Taro Sugase

Kishokai Medical Corporation

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Tetsu Akimoto

Jichi Medical University

Shigeaki Muto

Jichi Medical University

Daisuke Nagata

Jichi Medical University

Eiji Kusano

Kanazawa Institute of Technology

Osamu Saitô

Institute for Global Environmental Strategies

Yoshitaka Iwazu

Jichi Medical University

Takahiro Masuda

Jikei University School of Medicine

Takuya Miki

Insight (China)

Hiromichi Yoshizawa

Jichi Medical University

Takuya Murakami

Yokkaichi University

Cooperative Institutions

Jichi Medical University

Jichi Medical University Hospital

The University of Tokyo

Osaka University

Red Cross Hospital

Social Insurance Saitama Chuo Hospital

University of Tsukuba

Kitasato University

Saitama Medical University

Kyoto University

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Acute Interstitial Nephritis and Acute Tubular Injury Due to a Transdermal Loxoprofen Patch

Internal Medicine (2020)

Takahiro Shinzato Ken Ohara Hiroaki Kaminaga Taro Sugase Takahiro Masuda

A transdermal patch formulation of a non-steroidal anti-inflammatory drug (NSAID) used by a 44-year-old man resulted in acute interstitial nephritis and acute tubular injury. This patient also had a history of mild kidney dysfunction and osteoporosis. The NSAID patch had been prescribed after a traffic accident. He was also receiving a vitamin D analog and taking over-the-counter calcium supplements. Two months later, renal dysfunction and hypercalcemia were discovered. A renal biopsy showed acute interstitial nephritis and acute tubular injury. Once these agents were withdrawn, the renal function recovered. This is the first reported occurrence of biopsy-proven acute interstitial nephritis attributable to NSAID patch usage.

Interstitial nephritis

Nephritis

10.2169/internalmedicine.4945-20

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Citations (2)

Rituximab Treatment for PR3-ANCA-Positive Membranoproliferative Glomerulonephritis Associated with Adult-Onset Periodic Fever Syndrome

Case Reports in Nephrology and Urology (2012)

Yoshitomo Hamano Hiromichi Yoshizawa Taro Sugase Takuya Miki Naoko Ohtani

We report the case of a 36-year-old Japanese woman with nephrotic syndrome due to membranoproliferative glomerulonephritis (MPGN) Type I diagnosed after a 5-year history of periodic fever syndrome (PFS). Hypocomplementemia and elevation of anti-proteinase 3 anti-neutrophil cytoplasmic autoantibody (PR3-ANCA) were observed. HIV, and hepatitis B and C serology were negative. Nephrotic syndrome and periodic fever did not respond to oral steroid and intravenous steroid pulse therapies combined with cyclosporine, dipyridamole, warfarin and losartan. We tried immunotherapy using rituximab, a human-mouse chimeric monoclonal antibody directed against the CD20 antigen on mature B cells. This therapeutic approach led to improvement of renal function and remission of nephrotic syndrome and hypocomplementemia. However, it did not have a beneficial effect on periodic fever. Suspecting adult-onset hereditary PFS, we analyzed her genetic alteration of MEFV and TNFRSF1A genes. A rare genotype in intron 6 of TNFRSF1A was revealed. The etiological relationship between periodic fever and MPGN is discussed. Rituximab is a hopeful choice of induction therapy for refractory MPGN.

Membranoproliferative glomerulonephritis

10.1159/000341192

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Citations (3)

Balloon-Assisted Creation and Maturation of an Arteriovenous Fistula in a Patient with Small-Caliber Vasculature

Case Reports in Nephrology and Urology (2012)

Atsushi Kotoda Tetsu Akimoto Taro Sugase N. Miyamoto Eiji Kusano

The major problem associated with the creation of an arteriovenous fistula (AVF), which is the optimal form of vascular access for hemodialysis, is the fact that fistulas do not necessarily mature into a usable vascular access, requiring subsequent revision and construction of another access. The caliber of the vessels used for fistula creation is a pivotal factor predicting the presumable maturation of the constructed fistula, and veins less than 2.5 mm in diameter have poor outcomes. This report describes the balloon-assisted creation and maturation of an autogenous radial-cephalic AVF in a patient with a small-caliber vein and a radial artery measuring approximately 2 and 1.5 mm in diameter, respectively. The clinical impact of percutaneous radiological intervention for expediting the maturation of an autogenous AVF with small-caliber vessels is also discussed.

Caliber

Cephalic vein

10.1159/000339501

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Citations (8)

A hemodialysis patient who developed convulsive seizures following arteriovenous graft implantation : the considerable impact of dialysis shunts on organ blood flow

Nihon Toseki Igakkai Zasshi (2016)

Natsuko Wakabayashi Shin’ichi Takeda Taro Sugase Toshihiro Shimizu Akira Kurosawa

血液透析のための動静脈シャントは非生理的な血行動態であり, ときに諸臓器への悪影響を生じる. 症例は70歳女性. 糖尿病性腎不全のため20XX年3月に自己血管内シャントを造設, 5月より血液透析が開始されたが, 脱血不良のため8月に人工血管を挿入した. ところが, 透析中に全身の間欠的な痙攣が出現するようになり, 種々画像検査では両側内頸動脈閉塞および左椎骨動脈解離を認めた. 内シャント後に潜在的な盗血を生じ, 血液透析により脳血流障害が助長されたと考え, 直ちに人工血管を閉鎖した. 以降は中心静脈カテーテルを用いて血液透析を行ったところ, 痙攣発作は認めなくなり, シンチグラフィでも脳血流の著明な改善が示された. 内シャントに関連した中枢神経症状の報告は散見されるが, 既報例と異なり, 本症例では過剰血流は認めなかった. 動静脈シャント造設に際しては, 吻合血管のみならず, 全身性の血管病変にも注意を向ける必要性が考えられた.

10.4009/jsdt.49.419

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Citations (0)

Performing Anticoagulation: A Puzzling Case of Cholesterol Embolization Syndrome

Clinical Medicine Insights Case Reports (2017)

Yusuke Igarashi Tetsu Akimoto Takahisa Kobayashi Yoshitaka Iwazu Takuya Miki

The avoidance of any form of anticoagulation is advised in cases of cholesterol embolization syndrome (CES). We herein describe a case of CES in a man with a history of unprovoked pulmonary embolism for which warfarinization was performed. Despite anecdotal reports of successful anticoagulation in CES patients with certain indications, irreversible renal failure, which was sufficiently severe to require chronic hemodialysis, eventually developed in our patient. Our results emphasize the pitfalls of this procedure, which imply its limited feasibility and safety. Several therapeutic concerns associated with this case are also discussed.

Chronic renal failure

10.1177/1179547616684649

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Citations (6)

Membranous nephropathy in an HIV-positive patient complicated with hepatitis B virus infection

Clinical and Experimental Nephrology (2011)

Akihiko Numata Tetsu Akimoto Masaki Toshima Yoshitaka Iwazu Naoko Otani

Hepatitis B

Membranous Nephropathy

Nephrology

10.1007/s10157-011-0477-2

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Citations (7)

Clinical usefulness of serum levels of soluble fms-like tyrosine kinase 1/placental growth factor ratio to rule out preeclampsia in women with new-onset lupus nephritis during pregnancy

CEN Case Reports (2018)

Chikako Hirashima Manabu Ogoyama Miyuki Abe Satoru Shiraishi Taro Sugase

Nephrology

10.1007/s13730-018-0373-7

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Citations (19)

Relationship of thyroid function with renal hemodynamics and cholesterol metabolism in proteinuric kidney disease: A retrospective pilot study

Research Square (Research Square) (2023)

Yoshitaka Iwazu Kazuhiko Kotani Taro Sugase Daisuke Nagata Toshiyuki Yamada

Abstract Back ground. Massive proteinuria and hypothyroidism are respectively reported to influence renal hemodynamic and hypercholesterolemia. However, the relationship of proteinuria-associated thyroid function with renal hemodynamics and cholesterol metabolism has yet to be determined in a simultaneous analysis of thyroid, renal and cholesterol variables. We investigated the hypothesis that the changes in thyroid hormones by proteinuria may contribute to changes in lipid metabolism and renal hemodynamics by proteinuria. Methods. Twenty-nine patients (17 men) with proteinuric kidney disease (mean age 46 years) were enrolled in a pilot study. Data for serum free triiodothyronine (FT3), free thyroxine (FT4), total cholesterol, and filtration fraction (FF; assessed by para-aminohippuric acid clearance) were used in variable-adjusted correlation analyses. Results. The patients had the following data (mean ± standard deviation): urinary protein 5.18 ± 3.28 g/day, FT3 2.18 ± 0.44 pg/mL, FT4 1.03 ± 0.26 ng/dL, FF 0.27 ± 0.07, and total cholesterol 327 ± 127 mg/dL. There was a significant positive correlation of FT3 with FF (β = 0.58, P = 0.01) and a significant inverse correlation of FT4 with total cholesterol (β = -0.40, P = 0.01). Conclusions. The proteinuria associated reduction in serum thyroid hormone levels may be involved in a part of hypercholesterolemia and the impaired glomerular function due to massive proteinruia. Further studies of these relationships are required.

10.21203/rs.3.rs-3033673/v1

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[Internal medicine and gynecology-obstetrics, with reference to Sheehan's disease].

PubMed (1966)

Mitsuo Nishikawa K Moriwaki Tomoji Igarashi Taro Sugase

Sheehan's syndrome

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Challenges of Caring for an Advanced Chronic Kidney Disease Patient with Severe Thrombocytopenia

Clinical Medicine Insights Case Reports (2013)

Tetsu Akimoto Chiharu Ito Atsushi Kotoda Manabu Ogura Taro Sugase

An autogenous arteriovenous fistula has been considered to be the optimal form of vascular access for hemodialysis (HD) in the field of nephrology. Nevertheless, the decision regarding the type of access, whether it be an arteriovenous fistula, an arteriovenous graft, or a central venous catheter, must still be individualized. In the present report, we describe the case of a female patient with advanced chronic kidney disease (CKD) associated with a hemostatic disorder. Despite the exhausted peripheral vasculature, she required recurrent platelet transfusions for severe thrombocytopenia due to aplastic anemia. The goal of care for this patient was to optimize the dialysis treatment without increasing the bleeding risk. Various concerns regarding the therapeutic conundrums encountered in the case are also discussed.

Nephrology

10.4137/ccrep.s13238

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Citations (4)