoreactivity (DLI). Plasma DLI concentrations tended to correlate with blood pressure in all patient groups. Plasma DLI correlated to plasma aldosterone concentration in patients with essential hypertension, which suggested close interrelationship between DLI and electrolytes metabolism with adrenal steroids. Serum immunoreactive insulin (IRI) levels significantly correlated with blood pressure. Because plasma DLI levels correlated with serum IRI, increased levels of insulin could have induced sodium retention leading to increased DLI levels. Digitalislike substance, but not insulin, would have directly increased blood pressure in patients with abnormal glucose tolerance. Plasma DLI levels significantly correlated with the severity of renal insufficiency in patients with renal diseases. Plasma DLI highly correlated with amounts of plasma pro-teins, particularly with albumin, which would be due to the binding of DLI with albumin in plasma. Because the level of non-binding DLI is extremely low when assayed with a digoxin-radioimmunoassay, it was impossible to assess the level of a free-form of DLI, i.e., active DLI. That could be a reason why the correlation between the DLI and the other parameters was not highly significant. Collectively, these findings suggest that the DLI is one of the major determinants of blood pressure rises, regardless of any cause.

著者

山家 敏彦 張 光哲 赤池 真 露木 和夫 野村 正征 長谷 弘記 海老根 東雄

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.26, no.4, pp.399-406, 1984 (Released:2010-07-05)

参考文献数

24

---

In eight chronic hemodialysis patients, the effects of 7.4±2.6 months of exercise training on hemodialysis-induced hypotension and subjective complaints during hemodialysis therapy were studied. The evaluation was obtained through (1) comparing the exercise tolerance, dry weight, cardio-thracic ratio, hematocrit level, hemoglobin level, BUN level, serum creatinine level before and after training, (2) comparing frequency of hemodialysis-induced hypotension, frequency of normal saline infusion during hemodialysis therapy, and subjective complaints during hemodiolysis therapy before and after training. Exercise training resulted in increase in maximal oxygen consumption from 19.17±4.22 ml/kg/min. to 21.52±4.94 ml/kg/min. (p<0.05), in increase in hematocrit level from 22.1±4.2 % to 25.2±4.8 % (p <0.01), and in increase in hemoglobin level from 7.7±1.0 g/dl to 8.4±1.5 g/dl (p<0.05). With exercise training, the frequency of hemodialysis-induced hypotension decreased from 30.5 % to 12.9 % (p<0.05), frequency of normal saline infusion during hemodialysis therapy decreased from 34.5 % to 14.3 % (p<0.05), and frequency of complaining palpitation decreased from 5.2 % to 0.0 % (p <0.05). The decreased frequency of hemodialysis-induced hypotension, normal saline infusion, and complaining palpitation through exercise training may be due to improvement of peripheral circulation and/or increased hematocrit level. These findings suggest that subjective complaints, which are caused by hemodialysis-induced hypotension, will be decreased by exercise training.