基本情報
研究分野
1経歴
1-
2013年4月 - 現在
学歴
1-
- 現在
委員歴
1-
2014年12月 - 現在
論文
18-
CLINICAL AND EXPERIMENTAL NEPHROLOGY 19(2) 247-253 2015年4月 査読有りType 2 diabetic kidney disease (DKD) is frequently accompanied by uncontrollable hypertension due to the sodium sensitivity inherent in DKD and to diuretic-resistant edema. In general, diuretics are effective in treating this condition, but thiazide diuretics are thought to be innocuous in advanced chronic kidney disease (CKD). We examined the renoprotective effects of combination therapy with thiazides and loop diuretics in type 2 DKD patients with CKD stage G4 or G5. This study included 11 patients with type 2 DKD and an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m(2) who were suffering from severe edema even with loop diuretics. Each patient received additional hydrochlorothiazide (HCTZ) therapy, which was continued for more than 12 months. We examined clinical parameters including blood pressure (BP), proteinuria, and eGFR before and after the addition of HCTZ. Patients received a 13.6 +/- A 3.8 mg/day dose of HCTZ in addition to loop diuretics (azosemide: 120 mg/day in 6 cases, 60 mg/day in 3 cases and furosemide: 80 mg/day in 1 case, 120 mg/day in 1 case). Side effects of HCTZ were not observed in all patients. After the addition of HCTZ therapy, systolic and diastolic blood pressures (S-BP, D-BP) as well as proteinuria significantly decreased (S-BP: at 6 months, p < 0.05 and 12 months, p < 0.01 vs. 0 month, D-BP: at 12 months, p < 0.05 vs. 0 month, proteinuria: at 6 months, p < 0.05 and 12 months, p < 0.01 vs. 0 month). The annual decline in eGFR was not significantly different before and after HCTZ therapy (-7.7 +/- A 8.5 and -8.4 +/- A 4.8 mL/min/1.73 m(2)/year, respectively). Our findings suggest that the combination of HCTZ and loop diuretics improves BP levels, and decreases proteinuria even in advanced stage type 2 DKD patients with severe edema. The addition of HCTZ therapy was not found to negatively affect the change in eGFR in the present study.
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JOURNAL OF ARTIFICIAL ORGANS 18(1) 72-78 2015年3月 査読有りThe incidence of cholesterol crystal embolism (CCE) has increased along with increases in the prevalence of atheromatous diseases and intravascular procedures. CCE frequently results in the deterioration of renal function, which sometimes leads to end-stage renal failure. Although there has been no established therapy for CCE, the possibility that low-density lipoprotein apheresis (LDL-A) is an effective therapy for renal CCE was previously reported. However, whether LDL-A improves renal CCE remains uncertain. This study aimed to evaluate the effectiveness of LDL-A in renal CCE patients. Twelve renal CCE patients (9 men and 3 women, mean age 70.6 +/- A 1.7 years) were included in this retrospective study. All patients had received LDL-A therapy, and estimated glomerular filtration rate (eGFR) values were examined before and after LDL-A. In addition, monthly changes in eGFR before and after LDL-A were calculated for each patient. At initial diagnosis of renal CCE, the eGFR was 35.2 +/- A 4.8 mL/min/1.73 m(2). At the initiation of LDL-A, the eGFR significantly decreased to 11.0 +/- A 1.2 mL/min/1.73 m(2), and monthly changes in eGFR reached -7.2 +/- A 2.5 mL/min/1.73 m(2)/month. After the initiation of LDL-A, the progression of renal dysfunction stabilized in nearly two-thirds of patients, and monthly changes in eGFR after LDL-A significantly diminished to -0.3 +/- A 0.7 mL/min/1.73 m(2)/month (p < 0.05 vs. before LDL-A). Although 4 patients had to undergo hemodialysis, all patients were alive over 1 year after the initiation of LDL-A. LDL-A therapy ameliorated renal dysfunction in renal CCE patients.
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Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 29 Suppl 3 iii148-iii167 2014年5月 査読有り
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Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 29 Suppl 3 iii209-iii222 2014年5月 査読有り
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Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 29 Suppl 3 iii369-iii379 2014年5月 査読有り
MISC
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The Japanese journal of nephrology = / 日本腎臓学会 [編集] 45(4) 393-397 2003年
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日本透析医学会雑誌 34(8) 1185-1192 2001年8月目的: plasma refilling coefficient (mean Kr) はHD施行中の血管透過性を表すものとして近年, 提唱された新たな指標である. 今回, mean Krがドライウェイトの設定に有用であるか否かについて検討した.<br>対象および方法: 安定維持HD患者41例で12か月にわたりHD前後の体重とともにHD前のヘマトクリット, HD前後血清総蛋白濃度を測定し総計446回のmean Krを得た. 得られたmean Krを0<mean Kr≦1 (n=148, I群), 1<mean Kr≦4 (n=218, II群), 4<mean Kr (n=45, III群), mean Kr<0 (n=35, IV群) の4群に分け, DW設定に用いられる臨床的パラメーターとの関係を検討した.<br>結果: 1) mean Krと除水速度およびHD前TPとの間には一定の傾向は認めなかった. 2) CTRにおいてI群はIII, IV群に比し, II群はIV群に比し有意に小さかった. 3) HD前後の平均血圧変化率においてI群は他の3群に比し有意にその変化率が大きい, すなわちHD後に血圧の低下を認めた. 4) 昇圧処置の必要性ではI群は他の3群に比し有意にその必要性が高かった. 5) HD中の時間あたりの循環血液量変化率ではI群: -4.2±0.1, II群: -2.4±0.1, III群: -0.6±0.1, IV群: 1.0±0.1 (%) で, 各群間でそれぞれ有意差を認めた. 6) 経時的な体液量変化の比較を目的として各月毎のmean Krの比 (mean Kr/mean Kr) とANPの比 (ANP/ANP) との関連においては, 弱いながら有意な正相関を認めた. 以上より, I群はCTRは小さいもののHD中の血圧は低下しやすく昇圧処置の必要性も高い, さらに循環血液量の低下も大きいということでDWが厳しすぎる可能性が, また反対にIII群, IV群ではHD中の血圧低下は少なく昇圧処置の必要性も少ないもののCTRは大きく, 循環血液量の減少は少ない, もしくはかえってHD後に増加を認めることよりDWが甘くなっている可能性が考えられた.<br>まとめ: 今回の検討からmean Krは従来より用いられているDW設定の臨床的パラメーターを反映することよりDW設定の指標の一つとなりうるものと思われた. 目安とすべき適正なmean Krは1-4の範囲である可能性が考えられた.
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日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 34(8) 1185-1192 2001年7月28日目的: plasma refilling coefficient (mean Kr) はHD施行中の血管透過性を表すものとして近年, 提唱された新たな指標である. 今回, mean Krがドライウェイトの設定に有用であるか否かについて検討した.<br>対象および方法: 安定維持HD患者41例で12か月にわたりHD前後の体重とともにHD前のヘマトクリット, HD前後血清総蛋白濃度を測定し総計446回のmean Krを得た. 得られたmean Krを0<mean Kr≦1 (n=148, I群), 1<mean Kr≦4 (n=218, II群), 4<mean Kr (n=45, III群), mean Kr<0 (n=35, IV群) の4群に分け, DW設定に用いられる臨床的パラメーターとの関係を検討した.<br>結果: 1) mean Krと除水速度およびHD前TPとの間には一定の傾向は認めなかった. 2) CTRにおいてI群はIII, IV群に比し, II群はIV群に比し有意に小さかった. 3) HD前後の平均血圧変化率においてI群は他の3群に比し有意にその変化率が大きい, すなわちHD後に血圧の低下を認めた. 4) 昇圧処置の必要性ではI群は他の3群に比し有意にその必要性が高かった. 5) HD中の時間あたりの循環血液量変化率ではI群: -4.2±0.1, II群: -2.4±0.1, III群: -0.6±0.1, IV群: 1.0±0.1 (%) で, 各群間でそれぞれ有意差を認めた. 6) 経時的な体液量変化の比較を目的として各月毎のmean Krの比 (mean Kr/mean Kr) とANPの比 (ANP/ANP) との関連においては, 弱いながら有意な正相関を認めた. 以上より, I群はCTRは小さいもののHD中の血圧は低下しやすく昇圧処置の必要性も高い, さらに循環血液量の低下も大きいということでDWが厳しすぎる可能性が, また反対にIII群, IV群ではHD中の血圧低下は少なく昇圧処置の必要性も少ないもののCTRは大きく, 循環血液量の減少は少ない, もしくはかえってHD後に増加を認めることよりDWが甘くなっている可能性が考えられた.<br>まとめ: 今回の検討からmean Krは従来より用いられているDW設定の臨床的パラメーターを反映することよりDW設定の指標の一つとなりうるものと思われた. 目安とすべき適正なmean Krは1-4の範囲である可能性が考えられた.
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日本透析医学会雑誌 34(Supplement 1) 888 2001年5月25日
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日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 33(10) 1325-1327 2000年10月28日
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日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 32(7) 1051-1057 1999年7月28日
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日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 31(6) 1001-1005 1998年6月28日
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日本透析医学会雑誌 31(6) 1001-1005 1998年Purpose: We mathematically analysed the blood volume change during hemodialysis by continuous hematocrit monitoring using CRIT-LINE (IN-LINE DIAGNOSTICS). Methods: We measured the hematocrit and calculated the blood volume change (%BV) in eight chronic hemodialysis patients, 5 hemodialysis sessinons in each patient and studied the method of approximating %BV using the equation: %BV=b×[1-exp(cX)]-aX. Furthermore, we studied the relationship between the coefficients (a, b, c) and clinical parameters.Results: 1) Hematocrit decreased just after the start of hemodialysis and gradually increased from about 1 hour to the end of hemodialysis. Just after the start of hemodialysis, %BV increased then started to linearly decrease after about 1 hour and continued to decrease until the end of hemodialysis. 2) We approximated the linear part of %BV to the equation: y=b-aX and the curved part of the equation: y=b×[1-exp(cX)] and then gained a good correlation (r>0.95) in each part of %BV. Thus, we could approximate %BV to the equation: y=b×[1-exp(cX)]-aX. 3) Coefficient a, the slope of the linear part of %BV was 0.0859±0.0051. Coefficient b, the degree of increase of %BV, was 5.948±0.433. Coefficient c, the speed of increase of %BV, was -0.0396±0.0028. 4) As for the relationship of each coefficient to the clinical parameters, only coefficient a was significantly related to the volume removed during hemodialysis (r=0.50, p<0.05). Conclusions: %BV could be approximated to the equation: %BV=b×[1-exp(c×Time)]-a×Time. However, further studies will be needed to analyse the clinical importance of each coefficient.
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日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 29(5) 403-410 1996年5月28日
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日本透析医学会雑誌 29(5) 403-410 1996年We treated 10 patients suffering from septic shock by direct hemoperfusion using polymyxin B immobilized fiber column (PMX), after which 6 patients survived (alive group: AG) and 4 patients died (dead group: DG).To examine differences between the AG and DG groups, the laboratory findings before treatment by PMX and the clinical features with in 24hr of treatment were compared. Furthermore, we clarified the factors affecting prognosis.Before the treatment with PMX, septic severity scores did not differ between the two groups, however the MOF score was higher in the DG, and in the laboratory findings only serum creatinine differed, being higher in the DG.The heart rate gradually improved in the two groups after treatment by PMX, and mean blood pressure improved significantly in the AG just after the start of treatment, but remained unchanged in the DG. Urine volume an hour (UV/hr) before treatment was significantly higher in the AG and the response of UV/hr to PMX therapy was also significantly higher in the AG. Urine volume prior to treatment was a potentially significant determinant of prognosis, with critical urine volume of 30ml/hr.In conclusion, PMX was an effective therapy for patients suffering from septic shock, but PMX therapy should be started at an earlier time point, and urine volume should be maintained at more than 30ml per hour.
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The Japanese journal of nephrology = / 日本腎臓学会 [編集] 38(2) 98-102 1996年
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日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 28(9) 1269-1272 1995年9月28日
担当経験のある科目(授業)
1-
腎臓科 (自治医科大学附属さいたま医療センター)