里中 弘志

Eucommia ulmoides (Tochu) has been shown to possess a variety of beneficial effects on profiles affecting the onset of lifestyle- or aging-related diseases, such as hypertension, diabetes, dyslipidemia, or obesity. This exploratory single-arm clinical study was conducted on a total of 17 participants including those with mild chronic kidney disease (CKD) (n = 9), who were administered a tablet product containing Tochu leaf extract for a short period (median: 33 days), to investigate its effects on blood pressure or related clinical markers. Mean systolic blood pressure (SBP) of all the participants significantly decreased from 128.3 ± 12.3 mmHg at the start to 123.8 ± 10.2 mmHg at the end of the administration (p < 0.05). Analysis of CKD patients alone, however, revealed that SBP, to a greater extent, decreased from 130.7 ± 12.9 mmHg to 121.2 ± 10.7 mmHg (p < 0.01), while the change in non-CKD patients was not significant. Furthermore, SBP decrease in CKD patients with hypertension (n = 7) alone was also significant and comparable. Mean blood oxidative stress index of all participants was decreased from 300.2 ± 76.7 U.CARR to 285.9 ± 63.0 U.CARR (p < 0.05), while median atrial natriuretic peptide (ANP) of all the participants was increased from 8.1 (5.0-9.6) pg/mL to 8.8 (5.8-12.1) pg/mL (p < 0.05). Our findings suggested that Tochu-derived components may have potential therapeutic benefit at earlier stages in CKD, which could fill the gaps in currently underserved opportunities for prevention or intervention. Trial Registration: UMIN Clinical Trials Registry: UMIN000050727.

INTRODUCTION: Managing pregnancy in patients with end-stage kidney disease (ESKD) undergoing dialysis is challenging, with hypoalbuminemia significantly increasing risks to both maternal and neonatal outcomes. Intensive hemodialysis regimens are recommended; however, individualized and adaptive dialysis strategies, such as sequential online hemodiafiltration (OL-HDF) and intermittent HDF (i-HDF), may be required to optimize care in complex cases. CASE PRESENTATION: We report the case of a 27-year-old Japanese woman with ESKD who transitioned from OL-HDF to i-HDF during pregnancy due to progressive hypoalbuminemia at 30 + 5 weeks of gestation. Dry weight adjustments were guided by human atrial natriuretic peptide (hANP) levels, blood pressure measurements, and bioimpedance analysis. i-HDF reduced albumin loss compared to OL-HDF, stabilized maternal hemodynamics, and enabled term delivery at 39 + 1 weeks with a healthy neonate weighing 2,774 g. Bioimpedance analysis and hANP-guided adjustments allowed for precise fluid management, resulting in a total gestational weight gain of 6.4 kg. The patient developed superimposed preeclampsia during labor, which was successfully managed. CONCLUSION: This case demonstrates that sequential OL-HDF and i-HDF can effectively address hypoalbuminemia and fluid imbalances, contributing to successful maternal and neonatal outcomes in ESKD pregnancies.

A 79-year-old male patient with type 2 diabetic nephropathy and hypertension was admitted to our hospital because of acute kidney injury with significantly elevated serum creatinine (8.12 mg/dL) and urinary β2-microglobulin (β2MG, 31,748 μg/L) levels. α-Glucosidase inhibitor (α-GI) miglitol, started two weeks prior to presentation, was discontinued because drug-induced acute interstitial nephritis (AIN) was suspected. Renal biopsy revealed AIN and diabetic nephropathy. The drug-induced lymphocyte stimulation test for miglitol was also positive. After the discontinuation of miglitol, the urinary β2MG levels decreased to the normal range. This case raises the possibility that α-GI miglitol can worsen the renal function in patients with underlying renal dysfunction.