Researchers Database

akimoto tetsu

    DepartmentofChronicKidneyDiseasePathology Professor
Last Updated :2022/01/25

Researcher Information

URL

J-Global ID

Research Interests

  • FGF-2   NS-398   インドメタシン   VEGF   アスピリン   後腎   シクロオキシゲナーゼ   

Research Areas

  • Life sciences / Nephrology

Academic & Professional Experience

  • 2004 - 2006  Jichi Medical UniversitySchool of Medicine助手

Published Papers

  • Yuki Akiyama, Ryo Matsuoka, Takahiro Masuda, Sumiya Iwamoto, Shun Sugie, Takafumi Muto, Yuka Miyamoto, Takayuki Ohdate, Saki Nakagawa, Mari Okada, Toshimi Imai, Takanori Komada, Michiko Suzuki, Akito Maeshima, Tetsu Akimoto, Osamu Saito, Daisuke Nagata
    Blood purification 1 - 11 2021/08 
    INTRODUCTION: Isolated ultrafiltration (IUF) is an alternative treatment for diuretic-resistant patients with fluid retention. Although hemodialysis (HD) predominantly decreases extracellular water (ECW), the impact of IUF on fluid distribution compared with HD remains unclear. METHODS: We compared the effect of HD (n = 22) and IUF (n = 10) sessions on the body fluid status using a bioimpedance analysis device (InBody S10). RESULTS: The total ultrafiltration volume was similar between HD and IUF (HD 2.5 ± 0.3 vs. ICF 2.1 ± 0.3 L/session, p = 0.196). The reduction rate of ECW was significantly higher than that of intracellular water (ICW) after HD (ECW -7.9% ± 0.8% vs. ICW -3.0% ± 0.9%, p < 0.001) and IUF (ECW -5.8% ± 0.9% vs. ICW -3.6% ± 0.8%, p = 0.048). However, the change in the ratio of ECW to total body water in HD was significantly larger than that in IUF (HD -3.2% ± 0.3% vs. ICF -1.1% ± 0.4%, p < 0.001). The reduction rates in serum tonicity (effective osmolality) were higher after HD than after IUF (HD -1.8% ± 0.5% vs. IUF -0.6% ± 0.2%, p = 0.052). Among the components of effective osmolality, the reduction rates of serum K+ and glucose levels after HD were significantly higher than those after IUF (serum K+: HD -30.5% ± 1.6% vs. IUF -0.5% ± 3.8%, p < 0.001; serum glucose: HD -15.4% ± 5.0% vs. IUF 0.7% ± 4.8%, p = 0.026), while the serum Na+ level was slightly and similarly reduced (HD -0.8% ± 0.4% vs. IUF -0.8% ± 0.4%, p = 0.500). The reduction in the osmolal gap value (measured osmolality-calculated osmolarity) was significantly greater after HD sessions than after IUF sessions (HD -12.4 ± 1.4 vs. IUF 2.0 ± 1.0 mOsm/kg, p = 0.001). CONCLUSION: The extracellular fluid reduction effect of HD is stronger than that of IUF. The different changes in effective osmolality and osmolal gap after HD and IUF sessions may be related to the different effects of HD and IUF on fluid distribution.
  • Erika Hishida, Takahisa Kobayashi, Yuko Ono, Kentaro Oka, Takahiro Masuda, Yoshihiko Ueda, Tetsu Akimoto, Osamu Saito, Daisuke Nagata
    CEN case reports 2021/07 
    Isolated tubulointerstitial nephritis (TIN) without glomerular crescent formation is a rare manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Some patients with monoclonal gammopathy of undetermined significance present with renal complications due to serum monoclonal protein. Here, we present a case of TIN presumably attributable to AAV with monoclonal gammopathy. Laboratory data revealed acute kidney injury, elevated C-reactive protein (CRP) and ANCA titers, and elevated tubular injury markers. Renal biopsy revealed TIN with no apparent glomerular lesion. The findings of peritubular capillaritis and tubulitis indicated that AAV had contributed to the development of TIN. However, in situ hybridization for free light chains revealed kappa light chain restriction, indicating that the involvement of monoclonal gammopathy in the pathogenesis of TIN remains possible. The patient also developed ophthalmic neuropathy, probably caused by AAV. Oral prednisone (0.6 mg/kg/day) administration improved both the ocular symptoms and the laboratory parameters. Our case demonstrated that the concurrence of AAV and monoclonal gammopathy could pose a diagnostic dilemma in distinguishing the cause of TIN. Besides, some reports suggest an association between AAV and monoclonal gammopathy, although direct evidence is lacking. Further research is needed to establish this association.
  • Maki Asakura, Tetsu Akimoto, Ken Ohara, Takahiro Masuda, Yuko Ono, Osamu Saito, Daisuke Nagata
    Clinical medicine insights. Case reports 14 11795476211004604 - 11795476211004604 2021 
    A 70-year-old man presented with proteinuria, microscopic hematuria, and an increased level of serum creatinine. A systemic workup revealed that the patient had bronchogenic carcinoma and anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis concurrently. Despite the increase in the cumulative number of publications on paraneoplastic glomerulopathies, an awareness of the link between cancer and ANCA-associated glomerulonephritis is lacking. We strongly recommend the accumulation of more cases similar to our own, thereby allowing us to clarify the management strategies as well as the nature of this disease condition more precisely.
  • 肺胞出血を伴うANCA関連血管炎に対し選択的血漿交換が奏効した1例
    三木 敦史, 小林 高久, 平田 真美, 吉澤 寛道, 秋山 裕輝, 松岡 諒, 増田 貴博, 前嶋 明人, 秋元 哲, 斎藤 修, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 53 (Suppl.1) 543 - 543 1340-3451 2020/10
  • IgM陽性形質細胞浸潤を伴う尿細管間質性腎炎を認めたFanconi症候群の一例
    橋本 祐希, 村上 琢哉, 吉澤 寛道, 増田 貴博, 小林 高久, 鈴木 倫子, 伊藤 千春, 前嶋 明人, 小野 祐子, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 62 (6) 546 - 546 0385-2385 2020/09
  • αグルコシダーゼ阻害薬ミグリトールによる急性尿細管間質性腎炎を認めた1例
    由井 憲晶, 大野 和寿, 三木 敦史, 吉澤 寛道, 増田 貴博, 小林 高久, 鈴木 倫子, 前嶋 明人, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 62 (6) 549 - 549 0385-2385 2020/09
  • Ryo Matsuoka, Takahiro Masuda, Yuki Akiyama, Takafumi Muto, Yuka Miyamoto, Toshimi Imai, Tomoki Kamiyama, Manami Yokoyama, Sumiya Iwamoto, Shun Sugie, Kazutoshi Ono, Izumi Nagayama, Marina Kohara-Miura, Takanori Komada, Michiko Suzuki, Akito Maeshima, Tetsu Akimoto, Osamu Saito, Daisuke Nagata
    ASAIO journal (American Society for Artificial Internal Organs : 1992) 2020/07
  • Ken Ohara, Takahiro Masuda, Masato Morinari, Mari Okada, Atsushi Miki, Saki Nakagawa, Takuya Murakami, Kentaro Oka, Maki Asakura, Yasuharu Miyazawa, Akito Maeshima, Tetsu Akimoto, Osamu Saito, Daisuke Nagata
    Diabetology & metabolic syndrome 12 37 - 37 2020 
    Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic action. We recently reported that the SGLT2 inhibitor dapagliflozin ameliorates extracellular volume expansion with a mild increase in urine volume. However, the impact of the pretreatment extracellular volume status on the body fluid response to SGLT2 inhibitors remains unclear. Methods: Thirty-six diabetic kidney disease (DKD) patients were treated with dapagliflozin. The body fluid volume, including intracellular water (ICW), extracellular water (ECW) and total body water (TBW), were measured on baseline and day 7 using a bioimpedance analysis (BIA) device. The ECW/TBW and ECW were used as markers of the extracellular volume status. For a comparison, the extracellular volume status responses to loop diuretic furosemide (n = 16) and vasopressin V2 receptor antagonist tolvaptan (n = 13) were analyzed. Results: The body weight, brain natriuretic peptide and body fluid parameters measured by a BIA (ICW, ECW, TBW, and ECW/TBW) were significantly decreased for 1 week after dapagliflozin administration. The change in the ECW/TBW in the high-ECW/TBW group (over the median value of 0.413) was significantly higher than in the low-ECW/TBW group (- 2.1 ± 0.4 vs. - 0.5 ± 0.4%, p = 0.006). Only with dapagliflozin treatment (not furosemide or tolvaptan treatment) was the baseline ECW/TBW significantly correlated with the changes in the ECW/TBW (r = - 0.590, p < 0.001) and ECW (r = - 0.374, p = 0.025). Conclusions: The pretreatment extracellular volume status predicts the body fluid response to the SGLT2 inhibitor dapagliflozin in DKD patients. The diminished extracellular fluid reduction effect of dapagliflozin in patients without severe extracellular fluid retention may contribute to maintaining a suitable body fluid status.
  • 肺扁平上皮癌にMPO-ANCA関連腎炎を合併した1症例
    朝倉 真希, 菅生 太朗, 神永 洋彰, 大原 健, 川又 睦, 若林 奈津子, 中川 早紀, 岡田 麻里, 今井 利美, 大西 央, 増田 貴博, 小林 高久, 鈴木 倫子, 小野 祐子, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 61 (6) 716 - 716 0385-2385 2019/08
  • 各種急性腎障害バイオマーカーの推移を発症から回復まで比較検討し得た薬剤性急性腎障害の1症例
    植木 千絵, 大野 和寿, 永山 泉, 菅生 太朗, 増田 貴博, 前嶋 明人, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 61 (6) 729 - 729 0385-2385 2019/08
  • アルポート症候群を合併したIgA腎症に扁摘パルス療法が奏功した一症例
    常松 大帆, 村上 琢哉, 岡 健太郎, 金子 美和, 平田 真美, 三浦 麻里菜, 菱田 英里華, 三木 敦史, 小森 さと子, 伊澤 佐世子, 吉澤 寛道, 菅生 太朗, 小林 高久, 武田 真一, 小野 祐子, 秋元 哲, 斎藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 61 (6) 741 - 741 0385-2385 2019/08
  • SGLT2阻害薬の長期投与による体液貯留改善効果の検討
    大原 健, 増田 貴博, 森成 正人, 宮沢 保春, 前嶋 明人, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 61 (3) 365 - 365 0385-2385 2019/05
  • CKD患者の血清アルブミン低値はトルバプタン反応性の予測因子として有用である
    増田 貴博, 大原 健, 永山 泉, 松岡 諒, 村上 琢哉, 中川 早紀, 五十嵐 祐介, 深谷 幸祐, 宮澤 保春, 前嶋 明人, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 61 (3) 402 - 402 0385-2385 2019/05
  • 腹膜線維症におけるインフラマソームの関与についての検討
    菱田 英里華, 駒田 敬則, 秋元 哲, 高橋 将文, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 52 (Suppl.1) 547 - 547 1340-3451 2019/05
  • 末期腎不全患者に対する長時間血液透析が及ぼす骨代謝マーカー変化についての検討
    村上 琢哉, 齋藤 修, 朝倉 伸司, 小池 かおり, 菱田 英里華, 増田 貴博, 前嶋 明人, 秋元 哲, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 52 (Suppl.1) 652 - 652 1340-3451 2019/05
  • 大腸ポリペクトミー後に大腸菌による非穿孔性腹膜炎を来たしたCAPDの1例
    大原 健, 中川 早紀, 増田 貴博, 菅生 太朗, 平田 真美, 金子 美和, 小森 さと子, 小林 高久, 武田 真一, 秋元 哲, 齋藤 修, 武藤 重明, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 51 (Suppl.1) 514 - 514 1340-3451 2018/05
  • 血液透析患者におけるシャント肢体成分とエコー所見の関連性の検討
    中川 早紀, 増田 貴博, 岡田 麻里, 今井 利美, 秋山 裕輝, 松岡 諒, 岩津 好隆, 菅生 太朗, 小林 高久, 秋元 哲, 齋藤 修, 武藤 重明, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 51 (Suppl.1) 588 - 588 1340-3451 2018/05
  • 腹痛を契機に腹壁瘢痕ヘルニア、気腫性膀胱炎、腹膜炎と診断した1腹膜透析症例
    村上 琢哉, 菅生 太朗, 神永 洋彰, 岡 健太郎, 朝倉 真希, 永山 泉, 大原 健, 吉澤 寛道, 大西 央, 増田 貴博, 武田 真一, 秋元 哲, 武藤 重明, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 51 (Suppl.1) 631 - 631 1340-3451 2018/05
  • 保存的治療で腹膜透析(PD)を継続しえた横隔膜交通症の1例
    金子 美和, 若林 奈津子, 菅生 太朗, 伊澤 佐世子, 武島 えり, 今井 利美, 増田 貴博, 小林 高久, 秋元 哲, 齋藤 修, 武藤 重明, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 51 (Suppl.1) 694 - 694 1340-3451 2018/05
  • 保存期慢性腎臓病患者の血中FGF21は夜間間欠的低酸素血症と関連する
    村上 琢哉, 増田 貴博, 小原 麻里菜, 椎崎 和弘, 岡田 麻里, 大原 健, 吉澤 寛道, 三木 敦史, 永山 泉, 岡 健太郎, 金子 美和, 朝倉 真希, 渡邉 裕子, 秋元 哲, 齋藤 修, 武藤 重明, 黒尾 誠, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 60 (3) 365 - 365 0385-2385 2018/04
  • SGLT2阻害薬が体液分布に及ぼす効果 フロセミド,トルバプタンとの比較検討
    大原 健, 増田 貴博, 村上 琢哉, 今井 利美, 岡田 麻里, 中川 早紀, 菅生 太朗, 秋元 哲, 斎藤 修, 武藤 重明, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 60 (3) 445 - 445 0385-2385 2018/04
  • ANCA関連腎炎の新組織分類を用いた治療方針の検討
    小林 高久, 湯村 和子, 城 謙輔, 小川 弥生, 秋元 哲, 斎藤 修, 武藤 重明, 長田 太助
    日本腎臓学会誌 (一社)日本腎臓学会 60 (3) 357 - 357 0385-2385 2018/04
  • Takuya Murakami, Tetsu Akimoto, Mari Okada, Erika Hishida, Taro Sugase, Atsushi Miki, Marina Kohara, Hiromichi Yoshizawa, Takahiro Masuda, Takahisa Kobayashi, Osamu Saito, Shigeaki Muto, Daisuke Nagata
    Drug target insights 12 1177392818782899 - 1177392818782899 2018 
    A 66-year-old women with no history of renal disease was admitted due to a coma and acute kidney injury with a serum creatinine level of 7.44 mg/dL which were ascribed to valacyclovir neurotoxicity and nephrotoxicity, respectively. She had received valacyclovir at a standard dosage for the treatment of herpes zoster and was finally discharged, having fully returned to her normal baseline mental status with a recovered serum creatinine level of 0.68 mg/dL. We feel that awareness of this pathology remains a challenge for physicians and therefore strongly recommend the further accumulation of experiences similar to our own. Our experience underscores the pitfalls of administering valacyclovir to elderly patients who barely appear to have a favorable renal function. Several concerns regarding the therapeutic management, including blood purification strategies, that emerged in this case are also discussed.
  • Takuya Murakami, Tetsu Akimoto, Tomoyuki Yamazaki, Hiromichi Yoshizawa, Mari Okada, Atsushi Miki, Saki Nakagawa, Ken Ohara, Taro Sugase, Takahiro Masuda, Takahisa Kobayashi, Osamu Saito, Shigeaki Muto, Daisuke Nagata
    Clinical medicine insights. Case reports 11 1179547618785137 - 1179547618785137 2018 
    A 28-year-old man was referred and admitted to our hospital due to Escherichia coli O157-mediated hemorrhagic colitis with severe thrombocytopenia. A systemic workup concluded that the patient had acute pancreatitis as well as hemolytic uremic syndrome. The patient was ultimately discharged, with his platelet count having recovered. Our case serves an illustrative example of potentially serious complications of an increasingly recognized public health problem. Systemic studies on this topic are insufficient, and we strongly recommend the further accumulation of more experiences like ours. Several diagnostic and management concerns that emerged in this case are also discussed.
  • 人工血管感染を繰り返す透析患者に併発した粟粒結核の1例
    菱田 英里華, 増田 貴博, 小林 高久, 武田 真一, 秋元 哲, 齋藤 修, 武藤 重明, 長田 太助
    栃木県医学会々誌 栃木県医学会 47 104 - 106 0285-6387 2017/06
  • Mari Okada, Tetsu Akimoto, Mutsumi Kawamata, Toshimi Imai, Erika Hishida, Marina Kohara, Atsushi Miki, Takuya Murakami, Taro Sugase, Takahiro Masuda, Yuko Ono, Yoshihiko Ueda, Osamu Saito, Shigeaki Muto, Daisuke Nagata
    Clinical medicine insights. Case reports 10 1179547617723317 - 1179547617723317 2017 
    The association between nephrotic syndrome (NS) and a hypercoagulable state has been demonstrated. Controlling the blood clotting activity may therefore be attractive for patients with nephrosis in terms of thromboembolism prophylaxis. We herein report a 75-year-old woman with minimal change disease who developed pains in the right back, groin, and thigh because of retroperitoneal bleeding during prophylactic anticoagulation with unfractionated heparin. Although this procedure has not been accepted as the standard of care for patients with nephrosis, pharmacologic prophylaxis may already be practiced empirically, as in the present patient. We believe that our experience highlights the pitfalls of such a management in patients with nephrosis, implying the need for a diagnostic strategy for identifying those patients with NS who can benefit from prophylactic anticoagulation. Several concerns that emerged in this case are also discussed.
  • 人工血管感染を繰り返す透析患者に併発した粟粒結核の1例
    菱田 英里華, 増田 貴博, 山崎 智行, 菅生 太朗, 武島 えり, 五十嵐 祐介, 伊澤 佐世子, 黒澤 明, 南木 浩二, 小林 高久, 武田 真一, 秋元 哲, 八木澤 隆, 齋藤 修, 武藤 重明, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 49 (Suppl.1) 475 - 475 1340-3451 2016/05
  • アマンタジン中毒に対し血液吸着(DHP)と血液濾過透析(HDF)併用が有効であった1症例
    山崎 智行, 小林 高久, 三木 敦史, 岡田 麻里, 小原 麻里菜, 菱田 英里華, 中川 早紀, 小森 さと子, 吉澤 寛道, 小藤田 篤, 増田 貴博, 秋元 哲, 斉藤 修, 武藤 重明, 長田 太助
    日本透析医学会雑誌 (一社)日本透析医学会 49 (Suppl.1) 906 - 906 1340-3451 2016/05
  • Ayako Kokuzawa, Yoshiyuki Morishita, Hiromichi Yoshizawa, Kana Iwazu, Takanori Komada, Tetsu Akimoto, Osamu Saito, Takashi Oda, Fumi Takemoto, Yasuhiro Ando, Shigeaki Muto, Wako Yumura, Eiji Kusano
    Internal medicine (Tokyo, Japan) 52 (18) 2087 - 91 2013 
    We herein report the case of a 17-year-old man who developed an increased plasma creatinine level (11.1 mg/dL) and oliguria with massive proteinuria (27.3 g/day) four weeks after an abraded wound to his right knee. The histology of the renal biopsy specimens showed diffuse endocapillary proliferative glomerulonephritis with the deposition of nephritis-associated plasmin receptor in the glomerulus. A case of acute kidney injury due to nephrotic syndrome caused by acute post-streptococcal glomerulonephritis was diagnosed. His renal function and proteinuria were improved with supportive care, including hemodialysis, without the administration of immunosuppressive agents.

MISC

  • 伊藤 千春, 秋元 哲, 森下 義幸  The Japanese journal of nephrology = 日本腎臓学会誌  57-  (7)  1233  -1240  2015
  • Ito Chiharu, Ogura Manabu, Morishita Yoshiyuki, Takeshima Eri, Miki Atsushi, Takahashi Hideaki, Akimoto Tetsu, Kusano Eiji  Nihon Toseki Igakkai Zasshi  46-  (6)  561  -569  2013  [Not refereed][Not invited]
     
    The incidence of recurrent or bilateral chronic subdural hematoma has been shown to be high in hemodialysis patients. We report a hemodialysis patient who underwent emergency burr hole drainage for repeated chronic subdural hematoma a total of four times, and was subsequently diagnosed with hypofibrinogenemia. He started hemodialysis due to chronic renal damage with obstructive nephropathy in 2002. Prolonged PT-INR, but not APTT was noted in 2005 when compression hip screw fixation was performed for a left femur neck fracture. He had never presented with a major bleeding event before the onset of subdural hematoma. In January 2012, he exhibited bilateral subacute subdural hematoma, which was followed by the first burr hole drainage. Preoperative blood analysis at the third burr hole drainage revealed that his plasma fibrinogen level was not detected by the Clauss method. Immuno-quantitative analysis for plasma fibrinogen determined its level as 106 mg/dL. A mixing test for prolonged PT, in which the patient's plasma was mixed with normal pooled plasma, showed a factor deficient pattern. The anti-fibrinogen antibody was negative and his past thromboembolic event was denied. A fibrinogen preparation was administrated to prevent the augmentation of postoperative subdural hemorrhage. Since <I>in vivo</I> recovery with the immuno-quantitative method for his plasma fibrinogen level was 69%, the presence of a fibrinogen inhibitor was ruled out. Although the detailed relationship between subdural hematoma and his coagulation abnormality was obscure, the occurrence of subdural hematoma and the possibility of abnormal fibrinogen levels should be considered.
  • Taro Sugase, Osamu Saito, Takako Saito, Tetsu Akimoto, Makoto Inoue, Yasuhiro Ando, Fumi Takemoto, Eiji Kusano  Jichi Medical University journal  34-  67  -74  2012/03  [Not refereed][Not invited]
     
    We report a case of C1q nephropathy that manifested only as microhematuria in a 27-year-old man. The patient had presented with microhematuria for five years. A light microscopic study of a renal biopsy specimen showed predominant mesangial C1q deposition. Staining for C3 was positive in the same mesangial area. Stainings for IgA, IgG and IgM were slightly positive, however, these stainings were not on mesangial lesion, suggesting as non-specific pattern. Electron microscopy indicated high electron-dense deposits in the mesangial area. Histopathological studies were compatible with C1q nephrology. In addition, laboratory data showed no serological evidence of collagen disease. Usually proteinuria, occasionally nephrotic syndrome were reported in C1q nephropathy and C1q nephropathy often cause severe damage in the glomerulocapillary area from an early stage. From April 1994 to the end of 2010, we experienced 6 patients with possibility of C1q nephropathy among the all 3614 patients in whom renal biopsy was studied, and the prevalence of C1q nephropathy was 0.17%. All of 6 patients showed continuous microhematuria and proteinuria, and 2 of 6 cases had nephrotic syndrome. Current patient showed only hematuria without proteinuria. Hematuria alone is not a major manifestation of C1q nephropathy. Thus, the clinical findings in our patient may represent a rare phenotype of C1q nephropathy. We report the details of the case with a comparison with previous C1q cases.
  • YOSHIZAWA Hiromichi, AKIMOTO Tetsu, NISHINO Katsuhiko, INOUE Makoto, ITO Chiharu, TAKEDA Shinichi, KOTODA Atsushi, TAMBA Kaichiro, YUMURA Wako, MUTO Shigeaki, UEDA Yoshihiko, KUSANO Eiji  Clinical and experimental nephrology  15-  (4)  567  -571  2011/08
  • KATO Maki, KOTODA Atsushi, AKIMOTO Tetsu, TAKAHASHI Hideaki, MUTO Shigeaki, KUSANO Eiji  Nihon Toseki Igakkai Zasshi  44-  (2)  169  -172  2011/02  [Not refereed][Not invited]
     
    Percutaneous transluminal angioplasty (PTA) is being performed more frequently for the treatment of stenosis in order to increase the patency of arteriovenous fistulae. This report describes a 78-year-old female who was diagnosed as having heparin-induced thrombocytopenia (HIT) just after the initiation of renal replacement therapy due to end stage diabetic nephropathy. An arteriovenous fistula was surgically created to provide permanent access for hemodialysis ; however, it failed to mature. Therefore, she underwent PTA by proximal catheterization of the fistula with the insertion of introductory sheaths and 5 mg bolus injection of argatroban. A balloon was inflated for at least 2 minutes, and this was repeated until no residual waist remained in the balloon. A final fistulogram performed 30 minutes after the initiation of PTA demonstrated complete resolution of stenosis. These observations suggest that argatroban could play a role as an alternative agent for anti-coagulation replacing heparin during PTA for hemodialysis vascular access in patients with HIT.
  • KOTODA Atsushi, KATO Maki, AKIMOTO Tetsu, TAKAHASHI Hideaki, ITO Chiharu, TAKEDA Shinichi, ANDO Yasuhiro, MUTO Shigeaki, YUMURA Wako, KUSANO Eiji  Nihon Toseki Igakkai Zasshi  42-  (8)  587  -593  2009/08  [Not refereed][Not invited]
     
    Heparin-induced thrombocytopenia (HIT) is a relatively common complication of heparin treatment among the patients who are newly treated by hemodialysis. We herein describe an 81-year-old woman with polycythemia vera (PV) who developed HIT associated with respiratory failure. She developed uremia due to diabetic nephropathy and hemodialysis was therefore initiated. Ten days after the first hemodialysis session, an arteriovenous fistula was surgically created to provide permanent access to the blood stream. Several minutes after the intravenous infusion of unfractionated heparin during surgery, the patient developed chest pain and became tachypenic. Thereafter, diagnostic computed tomography demonstrated the presence of thrombus, which had formed around the catheter for hemodialysis and also a right kidney infarction. However, there were no signs of any pulmonary embolism, and the presence of platelet-activating antibodies that recognize the complexes of platelet factor 4 and heparin was serologically confirmed. We therefore discontinued heparin and initiated the administration of argatroban followed by the normalization of the depleted platelet count, and the patient's respiratory symptoms finally subsided. We attributed the sustained respiratory symptoms observed in our patient to a pseudopulmonary embolism that might have resulted from a microembolism of pulmonary capillaries. We must therefore always bear in mind that the development of respiratory symptoms may be associated with the onset of HIT in patients treated with heparin. In our patient, the role that PV may have played in the clinical course of HIT remains to be elucidated. However, the identification of PV among patients with end stage renal failure may facilitate the diagnosis of thrombotic disorders including HIT, since the combination of HIT and PV is not so exceptionally rare in clinical settings.
  • Satoko Komori, Eiko Nakazawa, Tetsu Akimoto, Daishi Meguro, Ryoko Tozawa, Shigeaki Muto, Eiji Kusano  Japanese Journal of Nephrology  51-  (2)  138  -144  2009  [Not refereed][Not invited]
     
    A 73-year-old male with nephrotic syndrome was admitted to our hospital. He was empirically treated with prednisolone, which resulted in the alleviation of proteinuria, hypoproteinemia, and pleural effusion. Thereafter, a computed tomographic scan revealed a mass lesion in the right-lower lung field. Finally, the patient died of multiple organ failure induced by disseminated intravascular coagulation. Adenocarcinoma of the lung and membranous nephropathy (MN) were revealed by autopsy. MN tends to occur in the elderly, and is also occasionally associated with solid tumors, such as lung and gastrointestinal cancer. Therefore, a malignancy survey may be useful in the management of cases with nephrotic syndrome in which MN is pathologically defined. However, the initiation of empirical treatment without a pathological diagnosis is not an exceptional phenomenon. Physicians should, therefore, bear in mind the potential association of malignancy and immediately and carefully investigate the potential presence of a malignancy in elderly patients with a new onset of nephrotic syndrome.
  • Daishi Meguro, Tetsu Akimoto, Eiko Nakazawa, Akira Onishi, Makoto Inoue, Osamu Saito, Shigeaki Muto, Eiji Kusano  Japanese Journal of Nephrology  51-  (2)  145  -149  2009  [Not refereed][Not invited]
     
    We report the case of a 72-year-old man with nephritic syndrome and rapidly progressive renal failure due to Henoch-Schonlein purpura nephritis (HSPN). He was successfully treated with methylprednisolone pulse therapy, followed by oral prednisolone at the dose of 30 mg per day. He was also diagnosed by immunoelectrophore-sis as IgAα monoclonal gammopathy of undetermined significance (igA-MGUS). Renal biopsy revealed the diffuse crescentic glomerulonephritis associated with mesangial deposition of IgA and C3. Since an immuno fluorescence examination failed to show the deposition of α, the significance of IgA paraproteinemia on the HSPN was obscure in the present case. However, we must bear in mind the latent presence of IgA-MGUS in cases of HSPN.
  • Maki Kato, Eiko Nakazawa, Tetsu Akimoto, Makoto Inoue, Eriko Kanashiki, Daishi Meguro, Ryoko Tozawa, Shigeaki Muto, Wako Yumura, Eiji Kusano  Japanese Journal of Nephrology  51-  (5)  569  -575  2009  [Not refereed][Not invited]
     
    A case of nephrotic syndrome associated with bilateral hydronephrosis in a 26-year-old female is reported. She was referred to our hospital because of persistent diarrhea, abdominal pain, and urinary disorders. On admission, ascites, intestinal edema, and bilateral hydronephrosis, were demonstrated by radiographic analysis. The findings of both physical and laboratory examinations showed evidence of systemic lupus erythematosus (SLE). In addition, diffuse proliferative lupus nephritis was consistently confirmed by a renal biopsy. Immediately after the initiation of steroid treatment, her abdominal symptoms disappeared followed by an improvement in the symptoms of intestinal edema, hydronephrosis, and the renal function. The relationship between ureterohydronephrosis and lupus cystitis, and the fact that lupus enteritis is often associated with lupus cystitis have been demonstrated by previous studies. Finally, the clinical manifestations observed in our case led us to consider the association of lupus enteritis and cystitis. We should bear in mind the possible association of several disorders, including nephrotic syndrome, enteritis, and hydronephrosis due to cystitis, in cases presenting with SLE.
  • Eriko Kanashiki, Eiko Nakazawa, Tetsu Akimoto, Maki Kato, Osamu Saito, Yasuhiro Ando, Shigeaki Muto, Eiji Kusano  Japanese Journal of Nephrology  50-  (8)  1024  -1029  2008  [Not refereed][Not invited]
     
    We report a case of purpura nephritis complicated with essential mixed cryoglobulinemia. The patient was referred to our hospital because of a petechial rash on the lower extremities, microscopic hematuria, and progressive deterioration of renal function. The presumptive diagnosis of Henoch-Schonlein purpura (HSP) was made, and the patient was treated with prednisolone at the dose of 40 mg/day. However, there was a persistent purpuric skin rash. On the other hand, Immunoelectrophoresis of the serum revealed the presence of IgA-lambda and polyclonal IgG in the cryoprecipitate. Granular staining for polyclonal rather than monoclonal IgA and C3 segmentally along the capillary walls demonstrated by immunofluorescence analysis of renal biopsy led to the diagnosis of purpura nephritis as the major mechanism of renal damage. After three sessions of cryofiltration, the patient's serum cryoglobulins decreased and the active rash finally settled, along with improvement of renal function. These observations suggest that the presence of cryoglobulinemia modulated the clinical course of HSP in our case. Therefore, the possibility of the latent presence of cryoglobulinemia in cases with HSP having an active rash refractory to steroid treatment should not be overlooked.
  • ONISHI Akira, AKIMOTO Tetsu, SAITO Osamu, YAMAMOTO Hisashi, MOTOMURA Manabu, ISHIGURO Yasunao, NISHINO Katsuhiko, ANDO Yasuhiro, MUTO Shigeaki, YASUDA Yoshikazu, NAGAI Hideo, KUSANO Eiji  Nihon Toseki Igakkai Zasshi  40-  (1)  83  -87  2007/01  [Not refereed][Not invited]
     
    We report a 51-year old man with idiopathic portal hypertension (IPH) receiving long-term hemodialysis treatment, who developed pancytopenia that had mildly progressed over a five-year period before the current admission. Abdominal ultrasound showed splenomegaly, and abdominal computed tomography showed dilatation of the portal and paraumbilical veins. Neither hematological nor collagen disease was suggested. We concluded that the patient had idiopathic portal hypertension, and splenectomy was performed. Liver biopsy was simultaneously performed and histological analysis demonstrated normal liver tissue ; there was no evidence of any excess inflammation and no features to suggest cirrhosis or drug-induced liver disease, consistent with IPH. Post operatively, recovery was uneventful and rapid improvement of pancytopenia was observed.
  • 大西 央, 斎藤 修, 本村 学, 山本 尚史, 秋元 哲, 井上 真, 安藤 康宏, 武藤 重明, 草野 英二  日本アフェレシス学会雑誌  25-  (3)  2006/10  [Not refereed][Not invited]
  • Akimoto Tetsu, Ando Yasuhiro, Masuda Takahiro, Ishii Eriko, Nakazawa Eiko, Kusano Eiji  Japanese journal of apheresis  25-  (2)  139  -144  2006/05  [Not refereed][Not invited]
     
    Apheresis has been used frequently to treat a variety of renal disease. The efficacy of apheresis has been assessed extensively in primary and secondary forms of rapidly progressive glomerulonephritis (RPGN), including immune complex-mediated glomerulonephritis and pauciimmune RPGN. Other disorders to which the procedure is often applied include refractory nephrotic syndrome due to focal glomerulosclerosis, lupus nephritis, acute renal failure associated with myeloma, and allograft rejection. There are various kinds of evidence that apheresis is a useful adjunct to conventional immunosuppression in the treatment of these diseases. In this review, we describe the effect of apheresis as initial monotherapy in several kinds of renal disorders, and discuss the putative criteria for the appropriate indications of therapeutic apheresis in the treatment of renal diseases.
  • TOZAWA Ryoko, TAKANO Ryuichi, OGURA Manabu, AKIMOTO Tetsu, NEMOTO Jun, SAITO Osamu, ANDO Yasuhiro, MUTO Shigeaki, TERAUCHI Humihito, YASHI Masahiro, MORITA Tatsuo, YAGISAWA Takashi, KUSANO Eiji  Journal of Japanese Society for Dialysis Therapy  39-  (3)  197  -201  2006/03  [Not refereed][Not invited]
  • ITO Chiharu, ANDO Yasuhiro, AKIMOTO Tetsu, KUSANO Eiji, ASANO Yasushi  The Japanese journal of nephrology = / 日本腎臓学会 [編集]  42-  (5)  374  -380  2000/07  [Not refereed][Not invited]
  • Megumi Kurosu, Yasuhiro Ando, Tetsu Akimoto, Shuichi Ono, Eiji Kusano, Yasushi Asano  Japanese Journal of Nephrology  41-  (2)  70  -76  1999  [Not refereed][Not invited]
     
    QT prolongation, a risk factor for arrhythmia and cardiac death, is observed in urémie patients. Though hypocalcemia, autonomie nerve dysfunction and cardiac hypertrophy are assumed to cause the urémie QT prolongation, the exact mechanism remains unspecified. We therefore examined factors related to the QT interval in chronic renal failure(CRF). Corrected QT interval(QTc) was significantly prolonged in CRF just before the induction of dialysis therapy (group A) compared with nephrotic syndrome with the intact or mildly impaired renal function (group B). QTc was also prolonged in acute renal failure (group C). Cardio-thoracic ratio, serum albumin and Ca correlated with QTc in group A, but not in B or C. A single HD session in group A failed to shorten QTc, despite a significant increase in serum Ca++. Autonomie dysfunction did not appear to be a major determinant of QT prolongation, since QTc was not different between diabetics and non-diabetics in group A and in chronic HD patients (group D). In group D, QTc did not correlate with SV, + RV5 on ECG or left ventricular wall thickness (LVWT) on echocardiography. In another group of chronic HD patients (group E), there was no significant correlation between QTc and the parameters of left ventricular mass, plasma brain natriuretic peptide(BNP). However, in the patients subjected to repeated echocardiography in group D, QTc and LVWT changed in parallel. In a retrospective analysis of QTc in group D, QTc was maximally prolonged at the time of starting HD therapy, and gradually improved in the following 1-5 years in both diabetics and nondiabetics. In contrast, chronic CAPD patients (group F) revealed no improvement of QTc. Thus, urémie QT prolongation cannot be explained simply by any of the previously assumed factors, but appears to be affected by multiple factors, which are partially correctable by chronic HD therapy.
  • 伊藤 千春, 秋元 哲, 安藤 康宏, 武藤 重明, 草野 英二, 浅野 泰  日本アフェレシス学会雑誌  17-  (1)  1998/02  [Not refereed][Not invited]
  • 秋元 哲, 田部井 薫, 丹波 嘉一郎, 船山 いずみ, 武藤 重明, 草野 英二, 三森 明夫, 狩野 庄吾, 浅野 泰  日本アフェレシス学会雑誌  16-  (2)  1997/05  [Not refereed][Not invited]


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