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詳細

秋元　哲 (ｱｷﾓﾄ ﾃﾂ)

  • 透析センター　教授
Last Updated :2023/05/31

研究者情報

ホームページURL

J-Global ID

研究キーワード

  • 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   

研究分野

  • ライフサイエンス / 腎臓内科学

経歴

  • 2018年04月 - 現在  自治医科大学医学部内科学講座腎臓内科学部門教授
  • 2012年11月 - 2018年03月  自治医科大学医学部内科学講座腎臓内科学部門准教授
  • 2007年07月 - 2012年10月  自治医科大学医学部内科学講座腎臓内科学部門講師

研究活動情報

論文

  • IgM陽性形質細胞浸潤を伴う慢性尿細管間質性腎炎に対しステロイド治療が奏功した一例
    三澤 響平, 村上 琢哉, 吉澤 寛道, 増田 貴博, 小林 高久, 伊藤 千春, 小野 祐子, 秋元 哲, 齋藤 修, 長田 太助
    日本腎臓学会誌 63 6-E 729 - 729 (一社)日本腎臓学会 2021年09月
  • 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 51 6 1 - 11 2021年08月 
    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 11 1 36 - 42 2021年07月 
    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.
  • 高用量メソトレキセート(MTX)の急性腎障害にオンラインHDF(OHDF)が奏功した1症例
    村上 琢哉, 吉澤 寛道, 大野 和寿, 三木 敦史, 今井 利美, 増田 貴博, 小林 高久, 秋元 哲, 齋藤 修, 長田 太助
    日本透析医学会雑誌 54 Suppl.1 457 - 457 (一社)日本透析医学会 2021年05月
  • Maki Asakura, Tetsu Akimoto, Ken Ohara, Takahiro Masuda, Yuko Ono, Osamu Saito, Daisuke Nagata
    Clinical medicine insights. Case reports 14 11795476211004604 - 11795476211004604 2021年 
    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.
  • 気がつきにくい水・電解質異常 妊娠を契機にループ利尿薬と下剤の大量服用を中止し、急激な体重増加と浮腫を認めた一例
    岡 健太郎, 小林 高久, 村上 琢哉, 朝倉 真希, 菅生 太朗, 増田 貴博, 前嶋 明人, 秋元 哲, 齋藤 修, 長田 太助
    臨床体液 47 12 - 16 臨床体液研究会 2020年12月 
    41歳女性。労作時の息切れ、体重増加及び下腿浮腫を主訴とした。高校生の頃からループ利尿薬と下剤を常用し、妊娠前はフロセミド160mgと市販薬のビサコジル含有下剤80錠を連日服用していた。また、慢性的な低カリウム血症があり、塩化カリウム製剤を服用していた。41歳時に妊娠5週目であることが判明し、自己判断で常用薬の服用を完全に中止したところ、尿量の減少と共に急激な体重増加と下腿浮腫が生じ、5日後に元体重の24%増加と労作時の息切れが出現した。血液検査で血漿浸透圧が低値にも関わらず、非浸透圧性アルギニンバソプレシンが高値であり、低カリウム血症が存在するにも関わらず、レニン-アンギオテンシン-アルドステロン系が亢進していた。減塩と水分制限に加え利尿薬としてフロセミドとスピロノラクトンの投与を開始したところ、尿量の増加と共に体重が減少し、浮腫や労作時の息切れが改善した。
  • 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 53 Suppl.1 543 - 543 (一社)日本透析医学会 2020年10月
  • 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 53 Suppl.1 543 - 543 (一社)日本透析医学会 2020年10月
  • 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 62 6 546 - 546 (一社)日本腎臓学会 2020年09月
  • 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 62 6 549 - 549 (一社)日本腎臓学会 2020年09月
  • 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年07月
  • 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) 66 10 1073 - 1075 2020年
  • 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年 
    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 61 6 716 - 716 (一社)日本腎臓学会 2019年08月
  • 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 61 6 729 - 729 (一社)日本腎臓学会 2019年08月
  • 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 61 6 741 - 741 (一社)日本腎臓学会 2019年08月
  • 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 61 3 365 - 365 (一社)日本腎臓学会 2019年05月
  • 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 61 3 402 - 402 (一社)日本腎臓学会 2019年05月
  • 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 52 Suppl.1 547 - 547 (一社)日本透析医学会 2019年05月
  • 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 52 Suppl.1 652 - 652 (一社)日本透析医学会 2019年05月
  • 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 51 Suppl.1 514 - 514 (一社)日本透析医学会 2018年05月
  • 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 51 Suppl.1 588 - 588 (一社)日本透析医学会 2018年05月
  • 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 51 Suppl.1 631 - 631 (一社)日本透析医学会 2018年05月
  • 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 51 Suppl.1 694 - 694 (一社)日本透析医学会 2018年05月
  • 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 60 3 365 - 365 (一社)日本腎臓学会 2018年04月
  • 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 60 3 445 - 445 (一社)日本腎臓学会 2018年04月
  • 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 60 3 357 - 357 (一社)日本腎臓学会 2018年04月
  • 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年 
    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年 
    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.
  • Tetsu Akimoto, Tomoyuki Yamazaki, Marina Kohara, Saki Nakagawa, Yoshihiko Kanai, Sayoko Izawa, Hisashi Yamamoto, Eiko Nakazawa, Takahiro Masuda, Takahisa Kobayashi, Osamu Saito, Shigeaki Muto, Eiji Kusano, Daisuke Nagata
    Clinical Medicine Insights: Case Reports 10 1 - 6 2017年10月 [査読有り][通常論文]
     
    Peritoneal dialysis has been a widely accepted modality for treating end-stage kidney disease, but a regular dialysis schedule can be seriously disrupted by various comorbid conditions requiring surgical intervention. A 40-year-old woman who had been receiving peritoneal dialysis was sequentially but separately complicated by pleuroperitoneal communication and ovarian cancer. Despite the need for temporary interruption of her peritoneal dialysis schedule, it was successfully resumed after the relevant surgeries for each disease. Several concerns regarding overall postoperative dialytic management strategies, including how to deal with the peritoneal dialysis catheter during the postoperative period as well as how long peritoneal dialysis should be interrupted, which remain an unresolved issue in the field of nephrology, 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 47 104 - 106 栃木県医学会 2017年06月
  • Yusuke Igarashi, Tetsu Akimoto, Takahisa Kobayashi, Yoshitaka Iwazu, Takuya Miki, Naoko Otani-Takei, Toshimi Imai, Taro Sugase, Takahiro Masuda, Shin-Ichi Takeda, Shigeaki Muto, Daisuke Nagata
    Clinical Medicine Insights: Case Reports 10 1 - 5 2017年01月 [査読有り][通常論文]
     
    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.
  • 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年 
    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.
  • Naoko Otani-Takei, Tetsu Akimoto, Ai Sadatomo, Osamu Saito, Shigeaki Muto, Eiji Kusano, Daisuke Nagata
    Clinical Medicine Insights: Case Reports 9 57 - 60 2016年08月 [査読有り][通常論文]
     
    Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery. The concerns about the perioperative dialytic management as well as the diagnostic problems regarding the disease that arose in our experience with the present patient 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 49 Suppl.1 475 - 475 (一社)日本透析医学会 2016年05月
  • 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 49 Suppl.1 906 - 906 (一社)日本透析医学会 2016年05月
  • Mutsumi Kawamata, Tetsu Akimoto, Taro Sugase, Naoko Otani-Takei, Takuya Miki, Takahiro Masuda, Takahisa Kobayashi, Shin-Ichi Takeda, Shigeaki Muto, Daisuke Nagata
    Clinical Medicine Insights: Case Reports 9 21 - 24 2016年03月 [査読有り][通常論文]
     
    A 16-year-old female patient was admitted to our hospital due to progressive renal dysfunction with an increased serum creatinine (sCr) level of 1.7 mg/dL. Her clinical course without any ocular manifestations and results of drug-induced, lymphocyte-stimulating tests, in addition to a renal histological assessment, initially encouraged us to ascribe the patient’s renal abnormalities to drug-induced acute interstitial nephritis (AIN). Four months later, she started to complain about reduced visual acuity when she was found to have anterior bilateral uveitis despite the recovered renal function with almost constant sCr levels around 0.7 mg/dL. Thus, a diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome was finally made. Our case illustrates the difficulties in distinguishing late-onset uveitis TINU syndrome from drug-induced AIN at the time of the renal biopsy, thereby suggesting the importance of a longitudinal follow-up to overcome the potential underdiagnosis of the disease. Several diagnostic conundrums that emerged in this case are also discussed.
  • Takahiro Masuda, Takuya Murakami, Yusuke Igarashi, Kyochika Okabe, Takahisa Kobayashi, Shin-ichi Takeda, Takako Saito, Chuji Sekiguchi, Yasuharu Miyazawa, Tetsu Akimoto, Osamu Saito, Shigeaki Muto, Daisuke Nagata
    INTERNAL MEDICINE 55 19 2759 - 2764 2016年 [査読有り][通常論文]
     
    Objective Tolvaptan, an oral selective V2-receptor antagonist, is a water diuretic that ameliorates fluid retention with a lower risk of a worsening renal function than conventional loop diuretics. Although loop diuretics predominantly decrease extracellular water (ECW) compared with intracellular water (ICW), the effect of tolvaptan on fluid distribution remains unclear. We therefore examined how tolvaptan changes ICW and ECW in accordance with the renal function. Methods Six advanced chronic kidney disease patients (stage 4 or 5) with fluid retention were enrolled in this study. Tolvaptan (7.5 mg/day) added to conventional diuretic treatment was administered to remove fluid retention. The fluid volume was measured using a bioimpedance analysis device before (day 0) and after (day 5 or 6) tolvaptan treatment. Results Body weight decreased by 2.6%+/- 1.3% (64.4 +/- 6.5 vs. 62.8 +/- 6.3 kg, p=0.06), and urine volume increased by 54.8%+/- 23.9% (1,215 +/- 169 vs. 1,709 +/- 137 mL/day, p=0.03) between before and after tolvaptan treatment. Tolvaptan significantly decreased ICW (6.5%+/- 1.5%, p=0.01) and ECW (7.5%+/- 1.4%, p=0.02), which had similar reduction rates (p=0.32). The estimated glomerular filtration rate remained unchanged during the treatment (14.6 +/- 2.8 vs. 14.9 +/- 2.7 mL/min/1.732 m, p=0.35). Conclusion Tolvaptan ameliorates body fluid retention, and induces an equivalent reduction rate of ICW and ECW without a worsening renal function. Tolvaptan is a novel water diuretic that has a different effect on fluid distribution compared with conventional loop diuretics.
  • Sugase Taro, Akimoto Tetsu, Kubo Taro, Imai Toshimi, Otani-Takei Naoko, Miki Takuya, Takeda Shin-ichi, Nukui Akinori, Muto Shigeaki, Morita Tatsuo, Nagata Daisuke
    Internal Medicine 55 17 2447 - 2452 一般社団法人 日本内科学会 2016年 

    Acute kidney injury (AKI) is caused by diverse pathologies, although it may occasionally result from concurrent renal efflux disturbances. We herein describe a case of AKI in a patient complicated by renal cell carcinoma (RCC) with renal vein and inferior vena cava (IVC) involvement. A neoplastic thrombus which disrupted the blood flow in the renal vein appeared to play a role in the rapid decline in the renal function. Such a scenario has rarely been mentioned in the previous literature describing the cases of RCC complicated by AKI. Concerns regarding the diagnostic and therapeutic strategies for RCC are also discussed.

  • 若林 奈津子, 武田 真一, 菅生 太朗, 清水 俊洋, 黒澤 明, 小森 さと子, 伊澤 佐世子, 木村 貴明, 秋元 哲, 齋藤 修, 武藤 重明, 八木澤 隆, 長田 太助
    日本透析医学会雑誌 49 6 419 - 423 一般社団法人 日本透析医学会 2016年 
    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.
  • Toshimi Imai, Tetsu Akimoto, Chiharu Ito, Takahiro Masuda, Daisuke Nagata
    Drug Target Insights 9 29 - 31 2015年11月 [査読有り][通常論文]
     
    A 48-year-old female was admitted to our hospital presenting with a chief complaint of progressive swelling because of diabetic nephrotic syndrome. Dapagliflozin seemed to play a role in accelerating the patient’s urinary sodium excretion as well as reducing gross fluid retention despite the fact that her nephrotic condition was resistant to furosemide. Our experience emphasizes a potential novel approach to overcoming loop diuretic resistance using this agent among some subsets of type 2 diabetic subjects complicated with severe volume accumulation. We believe that combination treatment consisting of dapagliflozin and furosemide may produce diuretic synergy via sequential nephron blockade. The accumulation of more experience with additional cases similar to ours requires continuous and careful attention.
  • Ken Ohara, Tetsu Akimoto, Takuya Miki, Naoko Otani, Taro Sugase, Takahiro Masuda, Takuya Murakami, Toshimi Imai, Shin-Ichi Takeda, Yasuhiro Ando, Shigeaki Muto, Daisuke Nagataa
    Clinical Medicine Insights: Case Reports 8 97 - 100 2015年09月 [査読有り][通常論文]
     
    In this report, we describe the case of an end-stage kidney disease patient with tetralogy of Fallot (TOF). A 33-year-old female with TOF was admitted to our hospital with complaints of general fatigue and appetite loss probably due to uremic milieu. She was ultimately treated with peritoneal dialysis (PD) with a favorable clinical course. TOF patients with chronic kidney disease are not exceptional, although the currently available information regarding the association between TOF and renal failure severe enough to require dialysis treatment is limited. We also discuss the complex processes of how and why PD was selected as a mode of chronic renal replacement therapy in this case.
  • 腎癌に対する後腹膜鏡下腎摘術後に腹膜透析(PD)を継続し得た1例
    小原 麻里菜, 武田 真一, 清水 俊洋, 今井 麗華, 木村 貴明, 山崎 智行, 駒田 敬則, 佐藤 隆太, 中澤 英子, 森下 義幸, 秋元 哲, 武藤 重明, 八木澤 隆, 長田 太助
    日本透析医学会雑誌 48 Suppl.1 929 - 929 (一社)日本透析医学会 2015年05月
  • Tetsu Akimoto, Chiharu Ito, Atsushi Kotoda, Manabu Ogura, Taro Sugase, Ryuta Sato, Eiji Kusano, Daisuke Nagata
    Clinical Medicine Insights: Case Reports 6 171 - 175 2013年11月 [査読有り][通常論文]
     
    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 cath-eter, 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. © the authors, publisher and licensee Libertas Academica Limited.
  • 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年 
    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.
  • Ito Chiharu, Akimoto Tetsu, Nakazawa Eiko, Komori Satoko, Sugase Taro, Chinda Junko, Takahashi Hideaki, Ioka Takashi, Muto Shigeaki, Kusano Eiji
    Internal Medicine 50 1 47 - 51 The Japanese Society of Internal Medicine 2011年 
    Paraneoplastic nephropathy is a rare complication of malignant disease. We present a case of cervical cancer with biopsy-proven membranous nephropathy and associated nephrotic syndrome. Irradiation to the specific neoplasm site and to the metastatic paraaortic lymph node tissues lead to regression of the nephrotic syndrome without causing severe adverse events. Radiation therapy can be the first choice in the treatment of paraneoplastic nephrotic syndrome if the primary neoplasm is unresectable. Invasiveness of intervention and patient prognosis should be carefully deliberated in the management of the two diseases.

MISC

  • 家族性LCAT欠損症を背景とした糖尿病性腎症による末期腎不全に対して生体腎移植術を施行した1例
    朝倉 真希, 齋藤 修, 南木 浩二, 清水 俊洋, 岡田 麻里, 三木 敦史, 秋元 哲, 八木澤 隆, 長田 太助 日本腎臓学会誌 60 (6) 892 -892 2018年08月 [査読無し][通常論文]
  • 岡田 麻里, 増田 貴博, 三木 敦史, 菱田 英里華, 小原 麻里菜, 村上 琢哉, 山崎 智行, 三木 拓哉, 菅生 太朗, 渡邉 裕子, 小林 高久, 秋元 哲, 齋藤 修, 武藤 重明, 長田 太助 日本高血圧学会総会プログラム・抄録集 39回 359 -359 2016年09月 [査読無し][通常論文]
  • 腎移植ドナーにおける腎摘前後での血中・尿中可溶型Klothoの変化に関する検討
    木村 貴明, 秋元 哲, 南木 浩二, 清水 俊洋, 黒澤 明, 武藤 重明, 長田 太助, 八木澤 隆 日本泌尿器科学会総会 103回 520 -520 2015年04月 [査読無し][通常論文]
  • 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年
  • Saito Osamu, Kotouda Atushi, Saito Takako, Sugase Taro, Akimoto Tetsu, Ando Yasuhiro, Muto Shigeaki, Kusano Eiji 自治医科大学紀要 = Jichi Medical University Journal 35 1 -6 2013年03月 
    Background： In hemodialysis patients, failure of arteriovenous fistula（ AVF） is a serious problem. AVFstenosis is dominant cause of vascular access failure. We hypothesized that vascular endothelial damage maybe involved in arteriovenous fistula（ AVF） stenosis.Methods： A cross-sectional observational survey was performed in 122 patients receiving maintenancehemodialysis in January - April 2004. Serum levels of adiponectin, adhesion molecules（ intercellular adhesionmolecule-1； ICAM-1 and vascular cell adhesion molecule-1； VCAM-1）, and endothelial injury markers（CD146 and thrombomodulin） were compared between 46 patients with AVF stenosis and 76 patientswithout AVF stenosis to determine factors associated with AVF stenosis.Results： The serum adiponectin level was significantly lower in patients with AVF stenosis compared tothose without AVF stenosis. Similarly, the serum levels of ICAM-1 and thrombomodulin were significantlylower in patients with AVF stenosis, whereas the serum level of VCAM-1 was significantly higher in patientswith AVF stenosis. There were no significant differences in other parameters between the two groups.Logistic regression analysis with the presence or absence of AVF stenosis as the dependent variable showedthat administration of an antihypertensive drug, VCAM-1, ICAM-1 and thrombomodulin were significantlyassociated with the presence of AVF stenosis in hemodialysis patients.Conclusion： The significant associations of administration of an antihypertensive drug, VCAM-1, ICAM-1 and thrombomodulin with AVF stenosis suggest that endothelial injury may play a critical role in thiscondition.
  • 伊藤 千春, 小倉 学, 森下 義幸, 武島 えり, 三木 敦史, 高橋 秀明, 秋元 哲, 草野 英二 日本透析医学会雑誌 46 (6) 561 -569 2013年 [査読無し][通常論文]
     
    維持血液透析症例では，再発性および両側性の慢性硬膜下血腫の発症頻度が多いことが報告されている．われわれは計4回の慢性硬膜下血腫に対する穿頭血腫除去術が施行され，その経過中に低フィブリノゲン（Fbg）血症と診断した症例を報告する．症例は50歳男性で，左大腿骨頸部骨折時に軽度のPT-INR延長を認めたが，経過観察とされていた．幼少期を含め，大出血イベントはなかったが，2012年1月に明らかな外傷の契機のない，両側硬膜下血腫を発症し，穿頭血腫除去術が施行された．術前の検査でAPTTは正常で，PT-INRの軽度の延長を認めた．同月に両側硬膜下血腫の再発があり，再穿頭血腫除去術が施行された．同年2月にも左硬膜下血腫の再発があり，術前の血漿Fbg値はClauss法で測定不能であったが，抗原定量法では106 mg/dLと低値を示した．正常血漿混合試験では因子欠損型を示した．抗Fbg抗体は検出されず，血栓塞栓症の既往がないことから，血腫悪化予防のため，Fbg製剤を投与したところ，<I>in vivo</I> recoveryは抗原定量法で69％であり，Fbg阻害因子の存在は否定的であった．低Fbg血症の原因として，薬剤性など後天的要素は否定的であった．本症例での血腫形成と凝固異常の因果関係については不明な点が多いが，凝固異常スクリーニングとして血漿Fbg値にも注意を払う必要があると考えられた．
  • 菅生 太朗, 斎藤 修, 斎藤 孝子, 秋元 哲, 井上 真, 安藤 康宏, 竹本 文美, 草野 英二 自治医科大学紀要 34 67 -74 2012年03月 [査読無し][通常論文]
     
    症例は27歳男性。5年前より顕微鏡的血尿を指摘されていた。仕事で海外駐在の予定があり,赴任前に血尿の精査目的にて入院となった。経皮腎生検を行い,光顕所見ではメサンギウム増殖性糸球体腎炎の所見を認めた。蛍光抗体法にてメサンギウム領域に主としてC1qの沈着を認めた。同部位にC3の僅かな沈着も認めたが,IgA,IgG,IgMの有意な沈着は認めなかった。電顕ではメサンギウム領域にdense depositsを認めた。一方,臨床症状または採血結果からは,膠原病を疑わせる所見はなかった。以上の所見よりC1q腎症と診断した。一般的にC1q腎症では蛋白尿が主体の症状であり,場合によってはネフローゼ症候群を呈することもある。1994年4月から2010年12月までの当科での腎生検施行全3614例中,C1q腎症と診断される患者は他に6例あったが,本症例のみが血尿単独を呈していた。本症例はC1q腎症の発症メカニズムを考えるうえで示唆に富む症例と考えられたので,若干の考察を加えて報告する。
  • 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年08月
  • 加藤 真紀, 小藤田 篤, 秋元 哲, 高橋 秀明, 武藤 重明, 草野 英二 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 44 (2) 169 -172 2011年02月 [査読無し][通常論文]
     
    血液透析症例におけるvascular accessの狭窄や閉塞に対して経皮的血管形成術（percutaneous transluminal angioplasty：PTA）が臨床応用されるようになり，vascular access修復の選択肢が近年拡がっている．今回われわれは，内シャント造設後に，ヘパリンにより血小板減少や血栓塞栓症がひき起こされるヘパリン起因性血小板減少症（heparin-induced thrombocytopenia：HIT）の診断に至った78歳女性の症例を経験した．シャント造設後，シャントの発達が不良であったことから，argatrobanによる抗凝固療法下にPTAを施行した．シース挿入後にargatroban 5 mgを静脈内に投与したのち，シャント近位側静脈本幹の狭窄部に対してPTAを行い，シャント血流不全の解除に成功した．治療時間は30分で，術後の経過も良好であった．ヘパリンを抗凝固療法として用いることのできないHIT症例において，内シャントPTA施行時にargatrobanが抗凝固薬として応用される可能性が示唆された．
  • 小藤田 篤, 加藤 真紀, 秋元 哲, 高橋 秀明, 伊藤 千春, 武田 真一, 安藤 康宏, 武藤 重明, 湯村 和子, 草野 英二 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 42 (8) 587 -593 2009年08月 [査読無し][通常論文]
     
    ヘパリン起因性血小板減少症（heparin-induced thrombocytopenia；HIT）は近年本邦でも広く認知されるようになってきた．今回われわれは，シャント造設中のヘパリン投与後より出現した呼吸器症状がHIT診断の契機となった1透析症例を経験した．症例は81歳，女性．真性多血症の既往があり，糖尿病性腎症による慢性腎不全の進行のため，平成19年12月28日カテーテル挿入下に透析導入となった．9日後の内シャント造設術中のヘパリン静注直後より肺血栓塞栓症を思わせる胸痛，頻呼吸，低酸素血症が出現し，翌日には透析導入時に52.8×10<SUP>4</SUP>/μLであった血小板数が3.2×10<SUP>4</SUP>/μLまで著減した．画像上右内頸静脈カテーテル周囲の血栓および腎梗塞像を認めたが，肺血栓塞栓症の所見は確認されなかった．抗platelet factor 4(PF4)-ヘパリン抗体が陽性であることが判明し，ヘパリンを中止しargatrobanによる治療を開始したところ，持続していた呼吸器症状は消失し，血小板数も安定した．本症例におけるHITの診断の契機になった呼吸器症状は，各種画像検査にて肺血栓塞栓症と診断しえない病態として知られる偽性肺塞栓症によるものと判断した．従って，シャント造設時のヘパリン投与により肺血栓塞栓症を思わせる胸部症状が急速に出現した場合は，HITの可能性を念頭に置き精査を進める必要があると思われた．また，真性多血症の存在が本症例のHITの臨床経過に及ぼした影響は不明であるものの両者の合併は決して例外ではなく，真性多血症を伴った血液透析導入症例に遭遇した場合には，HITを含めた血栓症の発現の可能性を念頭に置きながら加療にあたることも重要であると考えられた．
  • 小森 さと子, 中澤 英子, 秋元 哲, 目黒 大志, 戸澤 亮子, 武藤 重明, 草野 英二 The Japanese journal of nephrology 51 (2) 138 -144 2009年 [査読無し][通常論文]
     
    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.
  • 目黒 大志, 秋元 哲, 中澤 英子, 大西 央, 井上 真, 斉藤 修, 武藤 重明, 草野 英二 The Japanese journal of nephrology 51 (2) 145 -149 2009年 [査読無し][通常論文]
     
    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.
  • 加藤 真紀, 中澤 英子, 秋元 哲, 井上 真, 金敷 絵里子, 目黒 大志, 戸澤 亮子, 武藤 重明, 湯村 和子, 草野 英二 The Japanese journal of nephrology 51 (5) 569 -575 2009年 [査読無し][通常論文]
     
    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.
  • 金敷 絵里子, 中澤 英子, 秋元 哲, 加藤 真紀, 斉藤 修, 安藤 康宏, 武藤 重明, 草野 英二 The Japanese journal of nephrology 50 (8) 1024 -1029 2008年 [査読無し][通常論文]
     
    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.
  • 秋元 哲, 草野 英二 日本医事新報 (4320) 53 -56 2007年02月
  • 大西 央, 秋元 哲, 斎藤 修, 山本 尚史, 本村 学, 石黒 保直, 西野 克彦, 安藤 康宏, 武藤 重明, 安田 是和, 永井 秀雄, 草野 英二 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 40 (1) 83 -87 2007年01月 [査読無し][通常論文]
     
    緩徐に進行する汎血球減少症を呈した51歳男性の長期血液透析症例. 各種検査所見より血液疾患や膠原病などに起因する汎血球減少症は否定的であった. 画像検査上, 脾腫と門脈側副血行路の発達を認めるものの肝硬変等の肝疾患の合併は考えにくく, 特発性門脈圧亢進症 (IPH) が強く疑われた. 経過中白血球減少症が進行し, 発熱症状が持続するようになったため, G-CSF製剤や抗生剤による治療を継続したが明確な効果は得られず, 摘脾術を施行した. 術後速やかに汎血球減少症は改善し, 発熱症状も消失した. 肝生検で肝炎・肝硬変を示唆する所見を認めなかったことから, 汎血球減少症の原因として特発性門脈圧亢進症と診断した. 透析症例において汎血球減少を認めた場合は, IPHも念頭におき精査を進める必要があると思われる.
  • AKIMOTO Tetsu, SAITO Osamu, KOTODA Atsushi, NISHINO Katsuhiko, UMINO Tetsuo, MUTO Shigeaki, KUSANO Eiji Clinical and experimental nephrology 10 (4) 279 -283 2006年12月
  • 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) 260 -260 2006年10月 [査読無し][通常論文]
  • 秋元 哲, 安藤 康宏, 増田 貴博, 石井 恵理子, 中澤 英子, 草野 英二 日本アフェレシス学会雑誌 25 (2) 139 -144 2006年05月 [査読無し][通常論文]
     
    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.
  • 戸澤 亮子, 高野 隆一, 小倉 学, 秋元 哲, 根本 遵, 斎藤 修, 安藤 康宏, 武藤 重明, 寺内 文人, 安士 正裕, 森田 辰男, 八木澤 隆, 草野 英二 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 39 (3) 197 -201 2006年03月 [査読無し][通常論文]
  • 秋元 哲, 草野 英二 医学のあゆみ 215 (6) 519 -522 2005年11月
  • 伊藤 千春, 安藤 康宏, 秋元 哲, 草野 英二, 浅野 泰 The Japanese journal of nephrology = / 日本腎臓学会 [編集] 42 (5) 374 -380 2000年07月 [査読無し][通常論文]
  • 黒巣 恵美, 安藤 康宏, 秋元 哲, 大野 修一, 草野 英二, 浅野 泰 The Japanese journal of nephrology = / 日本腎臓学会 [編集] 41 (2) 70 -76 1999年 [査読無し][通常論文]
     
    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) 69 -69 1998年02月 [査読無し][通常論文]
  • 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) 416 -416 1997年05月 [査読無し][通常論文]

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