Eijin Ashikaga

Japan Organization of Occupational Health and Safety

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Tadao Akizawa

Showa University

Hirokazu Honda

Showa University

Hisako Nagai

Showa University

Hiroki Suzuki

University of Shizuoka

Kozo Kitazawa

Yokohama Municipal Citizen's Hospital

Daisuke Sanada

Showa University

Masanori Mukai

Konan University

Nozomu Hosaka

Showa University

Masayuki Iyoda

Showa University

Takanori Shibata

Waseda University

Cooperative Institutions

Showa University

Showa University Hospital

Japan Organization of Occupational Health and Safety

Kawasaki Hospital

Showa University Koto Toyosu Hospital

National Institute of Advanced Industrial Science and Technology

Showa University Fujigaoka Hospital

Yokohama Municipal Citizen's Hospital

Keio University

Yokohama Rosai Hospital

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Lupus nephritis associated with positive MPO-ANCA in a patient with underlying autoimmune hemolytic anemia

Clinical and Experimental Nephrology (2008)

Yuki Hirai Masayuki Iyoda Takanori Shibata Eijin Ashikaga Nozomu Hosaka

Nephrology

Nephritis

10.1007/s10157-008-0058-1

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Citations (15)

A case of recurrent vascular access failure in a patient with relapsing polychondritis receiving maintenance hemodialysis

Nihon Toseki Igakkai Zasshi (2006)

Yukihiro Wada Hirokazu Honda Eijin Ashikaga Junichi Uchida Kozo Kitazawa

症例は61歳女性の維持透析患者で血液透析のバスキュラーアクセスとして留置した人工血管と右浅大腿動脈との吻合部に腫瘤が出現したため来院した. 1999年原疾患不明で血液透析導入となり, 自己表在静脈に乏しく右前腕に人工血管内シャントを造設され, 維持透析が行われていた. 1997年より難治性副鼻腔炎に罹患していたが2002年頃から悪化し, 同年末に鼻腔軟骨炎発症, 組織所見より再発性多発軟骨炎 (RP) と診断された. RPに関連した鼻軟骨炎, 皮膚症状などは反復性に悪化し, ステロイド, 免疫抑制剤の投与が行われたが, 疾患の活動性は完全には抑えられなかった. RPの活動性上昇に伴い繰り返しシャントトラブルが出現し, 2002年から2004年の間に計3回の人工血管内シャントトラブルと, 人工血管動脈側吻合部周囲に腫瘤を生じた. 2005年2月に新たに人工血管と右大腿動脈の吻合部周囲に腫瘤が出現し, 急速に増大するため外科的処置にて確認したところ血清腫であった. 本経過から頻回な血清腫形成および人工血管閉塞にRPとの関連性が疑われた.

10.4009/jsdt.39.1537

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Citations (1)

[Case of microscopic polyangiitis presenting initially as prostatic vasculitis].

Nihon Jinzo Gakkaishi/Nihon Jinzō Gakkaishi (2009)

Eijin Ashikaga Masayuki Iyoda Hiroki Suzuki Hisako Nagai Takanori Shibata

A 79-year-old man was admitted to our hospital to evaluate prostatic vasculitis that was diagnosed on a prostatic biopsy performed due to an elevated prostate-specific antigen (PSA)level. He complained of general malaise and had hematuria, proteinuria, and interstitial pneumonitis in the lower lung field on admission. A renal biopsy showed necrotizing crescentic glomerulonephritis. He was diagnosed as having microscopic polyangiitis (MPA) based on the presence of small-vessel vasculitis and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA) (465 EU). He was effectively managed with methylprednisolone pulse therapy (500 mg/day x 3 days) followed by progressive dosage tapering. In the present case, the identification of prostatic vasculitis led to the early detection of MPA, which resulted in an excellent clinical course. Prostatic involvement has been also reported in patients with Wegener's granulomatosis or Churg-Strauss syndrome. Thus, physicians should be aware of the potential for the involvement of various organs, including the prostate, in patients with ANCA-associated vasculitis.

Microscopic polyangiitis

Rapidly progressive glomerulonephritis

Necrotizing Vasculitis

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Citations (3)

Single low-dose rituximab for the treatment of steroid-resistant nephrotic syndrome with acute kidney injury

CEN Case Reports (2016)

Eijin Ashikaga Susumu Uda Kazuhisa Kamata Yasuto Shikida Takashi Inoue

Prednisolone

Nephrology

Anuria

10.1007/s13730-015-0199-5

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Ultrapure Dialysate Influences Serum Myeloperoxidase Levels and Lipid Metabolism

Blood Purification (2009)

Hirokazu Honda Hiroki Suzuki Nozomu Hosaka Yuki Hirai Daisuke Sanada

Ultrapure dialysate (UD) might contribute to improvements in the morbidity and mortality of hemodialysis (HD) patients. However, it is unclear whether increasing dialysate purity affects chronic inflammation, oxidative stress, and lipid abnormalities.In a prospective cohort study, 126 patients undergoing maintenance HD using conventional dialysate (CD) with one endotoxin cut filter were assigned to either continuation of the same HD or HD using UD (more purified dialysate). At baseline and 6 months we measured lipids, high-sensitive (hs)CRP, oxidative LDL-cholesterol, and myeloperoxidase.Serum myeloperoxidase and hsCRP levels in the UD group were significantly decreased at 6 months compared with the CD group. Multivariate analysis showed that decreases in non-HDL-cholesterol and ApoB at 6 months were independently correlated with changes in myeloperoxidase.Endotoxin-free UD can improve the chronic inflammatory status, oxidative stress, and lipid abnormalities, suggesting a possible contribution to reduced cardiovascular disease risk and ultimately to lowered mortality in HD patients.

10.1159/000210035

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Citations (28)

Impact of Fibroblast Growth Factor 23 on Lipids and Atherosclerosis in Hemodialysis Patients

Therapeutic Apheresis and Dialysis (2010)

Eijin Ashikaga Hirokazu Honda Hiroki Suzuki Nozomu Hosaka Yuki Hirai

Levels of fibroblast growth factor (FGF) 23, a phosphatonin, are frequently elevated in patients with end-stage renal disease (ESRD) who are on maintenance hemodialysis (MHD). However, the role of FGF23 remains unclear because renal FGF receptor function might be impaired. The present cross-sectional study examines a cohort of patients (n = 196) on MHD who were not undergoing therapy with lipid-lowering drugs including sevelamer. Non-fasting venous blood samples were withdrawn before the hemodialysis (HD) session on the third day after the previous HD session to measure serum levels of albumin, calcium (Ca), phosphate (P), alkaline phosphatase, intact parathyroid hormone (PTH), total cholesterol (C), high-density lipoprotein (HDL)-C, low-density lipoprotein(LDL)-C, oxidative LDL-C, high-sensitivity C-reactive protein (HsCRP), interleukin-6 (IL-6), and FGF23. Nutritional status was assessed using the geriatric nutritional risk index (GNRI). Carotid intima-medial thickness (CIMT) was assessed using a B-mode ultrasound scanner. FGF23 was positively correlated with P, Ca(alb)xP product, and intact PTH, and inversely correlated with C and non-HDL-C. In the higher FGF23 tertile, levels of both non-HDL-C and C were significantly decreased and CIMT was less elevated compared to the lower FGF23 tertile. Multivariate analysis showed that the higher FGF23 tertile was independently associated with decreases in C (adjusted r(2) = 0.14) and non-HDL-C (adjusted r(2) = 0.20) levels and with a less-pronounced increase in CIMT (adjusted r(2) = 0.14). High FGF23 appears to be an independent biomarker of a decrease in C and non-HDL-C that is negatively associated with atherosclerosis in patients on MHD.

Sevelamer

10.1111/j.1744-9987.2009.00796.x

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Citations (33)

MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits

Clinical Kidney Journal (2009)

Kazuhiko Matsumoto Hirokazu Honda Takanori Shibata Daisuke Sanada Yukihiro Wada

An elderly woman presented with haematuria and proteinuria accompanied by elevated serum myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). A renal biopsy revealed mild mesangial proliferation with fibrocellular crescent formation and a membranous glomerular lesion. Immunofluorescence microscopy using FITC-labelled rabbit anti-human MPO antibodies revealed granular MPO deposition along the glomerular capillary walls (GCW) with a staining profile similar to that of glomerular IgG deposition. The one-year follow-up renal biopsy revealed minimal IgG and undetectable MPO deposition. Both MPO and MPO-ANCA might have been responsible for the IgG immune depositions along the GCW in this patient.

Membranous Nephropathy

Immunofluorescence

Immune complex

10.1093/ndtplus/sfp112

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Citations (13)

Elderly onset systemic lupus erythematosus (SLE) presenting with disseminated intravascular coagulation (DIC)

Clinical Rheumatology (2007)

Masayuki Iyoda Hiroki Suzuki Eijin Ashikaga Hisako Nagai Aki Kuroki

Systemic lupus

10.1007/s10067-007-0811-y

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Citations (1)

A case of acute renal failure due to mizoribine-associated uric acid nephropathy

Nihon Toseki Igakkai Zasshi (2007)

Eijin Ashikaga Hirokazu Honda Akio Yokochi Kasumi Sato Tadao Akizawa

患者は50歳代女性で, ループス腎炎 (LN ; type Vb) にてステロイド療法中 (プレドニゾロン10mg/日) であった. LNの活動性は落ち着きクレアチニン (Cr) 1.2mg/dL, 尿酸 (UA) 8.0mg/dL台を推移していたが, 平成17年10月中旬にCrが1.8mg/dLに上昇し, 検尿異常 (尿蛋白+, 沈〓赤血球>100/HPF) を認め, LNの活動性再燃を疑いミゾリビン (MZ) 50mg/日が追加された. 服用開始数日後より気分不快, 倦怠感出現し内服を自己中止した. しかし症状は持続し, 乏尿が出現したため, 服薬自己中止2週間後に受診したところ, Cr14.2mg/dL, UA25.1mg/dLと急激な腎機能の悪化を認めた. MZ血中濃度は内服中止後2週間を経ていたが, 0.43μg/mLと検出された. 血液検査および尿所見上 (尿中Cr/尿酸比=1.47), MZの副作用が一因となった急性尿酸性腎症による急性腎不全 (ARF) と診断した. 乏尿性のARFであり, MZおよび尿酸除去を促すため血液透析を計8回施行したところ, 尿量は増加し, 腎機能は回復した. 本症例は進行する腎機能障害とMZ代謝の遷延, 高尿酸血症との間で悪循環が形成された結果, 尿酸性腎症, 乏尿性ARFを発症したと推察された.

Mizoribine

10.4009/jsdt.40.361

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