著者

北浦 圭介 浅野 健一郎

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.8, pp.887-892, 2005-11-25 (Released:2010-05-18)

参考文献数

14

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抗糸球体基底膜 (GBM) 病は急速進行性糸球体腎炎の経過を辿り, 治療開始時から透析療法を必要とする場合は予後不良とされている.症例は29歳, 男性。 平成15年6月末から38度以上の発熱, 倦怠感を認め近医を受診した。 尿中白血球3+, 尿蛋白2+, 尿潜血3+を示し, 急性腎盂腎炎を疑い当院泌尿器科に紹介入院となった。 入院時CRP 18.9mg/dl, BUN 20mg/dl, Cr 2.9mg/dlを示し抗生剤の投与を行うも, 第11病日にはBUN 78mg/dl, Cr 9.2mg/dlと悪化したため当科転科となった。 細菌培養は陰性であり, 急速進行性糸球体腎炎を疑いソルメドロールパルスを含むステロイド療法, シクロフォスファミドを開始し, 同時に血液透析を行った. 胸部CTでは肺病変は認められず, 腎組織では4個中2個に細胞性半月体を認めた。 MPO-ANCA, PR-3-ANCA陰性, 抗GBM抗体169Uを認め, 抗GBM抗体型糸球体腎炎と診断した。 第30病日からアルブミンを置換液とした血漿交換を6回施行した。 血漿交換後, 抗GBM抗体は28Uまで低下し, それまで乏尿であったが1カ月後には尿量1,000~1,200ml/日を認め, また, 腎機能も徐々に改善し10月末にはBUN40mg/dl, Cr 4.1mg/dlまで低下したため血液透析を離脱した。 その後腎機能障害は悪化せず■に退院した。 後日再度腎生検を施行したが, 20個中18個が糸球体硬化に至っていた。 本例は臨床的に高度腎機能障害を有し, かつ発症から血漿交換開始まで約40日と期間が長かったにも関わらず透析を離脱し得た。 本例では透析を離脱できた原因として血漿交換療法の追加・併用療法が有用であったと考えた。

著者

木戸 千元

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.9, no.2, pp.221-234, 1967-03-30 (Released:2010-07-05)

参考文献数

50

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In order to investigate patho-physiology of the nephrotic syndrome, the author made on examination of lipid, energy and carbohydrate metabolism, with priority to liver, by using the experimental nephrotic rats induced by aminonucleoside (AN). The resalts were as follows 1) In the AN nephrotic rats, the significant increase in serum cholesterol, esterified fatty acid, and phospholipid were observed, although these lipid concentration in the livers were nearly unchanged. The incorporation with acetate-1-C14 into cholesterol, glucose-U-C14 into fatty acid, and NaHP32O4 into phospholipid respectively, in the liver slices, increased in the nephrotic rats injected nine times with AN, and the synthesis of these lipids in the liver was considered highly increasing. 2) O2 Consumpsion of the substrates in the liver slices generally increased in the nephrotic rats and the result suggested increasing energy metabolism in the nephrotic syndrome. 3) The content of glycogen in the livers and muscles decreased in the nephrotic rats at the time of taking food freely as well as after five hours fasting, and showed a tendency to decrease even after the administration of a certain quantitative of glucose, and the similar decreasing tendency was also seen in the blood sager. In the nephrotic rats, hypoglycemic state was clearly observed. The ratio yields of C14O2 from glucose-6-C14 to that from glucose-1-C14 in the slice of liver showed a tendency to decreased in the nephrotic rats and the above-mentioned fact suggested the possibility of increasing lipogenesis. By investigating the activity of glycolytic enzymes, the author observed that G-6-ease and MDH significantly decreased in the nephrotic group, while LDH strikingly increased. There were no significant differences in PG iso, PG mut, ALD, G6PD, and ICD. From the enzymological level, the existence of lipogenic pattern could not be concluded.

著者

杉山 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.46, no.7, pp.667-675, 2004 (Released:2010-05-18)

参考文献数

59

著者

血尿診断ガイドライン検討委員会

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.Supplement, pp.1-34, 2006-10-25 (Released:2010-05-18)

著者

岡田 満 吉岡 加寿夫 磯川 貞之 竹村 司 木下 智弘 赤野 則久 牧 淳

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.34, no.11, pp.1195-1199, 1992

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This paper describes a case report of acute interstitial nephritis associated with Bufferin(R). A 15-year-old girl were referred to our hospital due to fever and renal dysfunction. Laboratory findings showed elevation of serum BUN and creatinine, and increased urinary β2-MG excreation. Light microscopic findings of her renal biopsy specimen revealed edema and numerous inflammatory cells in the interstitium, and minor alterations in glomeruli. The interstitial infiltrates consisted mainly of T cells and also monocytes/macrophages. Interstitial cells were labelled with antibodies to interleukin (IL)-1 and tumor necrose factor (TNF). Bufferin(R) was positive by lymphocyte stimulation test . Thus, we considered that this drug was causative in this case. This observation suggests the participation of cell -mediated immune injury in drug induced acute interstitial nephritis .

著者

石村 栄治

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.4, pp.416-422, 2005-05-25 (Released:2010-05-18)

参考文献数

5

著者

望月 隆弘 原 茂子

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.1, pp.24-29, 2000-01-25 (Released:2010-07-05)

参考文献数

21

被引用文献数

4

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Diet therapy for patients with chronic renal failure is based on low protein and high energy. To achieve strict diet therapy, it is necessary to use specially. formulated low protein foods. Previously, rice with a low content of protein was not available, but recently, a low protein rice (LGC-1 : low glutelin content-1)has been developed. LGC-1 was found to have a low content of glutelin in its seed protein compared to other ordinary rice. Glutelin is the major digestive protein in the rice grain. We studied the usefulness of LGC-1 in the diet therapy of patients with chronic renal failure. Twenty-three patients were placed on the low protein diet (0.6-0.9 g/kg/day) during the pre-study period (a mean of 10 months). Subsequently they were followed with the same diet using LGC-1 for the staple foods during the study period (mean of 7 months). Protein intake and the slope of the reciprocal of serum creatinine did not differ between each study period in all patients. Among the 23 patients, 9 consumed rice mainly as the staple food (120-180 g/day as polished rice : rice group), according to the results of a questionnaire. In the rice group, protein intake decreased (from 47±9 to 42±9 g/day, p<0.05), and the slope of the reciprocal of serum creatinine reduced (from-4.59±4.33 to-1.47±3.51×10-4 dl/mg/day, p<0.05) during the study period, compared with the prestudy period. We conclude that LGC-1 is a useful and effective food for a low protein diet in patients with chronic renal failure, especially, for those who consume rice mainly as their staple food.

著者

富田 益臣 大塚 泰史 飯田 里菜子 小林 政司 栗山 哲 細谷 龍男

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.5, pp.531-535, 2005-07-25 (Released:2010-05-18)

参考文献数

11

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An 85-year-old woman with Parkinson's disease was admitted to our hospital to conduct a further work-up for progressive gait disturbance. She had been on medications for the disease for more than a decade prior to admission. In order to improve her condition, she was newly administered pramipexole, a dopamine agonist, from day 3 in addition to the preceding anti-Parkinson's therapy. However, on day 10, her consciousness level was rapidly deteriorated into delirium (JCS II-10), which was not accompanied by neurological signs and symptoms. Laboratory tests showed severe hyponatoremia with relatively increased urinary sodium excretion, and severe low serum osmolarity with an increased urinary osmolarity. Brain CT and brain MRI showed no specific abnormalities except for those related to aging. Blood concentration of ADH measured at the onset was substantially higher (39.5pg/ml) than normal (0.3-3.5pg/ml under normal osmolarity). Diseases causing hyponatremia, such as liver cirrhosis, congestive heart failure, hypotonic dehydration, and malignancy-associated inappropriate ADH secretion (SIADH), were all excluded. Under the suspicion of SIADH due to pramipexole, the drug was discontinued and as a result, her consciousness level improved rapidly together with a prompt reduction in ADH level (9.2pg/ml).To the best of our knowledge, the present case is the first that demonstrates pramipexole-induced SIADH. Since pramipexole is classified as a dopaminergic receptor agonist, this case may provide new insight into a link between ADH and the dopaminergic receptor in the central nervous system.

著者

Yoshihiro AKASHI Nobuyuki YOSHIZAWA

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.37, no.8, pp.462-467, 1995 (Released:2010-07-05)

参考文献数

22

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To evaluate the role of histones and ubiquitin in lupus nephritis, we searched for glomerular deposits of histones and ubiquitin in renal biopsy specimens from 53 patients with systemic lupus erythematosus (SLE) and 30 with non-lupus glomerulonephritis. Glomerular immunofluorescence staining revealed positive for histone H2A, H1 + H3, H4 and ubiquitin in 49.1% (26/53), 45.3% (24/53), 32.1% (17/53) and 22.6% (12/53) of the SLE patients, respectively. Non-SLE renal biopsies revealed absence of positive staining with histone H2A, H1 + H3, H4 and ubiquitin. The positive incidence of histone H1 + H3 and ubiquitin in diffuse proliferative lupus nephritis was significantly different (p<0.01) from that in minor glomerular abnormality. Levels of CH50 in patients with glomerular deposition of histone H1+H3 (p < 0.001) and ubiquitin (p < 0.01) were significantly lower than in patients without deposition. Levels of anti-DNA antibody in patients with glomerular deposition of histone H1 + H3 were significantly higher than in patients without deposition (p < 0.05). Only the positive incidence of glomerular deposition of ubiquitin was correlated with the histological activity index (p <0.05). These results suggest that histones and ubiquitin may play an important role in the induction of lupus nephritis.

著者

副島 昭典 石塚 俊二 鈴木 道彦 蓑島 忍 中林 公正 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.37, no.1, pp.81-85, 1995 (Released:2010-07-05)

参考文献数

23

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In recent years, several laboratories have suggested that serum levels of antioxidant activity and redox balance are reduced in patients with chronic renal failure. Some clinical reports have also proposed that defective serum antioxidative enzymes may contribute to a certain uremic toxicity through peroxidative cell damage. A 48-year-old woman was referred to us from the surgical department of our hospital because of consciousness disturbance, panctytopenia and acute acceleration of chronic azotemia after postoperative radiation therapy. We diagnosed acute acceleration of chronic renal failure with severe acidemia and started hemodialysis therapy immediately. Two days after admission to our department, she developed upper abdominal sharp pain and bradyarrhythmia. Serum amylase activity was elevated markedly and the ECG finding showed myocardial ischemia. On the 24th hospital day these complications were treated successfully with conservative therapy and hemodialysis. We considered that radiation therapy in this patient with chronic renal failure evoked marked oxidative stress and that deficency of transferrin played an important role in peroxidative cell damage.

著者

河野 南雄 佐々木 則子 溝上 隆

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.17, no.3, pp.171-189, 1975

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Small bodies with suspicion of a platelet by its size and appearance with granules contained were found in the human urine. In this study, a comparison has been made between the small body and normal platelets in the blood and also between platelets suspended in normal urine supernatant by the Giemsa staining method, the phase microscopy and the scanning electron microscopy. By Giemsa staining and the phase microscopy, the small bodies and platelets suspended in urine supernatant were showed similar to that in blood. Through scanning electron microscope, the majority of platelets suspended in urine were spherical form with smooth surface, or dendritic form with pitted and irregular surface similar to that in blood, but some remained as discs which were swelling than that in blood. Moreover the surface of these various platelets in urine were like that of platelets in blood. The small bodies in urine were similar to platelets suspended in urine. Although further investigations are required, we would like to consider that these small bodies are platelets and platelets could be found in urine.

著者

竹村 克己 青柳 一正 永瀬 宗重 坂本 まさ子 石川 敏子 成田 光陽

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.11, pp.1195-1201, 1990 (Released:2011-03-01)

参考文献数

19

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Methylguanidine (MG) which is known as a uremic toxin, is synthesized from creatinine(Cre). We have clarified that active oxygen plays an important role on MG synthesisin vitro and in rat hepatocytes. On the other hand, hyperoxia is very injurious in various tissues, and it has been reported that active oxygen produced in hyperoxia plays an important role on the tissue injury. This study was performed to investigate the effect of hyperoxia on MG synthesis in vivo. The subjects in this study were patients who were treated by hyperbaric oxygen therapy (HBO), Serum Cre, MG, and urinary Cre, MG before and after HBO were measured in these subjects. The subjects were classified into four groups. Group 1-III were undergone HBO with condition of 100% 02, 2 atomosphere absolute (ATA), 1 hour, (I: Ccr<10 ml/min, II: l0≤Ccr<50 m1/min, III: Ccr≥50ml/min) and group IV (Ccr≥50ml/min) with 100%O2, 3ATA. 1 hour. Urinary excretion rate of MG (urine MG/urine Cre) significantly increased after HBO therapy in every group. Urine MG/urine Cre/serum Cre ratio which was used as a index of MG synthesis rate also increased. In this study, it is clarified that MG excretion rate increases in hyperoxic condition. These results suggest that active oxygen plays an important role on MG synthesis in vivo, and that the urine MG/urine Cre/serum Cre ratio can be a uaeful maker of the active oxygen products in vivo.

著者

西 園子 曽根 正好 二瓶 宏 清水 倉一

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.38, no.4, pp.177-184, 1996 (Released:2010-07-05)

参考文献数

23

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Proximal and distal sodium reabsorption values were calculated from lithium clearance in 63 patients with renal diseases, 13 cirrhotic patients with ascites and 12 control subjects. In the patients with renal diseases, fractional excretion of lithium (FELT) and fractional proximal reabsorption of sodium (FPRNa) were not changed in patients whose glomerular filtration rate (GFR), was over 30 ml/min, but FELi was increased and FPRNa was decreased when the GFR was lower than 30ml/min. Moreover, fractional distal reabsorption of sodium (FDRNa) was decreased in patients whose GFR was under 40ml/min. These results indicate that proximal tubular function is well adapted to the degree of renal function even if the etiologies of renal diseases are different. Five patients with nephrotic syndrome (minimal change type) were subjected to lithium clearance method before and after steroid treatment. FPRNa in nephrotic patients was reduced after the treatment, though there was no significant difference in FDRNa. In cirrhotic patients, FELT, FPRNa and FDRNa did not differ from the values in the control subjects, which were not influenced by the decreace in GFR. Thus, the reduction of FPRNa with GFR which was observed in renal disease, was absent in liver cirrhosis. In conclusion, these data indicate that renal adjustment of sodium excretion in chronic renal disease at first takes place in the distal parts of the nephron and later in the proximal tubule, and in addition, that in appopriate reabsorption of sodium from the proximal tubule probably plays a role in ascites formation in cirrhotic patients.

著者

藤本 守

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.7, pp.848-856, 1986 (Released:2010-07-05)

参考文献数

15

著者

加藤 満利子

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.29, no.10, pp.1249-1259, 1987-10-25 (Released:2011-03-01)

参考文献数

29

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The autonomic function was evaluated in 18 hypotensives (HP), 22 normotensives (NT) and 16 hypertensives (HT) patients on longterm hemodialysis (HD) and compared with 8 with Shy-Drayger syndrome (SDS), etc. The interbeat interval response to Valsalva maneuver (Vm) was significantly lower in HP than NT (p<0 .01) or HT (p<0.001) and was similar to those of SDS (n, s.).Overshoot in arterial pressure after Vm was positive in HP 8.3%, NT 71.4%, HT 100% and SDS 0%. Among HD patients, HP showed the most serious baroreflex arc dysfunction. However, the response to cold pressor test in HD patients was as same as those of SDS and controls . Clonidine test demonstrated depressor response in HP. Although, the decrease of SBP (p<0 .01) and DBP (p<0, 02) during orthostasis was smaller in HP than SDS, no change of heart rate was observed between HP and SDS. Thus, the afferent or efferent limbs and central sympathetic activity appeared to be intact. Although the decrease of pressor response to angiotensin II independent of PRA levels in HP, the response to norepinephrine (NE) was related to plasma NE levels. Furthermore, motor nerve conduction velocity was delayed in HP in comparison with NT and HT Administration of midodrine raised SBP from 91.0±7.6 to 110.0±27.2 mmHg and DBP from 51.613.4 to 61.8±19.6 mmHg. The results suggest the abnormalities in baroreflex arc and vascular wall contractility with peripheral neuropathy. Therefore, we conclude that, although the sites remained to be clarified, HP show the autonomic disorders and that midodrine seems to be effective on such patients.

著者

大塚 雄司 原澤 信介 杉浦 仁 小池 美由紀 秋元 秀郎 石井 利明 阿部田 ひろみ 岡部 龍也 久代 登志男 上松瀬 勝男

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.42, no.8, pp.619-624, 2000

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Previous studies have shown that hypertension causes endothelial dysfunction. To study the influence of exogenous nitric oxide (NO) on endothelial dysfunction produced by hypertension, we administered a non-depressor dose of nipradilol to two-kidney, one clip renovascular hypertensive rats (2K1C). Sprague-Dawley rats underwent either sham surgery (G-l) or clipping of the left renal artery. From day seven, 2K1C were randomized into 3 groups, placebo treatment (G-2), nipradilol treament (G-3, ) and propranolol treatment (G-4). Urinary NO<SUP>-</SUP><SUB>2</SUB> +N0<SUP>-</SUP><SUB>3</SUB> (NOx) excretion (UNOxV) was measured 4 weeks after clipping, and then, acetylcholine (Ach), A23187, or sodium nitroprusside (SNP) -induced relaxation were measured in the aorta. Blood pressure was increased in G-2, G-3, and G-4 compared to G-1. UNOxV was lower in G-2, G-3, and G-4 compared to G-1, but UNOxV was higher in G-3 compared to G-2 and G-4. Although Ach or A23187-induced relaxation was significantly decreased in isolated artery from G-2, G-3, and G-4 compared with those from G-1. Ach- or A23187-induced relaxation was improved in G-3. SNP induced relaxation did not differ among the 4 groups. These results suggest that exogenous NO from nipradilol reduces the endothelial dysfunction caused by hypertension without changing the blood pressure.

著者

守田 吉孝 槇野 博史 太田 康介 和田 淳 四方 賢一 柏原 直樹 池田 修二 小倉 俊郎 太田 善介

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.36, no.7, pp.832-838, 1994 (Released:2011-07-04)

参考文献数

16

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Effect of heparin and low-molecular-weight heparin (LMWH) were evaluated on 15 patients with proliferative glomerulonephritis with various degrees of sclerosing legion. Five cases were subcutaneously administered with 7000 to 11000 units of heparin for 4 weeks. Ten cases were administered with 60 unit/kg of LMWH by drip infusion for 4 weeks. Eleven cases were treated with prednisolone and all cases were treated with anti-platelet agent as well. Urinary protein excretion reduced from 3.0±1.8 to 1.8±0.6g/day in the heparin-treated group and from 2.4±1.9 to 1.8±1.4g/day in the LMWH-treated group, respectively. There were no remarkable changes in the renal functions of both groups. In one case, both heparin and LMWH brought about reduction of proteinuria. Therefore, LMWH reduced urinary protein excretion by the same mechanism as heparin. The LMWH has an advantage over heparin in that the former has less risk of causing bleeding. We conclude that heparin and LMWH reduce proteinuria in some patients with proliferative glomerulonephritis. The LMWH is beneficial in the treatment of proliferative glomerulonephritis with a sclerosing lesion.

著者

本山 治 永井 洋子 小原 武博 長谷川 昭

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.34, no.3, pp.279-286, 1992-03-25 (Released:2011-07-04)

参考文献数

19

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It is presumed that graft size after renal transplantation from adult donor decreases in infant or very young recipient and increases in older recipient. Measurement of graft length, width, parenchymal thickness on intravenous pyelography (IVP) films, measurement of area of Bowman's capsule, glomerulus, capillary tuft and tubule on graft biopsy specimens were compared between 3 months and lyear after renal transplantation. The graft sizes decreased in recipients below 6 years-old or body height (Ht.) 90 cm and increased in recipients above 6 years-old, Ht. 100 cm. The case of decreased graft size was found a decrease of area of Bowman's capsule, glomerulus, capillary tuft and tubule. We suggest that it is caused by a difference between renal blood flow in infant and in adult. It is suggested that graft hypertrophy depends predominantly on increased tubular size and capillary tuft enlargement occurs prior to glomerular, tubular change. But, an increase in creatinine clearance (Ccr) was not found following graft hypertrophy.

著者

石川 清

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.21, no.12, pp.1288-1288, 1979-12-25 (Released:2010-07-05)

著者

栗山 哲 友成 治夫 大塚 泰史 大城戸 一郎 細谷 龍男

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.45, no.4, pp.367-371, 2003-05-25 (Released:2011-03-01)

参考文献数

19

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Combination therapy with angiotensin receptor antagonist (ARB) plus angiotensin converting enzyme inhibitor (ACE-I) (ARB/ACE-I) was efficacious in reducing proteinuria in patients with progressive renal disease. However, this therapy may be associated with the worsening of anemia and hyperkalemia. The present study addressed whether or not triple therapy with low dose ARB, low-dose diuretic (D) and calcium channel blocker(CCB) (ARB/D/CCB) is as effective as therapy with low-dose ARB/ACE-I in retarding the progression of overt diabetic nephropathy. In the triple therapy, the patients were initially subjected to monotherapy with CCB for 24 weeks. Low-dose ARB and low-dose D were added to the treatment for an additional 24-week period. In parallel, patients undergoing double therapy were initially treated with low-dose ACE-I alone for 24 weeks, and then low-dose ARB was added for an additional 24-week period. The results were as follows: 1) In the triple therapy, blood pressure was reduced by 9 mmHg in systole and 5 mmHg in diastole (not significant) compared to monotherapy with CCB. There was a significant decline in proteinuria (3.3±1.2 g/day in the CCB-treated period vs. 2.1± 1.0 g/day in the ARB/D/CCB-treated period, n=12, p=0.0143) . Furthermore, a significant improvement in the slope of reciprocal serum creatinine concentration (1/Cr) was found in response to triple therapy (l /Cr : -0.0118±0.0009 in the CCB-treated vs. -0.0035±0.0028 (1/mg/dl/month) in the ARB/D/CCB-treated period, n =12, p <0.001) . There was neither a worsening of anemia nor an increase in the serum potassium (K) concentration. 2) In the double therapy, blood pressure was reduced by 12 mmHg in systole(p=0.0079, n=11) and 6 mmHg in diastole(n=11, p=0.0037) compared to the monotherapy with ACE -I . A significant improvement in the slope of 1/Cr was found in the double therapy (1/Cr : -0.00952±0.0052 in the ACE- I treated period vs. -0.0029±.0028(1/mg/dl/month) in the ARB/ACE-I, n=1 I, p<0.001). In addition, there was a substantial reduction in hematocrit and increase in serum K concentration. The present result suggests that triple therapy consisting of ARB/D/CCB is as efficacious as double therapy with ARB/ACE-I in protecting the kidney from the progression in patients with diabetic overt nephropathy. The former may be expected to have less adverse effects.