Macrophages are heterogeneous immune cell populations that include classically activated and alternatively activated (M2) macrophages. We examined the anti-inflammatory effect of ANG II type 1 receptor (AT 1 R) blocker (ARB) on glomerular inflammation in a rat model of anti-glomerular basement membrane (GBM) glomerulonephritis (GN). The study focused on infiltrating CD8 + and CD4 + cells and macrophages, as well as the heterogeneity of intraglomerular macrophages. Wistar-Kyoto rats were treated with high-dose olmesartan (3 mg·kg −1 ·day −1 ), low-dose olmesartan (0.3 mg·kg −1 ·day −1 ), or vehicle (control) 7 days before induction of anti-GBM GN. Control rats showed mainly CD8 + cells and ED1 + macrophages, with a few CD4 + cells infiltrating the glomeruli. Necrotizing and crescentic glomerular lesions developed by day 7 with the increase of proteinuria. AT 1 R was expressed on CD8 + and CD4 + cells and on ED1 + macrophages. Low-dose ARB had no anti-inflammatory effects in anti-GBM GN. However, high-dose ARB reduced glomerular infiltration of CD8 + cells and ED1 + macrophages and suppressed necrotizing and crescentic lesions by days 5 to 7 ( P < 0.05). In addition, high-dose ARB reduced the numbers of ED3 + -activated macrophages, suppressed glomerular TNF-α and IFN-γ production, and downregulated M1-related chemokine and cytokines (monocyte chemoattractant protein type 1, IL-6, and IL-12). High-dose ARB also enhanced ED2 + M2 macrophages by day 7 with upregulation of glomerular IL-4 and IL-13 and augmented CCL17, IL-1 receptor antagonist, and IL-10. We concluded that high-dose ARB inhibits glomerular inflammation by increasing the numbers of M2 macrophages and upregulation of anti-inflammatory cytokines and by suppressing M1 macrophage development with downregulation of M1-related proinflammatory cytokines.
A 45-year-old woman underwent hepatectomy for hepatocellular carcinoma developing after 2 renal transplants. She had a solitary hepatocellular carcinoma and central bisegmentectomy of the liver was performed. Administration of immunosuppressants was continued to maintain renal function in the perioperative period. Although our patient suffered from severe pneumonia postoperatively, she recovered without a decline in renal function. She has been alive for 1 year and 3 months after hepatectomy with hepatocellular carcinoma recurrence in the remnant liver. Any patient undergoing hepatectomy for hepatocellular carcinoma after renal transplantation should be managed as an immunocompromised host. Previously reported cases of hepatectomy for hepatocellular carcinoma in renal transplant recipients were reviewed.
A woman successfully delivered two children after cadaveric kidney transplantation. She received a kidney graft at the age of 18 years because of end-stage renal failure due to chronic glomerulonephritis. Eighteen months after surgery, she became pregnant. As she was receiving immunosuppressive therapy with cyclosporin, azathioprine, mizoribine and prednisolone, we discontinued mizoribine. The child was delivered by a caesarean section in week 30 of gestation. Both the increase of liver enzymes and the decrease of creatinine clearance were slight and transient. She successfully delivered another child just a few days before the 4th anniversary of her kidney transplantation. Including this patient, we have experienced 11 deliveries by women bearing kidney grafts. Intensive joint management with the obstetric service is necessary to achieve successful delivery without losing the graft.
A submucosal tumor (SMT) was found during a regular health check-up in a 59-year-old man. Following barium meal study the SMT was shown to be growing. He visited our hospital for further examination.
Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is a potentially fatal condition that is difficult to diagnose. The authors diagnosed IAD in a patient who presented with recurrent oesophageal ulceration resulting in oesophageal stenosis. The recurrent oesophageal ulcers were due to frequent nausea and vomiting that were the presenting digestive symptoms of adrenal insufficiency. Severe hypoglycaemia during this patient9s course suggested the diagnosis of adrenal insufficiency. This case is educational because digestive symptoms are the most common symptoms in patients with adrenal insufficiency, but the diagnosis of adrenal insufficiency in such patients is not easy.
