研究者業績
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  2. 大河原 晋

大河原 晋

susumu ookawara

基本情報

所属
自治医科大学 医学部総合医学第1講座 教授
J-GLOBAL ID
201401038668303000
researchmap会員ID
B000237795

研究キーワード

 4

研究分野

 1

経歴

 1

学歴

 1

委員歴

 1

論文

 18
  • Taro Hoshino, Susumu Ookawara, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Yoshio Kaku, Keiji Hirai, Honami Mori, Izumi Yoshida, Kaoru Tabei
    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.
  • Keiji Hirai, Susumu Ookawara, Haruhisa Miyazawa, Kiyonori Ito, Yuichirou Ueda, Yoshio Kaku, Taro Hoshino, Izumi Yoshida, Kaoru Tabei
    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.
  • Kurnatowska I, Grzelak P, Masajtis-Zagajewska A, Kaczmarska M, Stefańczyk L, Vermeer C, Maresz K, Nowicki M, Patel L, Bernard LM, Elder GJ, Leonardis D, Mallamaci F, Tripepi G, D'Arrigo G, Postorino M, Enia G, Caridi G, Marino F, Parlongo G, Zoccali C, On Behalf, Of, Mauro Working Group, Genovese F, Boor P, Papasotiriou M, Leeming DJ, Karsdal MA, Floege J, Delmas-Frenette C, Troyanov S, Awadalla P, Devuyst O, Madore F, Jensen JM, Mose FH, Kulik AE, Bech JN, Fenton RA, Pedersen EB, Lucisano S, Villari A, Benedetto F, Pettinato G, Cernaro V, Lupica R, Trimboli D, Costantino G, Santoro D, Buemi M, Carmone C, Robben JH, Hadchouel J, Rongen G, Deinum J, Navis GJ, Wetzels JF, Deen PM, Block G, Fishbane S, Shemesh S, Sharma A, Wolf M, Chertow G, Gracia M, Arroyo D, Betriu A, Valdivielso JM, Fernández E, Cantaluppi V, Medica D, Quercia AD, Dellepiane S, Gai M, Leonardi G, Guarena C, Migliori M, Panichi V, Biancone L, Camussi G, Covic A, Ketteler M, Rastogi A, Spinowitz B, Sprague SM, Botha J, Rakov V, Floege J, Floege J, Ketteler M, Rastogi A, Spinowitz B, Sprague SM, Botha J, Braunhofer P, Covic A, Kaku Y, Ookawara S, Miyazawa H, Ito K, Ueda Y, Hirai K, Hoshino T, Mori H, Nabata A, Yoshida I, Tabei K, El-Shahawy M, Cotton J, Kaupke J, Wooldridge TD, Weiswasser M, Smith WT, Covic A, Ketteler M, Rastogi A, Spinowitz B, Sprague SM, Botha J, Braunhofer P, Floege J, Hanowski T, Jäger K, Rong S, Lesch T, Knöfel F, Kielstein H, McQuarrie EP, Mark PB, Freel EM, Taylor A, Jardine AG, Wang CL, Du Y, Nan L, Hess K, Savvaidis A, Lysaja K, Dimkovic N, Floege J, Marx N, Schlieper G, Skrunes R, Larsen KK, Svarstad E, Tøndel C, Singh B, Ash SR, Lavin PT, Yang A, Rasmussen HS, Block GA, Egbuna O, Zeig S, Pergola PE, Singh B, Braun A, Yu Y, Sohn W, Padhi D, Block G, Chertow G, Fishbane S, Rodriguez M, Chen M, Shemesh S, Sharma A, Wolf M, Delgado G, Kleber ME, Grammer TB, Kraemer BK, Maerz W, Scharnagl H, Ichii M, Ishimura E, Shima H, Ohno Y, Tsuda A, Nakatani S, Ochi A, Mori K, Inaba M, Filiopoulos V, Manolios N, Hadjiyannakos D, Arvanitis D, Karatzas I, Vlassopoulos D, Floege J, Botha J, Chong E, Sprague SM, Cosmai L, Porta C, Foramitti M, Masini C, Sabbatini R, Malberti F, Elewa U, Nastou D, Fernández B, Egido J, Ortiz A, Hara S, Tanaka K, Kushiyama A, Sakai K, Sawa N, Hoshino J, Ubara Y, Takaichi K, Bouquegneau A, Vidal-Petiot E, Vrtovsnik F, Cavalier E, Krzesinski JM, Flamant M, Delanaye P, Kilis-Pstrusinska K, Prus-Wojtowicz E, Szepietowski JC, Raj DS, Amdur R, Cric Study Investigators, Yamamoto J, Mori M, Sugiyama N, Inaguma D, Youssef DM, Alshal AA, Elbehidy RM, Bolignano D, Palmer S, Navaneethan S, Strippoli G, Kim YN, Park K, Gwoo S, Shin HS, Jung YS, Rim H, Rhew HY, Tekce H, Kin Tekce B, Aktas G, Schiepe F, Draz Y, Rakov V, Yilmaz MI, Siriopol D, Saglam M, Kurt YG, Unal H, Eyileten T, Gok M, Cetinkaya H, Oguz Y, Sari S, Vural A, Mititiuc I, Covic A, Kanbay M, Filiopoulos V, Manolios N, Hadjiyannakos D, Arvanitis D, Karatzas I, Vlassopoulos D, Okarska-Napierala M, Ziolkowska H, Pietrzak R, Skrzypczyk P, Jankowska K, Werner B, Roszkowska-Blaim M, Cernaro V, Trifirò G, Lorenzano G, Lucisano S, Buemi M, Santoro D, Krause R, Fuhrmann I, Degenhardt S, Daul AE, Sallee M, Dou L, Cerini C, Poitevin S, Gondouin B, Jourde-Chiche N, Brunet P, Dignat-George F, Burtey S, Massimetti C, Achilli P, Madonna MP, Muratore MT, Fabbri GD, Brescia F, Feriozzi S, Unal HU, Kurt YG, Gök M, Cetinkaya H, Karaman M, Eyileten T, Vural A, Oguz Y, Yılmaz MI, Sugahara M, Sugimoto I, Aoe M, Chikamori M, Honda T, Miura R, Tsuchiya A, Hamada K, Ishizawa K, Saito K, Sakurai Y, Mise N, Gama-Axelsson T, Quiroga B, Axelsson J, Lindholm B, Qureshi AR, Carrero JJ, Pechter U, Raag M, Ots-Rosenberg M, Vande Walle J, Greenbaum LA, Bedrosian CL, Ogawa M, Kincaid JF, Loirat C, Liborio A, Leite TT, Neves FM, Torres De Melo CB, Leitão Rde A, Cunha L, Filho R, Sheerin N, Loirat C, Greenbaum L, Furman R, Cohen D, Delmas Y, Bedrosian CL, Legendre C, Koibuchi K, Aoki T, Miyagi M, Sakai K, Aikawa A, PoznańSki P, Sojka M, Kusztal M, Klinger M, Fakhouri F, Bedrosian CL, Ogawa M, Kincaid JF, Loirat C, Heleniak Z, Aleksandrowicz E, SWierblewska E, Kunicka K, Bieniaszewski L, Zdrojewski Z, Rutkowski B
    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
  • Sciancalepore AG, Sallustio F, Girardo S, Passione LG, Camposeo A, Mele E, Di Lorenzo M, Costantino V, Schena FP, Pisignano D, Casino FG, Mostacci SD, Di Carlo M, Sabato A, Procida C, Créput C, Vanholder R, Stolear JC, Lefrancois G, Hanoy M, Nortier J, Potier J, Sereni L, Midemm Study Group, Ferraresi M, Pereno A, Nazha M, Barbero S, Piccoli GB, Ficheux A, Gayrard N, Duranton F, Guzman C, Szwarc I, Bismuth-Mondolfo J, Brunet P, Servel MF, Argilés A, Bernardo A, Demers J, Hutchcraft A, Marbury TC, Minkus M, Muller M, Stallard R, Culleton B, Krieter DH, Körner T, Devine E, Rüth M, Jankowski J, Wanner C, Lemke HD, Surace A, Rovatti P, Steckiph D, Mancini E, Santoro A, Leypoldt JK, Agar BU, Bernardo A, Culleton BF, Vankova S, Havlin J, Klomp DJ, Van Beijnum F, Day JP, Wieringa FP, Kooman JP, Gremmels H, Hazenbrink DH, Simonis F, Otten ML, Wester M, Boer WH, Joles JA, Gerritsen KG, Umimoto K, Shimamoto Y, Mastushima K, Miyata M, Muller M, Naik A, Pokropinski S, Bairstow S, Svatek J, Young S, Johnson R, Bernardo A, Rikker C, Juhász E, Gáspár R, Rosivall L, Rusu E, Zilisteanu D, Balanica S, Achim C, Atasie T, Carstea F, Voiculescu M, Monzon Vazquez T, Saiz Garcia S, Mathani V, Escamilla Cabrera B, Cornelis T, Van Der, Sande FM, Eloot S, Cardinaels E, Bekers O, Damoiseaux J, Leunissen KM, Kooman J, Baamonde Laborda E, Bosch Benitez-Parodi E, Perez Suarez G, Anton Perez G, Batista Garcia F, Lago Alonso M, Garcia Canton C, Hashimoto S, Seki M, Tomochika M, Yamamoto R, Okamoto N, Nishikawa A, Koike T, Ravagli E, Maldini L, Badiali F, Perazzini C, Lanciotti G, Steckiph D, Surace A, Rovatti P, Severi S, Rigotti A, McFarlane P, Marticorena R, Dacouris N, Pauly R, Nikitin S, Amdahl M, Bernardo A, Culleton B, Calabrese G, Mancuso D, Mazzotta A, Vagelli G, Balenzano C, Steckiph D, Bertucci A, Della Volpe M, Gonella M, Uchida T, Ando K, Kofuji M, Higuchi T, Momose N, Ito K, Ueda Y, Miyazawa H, Kaku Y, Nabata A, Hoshino T, Mori H, Yoshida I, Ookawara S, Tabei K, Umimoto K, Suyama M, Shimamoto Y, Miyata M, Kamada A, Sakai R, Minakawa A, Fukudome K, Hisanaga S, Ishihara T, Yamada K, Fukunaga S, Inagaki H, Tanaka C, Sato Y, Fujimoto S, Potier J, Bouet J, Queffeulou G, Bell R, Nolin L, Pichette V, Provencher H, Lamarche C, Nadeau-Fredette AC, Ouellet G, Leblanc M, Bezzaoucha S, Kouidmir Y, Kassis J, Alonso ML, Lafrance JP, Vallee M, Fils J, Mailley P, Cantaluppi V, Medica D, Quercia AD, Dellepiane S, Ferrario S, Gai M, Leonardi G, Guarena C, Caiazzo M, Biancone L, Enos M, Culleton B, Wiebenson D, Potier J, Hanoy M, Duquennoy S, Tingli W, Ling Z, Yunying S, Ping F, Dolley-Hitze T, Hamel D, Lombart ML, Leypoldt JK, Bernardo A, Hutchcraft AM, Vanholder R, Culleton BF, Movilli E, Camerini C, Gaggia P, Zubani R, Feller P, Pola A, Carli O, Salviani C, Manenti C, Cancarini G, Bozzoli L, Colombini E, Ricchiuti G, Pisanu G, Gargani L, Donadio C, Sidoti A, Lusini ML, Biagioli M, Ghezzi PM, Sereni L, Caiazzo M, Palladino G, Tomo T, Ishida K, Nakata T, Hamel D, Dolley-Hitze T
    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
  • Onuigbo M, Agbasi N, Wu MJ, Shu KH, Kugler E, Cohen E, Krause I, Goldberg E, Garty M, Krause I, Jansen J, De Napoli IE, Schophuizen CM, Wilmer MJ, Mutsaers HA, Heuvel LP, Grijpma DW, Stamatialis D, Hoenderop JG, Masereeuw R, Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Hoymans VY, Couttenye MM, Erkmen Uyar M, Tutal E, Bal Z, Guliyev O, Sezer S, Liu L, Wang C, Tanaka K, Kushiyama A, Sakai K, Hara S, Ubara Y, Ohashi Y, Kunugi Y, Kawazu S, Untersteller K, Seiler S, Rogacev KS, Emrich IE, Lennartz CS, Fliser D, Heine GH, Hoshino T, Ookawara S, Miyazawa H, Ueda Y, Ito K, Kaku Y, Hirai K, Mori H, Yoshida I, Kakuta S, Hayama N, Amemiya M, Okamoto H, Inoue S, Tabei K, Campos P, Dias C, Baptista J, Papoila AL, Ortiz A, Inchaustegui L, Soto K, Moon KH, Yang S, Lee DY, Kim HW, Kim B, Isnard Bagnis C, Guerraoui A, Zenasni F, Idier L, Chauveau P, Cerqueira A, Quelhas-Santos J, Pestana M, Choi JY, Jin DC, Choi YJ, Kim WY, Nam SA, Cha JH, Cernaro V, Loddo S, Lacquaniti A, Romeo A, Costantino G, Montalto G, Santoro D, Trimboli D, Ricciardi CA, Lacava V, Buemi M, Emrich IE, Zawada AM, Rogacev KS, Seiler S, Obeid R, Geisel J, Fliser D, Heine GH, Meneses GC, Silva Junior G, Costa MF, Gonçalves HS, Daher EF, Libório AB, Martins AM, Ekart R, Hojs N, Bevc S, Hojs R, Lim CS, Hwang JH, Chin HJ, Kim S, Kim DK, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Lemoine S, Panaye M, Juillard L, Dubourg L, Hadj-Aïssa A, Guebre-Egziabher F, Silva Junior G, Vieira AP, Couto Bem AX, Alves MP, Meneses GC, Martins AM, Libório AB, Daher EF, Ito K, Ookawara S, Miyazawa H, Ueda Y, Kaku Y, Hirai K, Hoshino T, Mori H, Yoshida I, Tabei K, Stefan G, Capusa C, Stancu S, Margarit D, Petrescu L, Nedelcu ED, Mircescu G, Szarejko-Paradowska A, Rysz J, Hung CC, Chen HC, Ristovska V, Grcevska L, Podestà MA, Reggiani F, Cucchiari D, Badalamenti S, Buemi M, Ponticelli C, Graziani G, Nouri-Majalan N, Moghadasimousavi S, Eshaghyeh Z, Greenwood S, Koufaki P, Maclaughlin H, Rush R, Hendry BM, Macdougall IC, Mercer T, Cairns H
    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
  • Susumu Ookawara, Hiroya Sato, Hisatoshi Takeda, Kaoru Tabei
    THERAPEUTIC APHERESIS AND DIALYSIS 18(2) 202-207 2014年4月  査読有り
    Colloid osmotic pressure (COP) is important in calculating vascular permeability during hemodialysis (HD). However, few reports have directly measured COP in HD patients. Therefore, the currently published formulas may not be clinically optimal for predicting COP for HD patients. Here, the study aims were (i) to directly measure COP in HD patients and compare the measured and predicted COP values using four previously reported formulas, and (ii) to develop a formula for approximating COP using clinical parameters. We obtained 212 measured COP values using an osmometer; the average value was 22.0 +/- 0.2mm Hg. The predicted COP based on the four different formulas was positively correlated with the measured COP (0.87<r<0.89), but was significantly overestimated compared to it (P<0.001). We also performed a stepwise analysis using serum albumin and non-albumin protein concentrations and obtained the following simple formula for COP approximation: COP (mmHg)=-7.91+5.64xalbumin (g/dL)+3.00xnon-albumin proteins (g/dL). A positive linear correlation was observed between the measured COP and approximated COP using this formula (r=0.90, P<0.001). We calculated the mean Kr (plasma-refilling coefficient) as a marker for determining dry weight in HD patients using the measured COP and approximated COP. No differences were observed between the mean Kr derived from the measured and approximated COP. We report here significant differences between measured and predicted COP values, and have devised a simple formula for COP approximation in HD patients.
  • Hoshino T, Ookawara S, Goto S, Miyazawa H, Ito K, Ueda Y, Kaku Y, Hirai K, Nabata A, Mori H, Yoshida I, Tabei K
    Nephron. Clinical practice 126(1) 57-61 2014年  査読有り
  • Goto S, Ookawara S, Sugai M
    CEN Case Reports 3(1) 14-16 2014年  
    A 74-year-old woman had been treated conservatively for type 2 diabetes mellitus (DM) and DM nephropathy since 2004. Her renal function gradually deteriorated, and she developed chronic renal failure (CRF) with a serum creatinine level between 2.5 and 3.0 mg/dl in 2010. She presented to our hospital with nausea and vomiting related to the progression of CRF in May 2011. An abdominal computed tomography (CT) scan showed distention of the upper digestive tract from the stomach to the third portion of the duodenum, ascites, and compression of the duodenum by the abdominal aortic artery and the overlying superior mesenteric artery (SMA), which was caused by edema along the gastrointestinal tract, in particular, at the duodenum. Therefore, she was diagnosed with SMA syndrome. Decompression of the distended upper digestive tract was achieved using a nasogastric tube, and hemodialysis was also initiated in order to adequately control her fluid balance disorder, which was thought to have induced the duodenal edema and ascites. After initiating these treatments, her condition gradually improved, and she fully recovered after approximately 2 months of treatment. Thus far, there has been no report of SMA syndrome caused by duodenal edema associated with the progression of CRF that was successfully treated by conservative treatment and the initiation of blood purification.
  • Izumi Yoshida, Susumu Ookawara, Katsunobu Ando, Takayuki Uchida, Atsushi Horiguchi, Itsuro Nakajima, Takanori Komada, Honami Mori, Kaoru Tabei
    THERAPEUTIC APHERESIS AND DIALYSIS 15(3) 319-326 2011年6月  査読有り
    Together with Nikkiso in Shizuoka, Japan, we developed a new method for measuring the rate of vascular access recirculation by the blood volume monitor. This measurement is performed via a method of dilution that employs a marker produced by rapid ultrafiltration using a dialysis machine. In this paper, we evaluate the reliability and safety of this machine, in vitro and in vivo. The safety of this method was evaluated by investigating hemolysis after rapid ultrafiltration. The measurement of free hemoglobin, potassium and haptoglobin in the circulating blood were performed before and after rapid ultrafiltration. No data was found to indicate hemolysis in vivo, detected by an increase in potassium or a decrease in haptoglobin. Evaluation of reliability in an experimental system was also performed on an in vitro recirculation system at a rate of 0, 10, 25, 50, and 70%. Almost all of the measured rates were within +/- 10% of the theoretical rate. We performed 20 hemodialysis experiments with vascular access recirculation applying this monitor and simultaneous urea and creatinine dilution methods, which were the recommended standard measurements for vascular recirculation. In 53 measurements of standard vascular shunts with no postural change, differences of the results between the monitor and both dilution methods were only 4.0% and 3.2%, respectively. Regression analysis showed a significant and positive correlation between them (P < 0.0001). We conclude that this new method for measuring vascular access recirculation is applicable in terms of both accuracy and ease of operation.
  • Izumi Yoshida, Katsunobu Ando, Yasuhiro Ando, Susumu Ookawara, Masayuki Suzuki, Hiroaki Furuya, Osamu Iimura, Daisuke Takada, Masaharu Kajiya, Takanori Komada, Honami Mori, Kaoru Tabei
    THERAPEUTIC APHERESIS AND DIALYSIS 14(6) 560-565 2010年12月  査読有り
    We developed a new optical device (Nikkiso) to assess changes through blood volume monitoring (BVM) during hemodialysis and were able to determine the ideal levels in which changes in blood volume percentage (BV%) occur among hemodialysis patients in one hemodialysis center. We evaluated both the reliability of BVM and these ideal levels in a multicenter group. The purpose of this manuscript is to develop a navigating system to set dry weight in a variety of situations as the final goal. First, based on the obtained BVM (BV%(BVM)) measurements, the relationships between BV% and hematocrit (BV%(HT)) and between BV% and CRIT-LINE (BV%(CLM); Hema Metrics, Kaysville, UT, USA) were then evaluated. In 30 hemodialysis patients, there was a close correlation between both BV%(BVM) vs. BV%(HT) and BV%(BVM) vs. BV%(CLM) (n = 30, r = 0.967, P < 0.001, and n = 36, r = 0.7867, P < 0.001, respectively). Second, BV% data were obtained from 464 treatment cases performed on 26 subjects in one satellite hemodialysis center on patients whose body weight was deemed clinically suitable. The formulas for the levels of BV% (standardized by the percent change in body weight at the end of hemodialysis treatment: BW%end) were determined. Finally, we revalidated the reliability of the above levels. A total of 1126 measurements were performed on 201 patients whose body weights were deemed suitable in seven hemodialysis centers. New ideal levels were then recalculated. We therefore conclude that BVM is a sufficiently accurate method of monitoring BV% in hemodialysis treatment. Most well-controlled hemodialysis patients display the same pattern of BV%/BW%end. Monitoring BV% during hemodialysis is beneficial for determining dry weight (DW).
  • S Sanada, S Ookawara, H Karube, T Shindo, T Goto, T Nakamichi, M Saito, M Matsubara, M Suzuki
    AMERICAN JOURNAL OF KIDNEY DISEASES 47(4) 672-679 2006年4月  査読有り
    POEMS syndrome Is a rare plasma cell disorder, characterized by polyneuropathy, organomegaly, endocrinopathy, serum monoclonal protein, and skin lesions. Although not included in the acronym, renal lesions also are characteristic of this disease and sometimes require dialysis therapy. We treated a 61-year-old woman with POEMS syndrome with high-dose melphalan therapy (HDT) supported by autologous blood stem cell transplantation (SCT), and clinical remission was achieved. A repeated renal biopsy showed the striking effectiveness of this therapy on renal lesions. Pathological features of the renal lesions, such as membranoproliferative glomerulonephritis-like lesions, microangiopathic glomerulopathy, and mesangiolytic lesions with microcapillaries, almost completely disappeared. This treatment also markedly decreased serum levels of vascular endothelial growth factor (VEGF). These findings Indicate that HDT with SCT is effective, even on renal lesions In patients with POEMS syndrome, and suggest that high serum VEGF concentrations are associated closely with the development of renal lesions in patients with this type of plasma cell disorder.
  • Ookawara S, Suzuki M, Saitou M, Tabei K
    Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 9 167-172 2005年4月  査読有り
  • Sanada S, Ookawara S, Shindo T, Morino K, Ishikawa H, Suzuki M
    Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 8 503-506 2004年12月  査読有り
  • S Sanada, S Ookawara, T Shindo, K Morino, H Ishikawa, M Suzuki
    THERAPEUTIC APHERESIS AND DIALYSIS 8(6) 503-506 2004年12月  
    We report here the case of a patient suffering from hemophagocytic syndrome (HPS) associated with toxic shock syndrome (TSS). A 50-year-old man was admitted because of fever, watery diarrhea and shortness of breath. Clinical analysis revealed systemic cyanosis, sunburn-like erythema and septic shock. Staphylococcus aureus was identified from both blood and sputum culture and the serum enterotoxin A antibody test was positive, suggesting that this was a case of TSS. Though the respiratory and hemodynamic status improved by the mechanical ventilation, fluid resuscitation with catecholamine and antibiotic therapy, the platelet count decreased rapidly. Bone marrow aspiration revealed a large quantity of hemophagocytosis by macrophages. This reactive HPS was treated not with immunosuppressive drugs but with therapeutic plasma exchange in order to prevent worsening of S. aureus infection. After plasma exchange, the circulating macrophage colony-stimulating factor (M-CSF) level was reduced and the platelet count increased rapidly. Bacteria associated HPS remains a difficult diagnosis with high mortality and there is a crucial question of whether this should be treated with immunosuppressive drugs. The patient's clinical course would suggest that the therapeutic plasma exchange should be considered as a therapeutic tool for the bacteria associated HPS instead of immunosuppressive drugs.
  • S Ookawara, M Suzuki, T Yahagi, M Saitou, K Tabei
    NEPHRON 87(1) 27-34 2001年1月  
    In healthy subjects, the blood volume (BV) increases rapidly after postural change from standing to the supine position. However, little is known about the effect of postural change on BV in long-term hemodialysis (HD) patients. Therefore, we have examined the BV change caused by adopting the supine position from standing by continuous hematocrit monitoring, using the CRIT-LINE instrument, in 8 anuric HD patients. The hematocrit was monitored for 25 min with the patient in the supine position just before HD. The percentage change in the BV (% Delta BV) was calculated from the hematocrit and approximated using the equation: % Delta BV = b - [1 - exp(-c x time (min)] -a x time (min). Coefficient a was the slope of the linear part in the % Delta BV, b was the magnitude of BV increase and c was the rate of BV increase. Then we examined the relationship between the coefficients (a, b and c) and clinical parameters. In all patients, % Delta BV increased quickly after adopting the supine position. The mean increases were 2.8 +/- 0.6% after 5 min and 4.8 +/- 0.5% after 25 min. There was a significant correlation between the value of % Delta BV calculated from the hematocrit and the value calculated using above equation (0.92 < r < 0.99, p < 0.001). Although coefficient a did not correlate with a clinical parameter, coefficient b showed a significant positive linear correlation with the serum albumin level (r = 0.816, p < 0.05) and coefficient c showed a significant positive linear correlation with the percentage change in interdialytic weight gain (r = 0.736, p < 0.05). Furthermore, based on the % <Delta> BV, we calculated the change in total BV, which had increased by 181.5 +/- 21.9 ml after 25 min in the supine position. In conclusion, the change in the BV with time by continuous hematocrit monitoring using the CRIT-LINE instrument can be approximated by a modified monoexponential equation. BV increased quickly in HD patients after postural change from standing to the supine position. Copyright (C) 2001 S. Karger AG, Basel.
  • O Susumu, T Kaoru, F Hiroaki, A Yasushi
    EUROPEAN JOURNAL OF PHARMACOLOGY 378(1) 63-68 1999年7月  
    cis-Diamminedichloroplatinum II (CDDP) is an antineoplastic drug against solid malignant tumors. However, its clinical use is limited by nephrotoxicity. CDDP also causes hypokalemia and in vivo microperfusion method have demonstrated that luminal CDDP increases K+ secretion by hyperpolarization of the transepithelial voltage difference through stimulating Na+ transport in the distal segments. However, there is no direct evidence for this mechanism. We therefore examined the effect of luminal CDDP on Na+ and K+ transport in the rabbit cortical collecting duct (CCD) using in vitro isolated tubular microperfusion. Luminal CDDP hyperpolarized the transepithelial voltage difference (V-T) in a dose-dependent manner at concentrations from 10(-5) M to 10(-3) M and at 10(-3) M CDDP, V-T was hyperpolarized from -11.6 +/- 2.3 mV to - 16.6 +/- 3.3 mV(P < 0.001). A concentration of 10(-5) M ouabain, 10(-4) M amiloride and 2 mM BaCl2 all completely abolished CDDP-induced hyperpolarization. To confirm the mechanism, Na+ and K+ flux were measured in the presence of 10(-3) M CDDP. CDDP decreased net K+ secretion from - 22.2 +/- 5.7 to - 15.2 +/- 2.9 pmol mm(-1) min(-1) (P < 0.01) without any effect on the lumen-to-bath isotope flux of Na+ (52.6 +/- 10.6 to 52.1 +/- 10.7 pmol mm(-1) min(-1)). These data suggest that luminal CDDP hyperpolarizes V-T primarily by inhibiting K+ conductance but did not influence Na+ transport of the luminal membrane. We conclude that the CCD does not play a role in CDDP-induced hypokalemia when CDDP is applied from the luminal side. (C) 1999 Elsevier Science B.V. All rights reserved.
  • S Ookawara, K Tabei, H Furuya, Y Asano
    MINERAL AND ELECTROLYTE METABOLISM 25(3) 191-198 1999年5月  
    Epidermal growth factor (EGF) inhibits amiloride-sensitive Na+ conductance in the apical membrane of the isolated rabbit cortical collecting duct. However, there is no information on the relationship between electrolyte transport and tyrosine kinase. We examined the effect of EGF on transport of potassium and chloride as well as sodium a nd the roles of tyrosine kinases in the rabbit cortical collecting duct using in vitro isolated tubular microperfusion. Basolateral EGF depolarized the transepithelial voltage in a dose-dependent manner within a concentration range of 10(-10) in 10(-8) M. Basolateral ouabain and luminal amiloride completely abolished EGF-induced depolarization. However, luminal BaCl2 did not abolish its depolarization. To confirm the mechanism, sodium, potassium, and chloride fluxes were measured in the presence of 10(-10) M EGF. EGF significantly decreased the lumen-to-bath isotope flux of sodium and chloride from 93.6+/-12.5 to 61.1+/-9.6 pmol/mm/min (n=5, p < 0.05) and from 86.6 +/- 10.0 to 54.8 +/-9.7 pmol/mm/min (n=10, p<0.01), respectively. EGF also decreased net potassium secretion from -27.7+/-5.9 to -7.8+/-1.5 pmol/mm/min (n=6, p<0.01). To era mine whether EGF-induced depolarization is mediated by tyrosine kinase, tyrosine kinase inhibitors were applied from the basolateral side. Pretreatment with 1 mu g/ml herbimycin A for 120 min completely abolished EGF-induced depolarization (90.9+/-5.4%, n=4; NS). Herbimycin A itself also did not change the lumen-to-bath isotope flux of sodium and completely abolished the inhibition of Na+ absorption on EGF action (control 65.4+/-6.8, herbimycin A 61.8+/-6.3, EGF with herbimycin A 60.0+/-4.4 pmol/min/min, n=5; NS). In conclusion, EGF depolarizes transepithelial voltage by inhibiting sodium transport primarily and potassium and chloride transport secondarily. These effects were blocked by nonspecific tyrosine kinase inhibitors.
  • S Ookawara, K Tabei, T Sakurai, Y Sakairi, H Furuya, Y Asano
    EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 51(2) 149-151 1996年10月  
    Objective: Nafamostat mesilate, a potent protease inhibitor, is widely used for the treatment of pancreatitis, disseminated intravascular coagulation and as an anticoagulant in haemodialysis. However, hyperkalaemia associated with nafamostat mesilate has been reported. It is thought to be due to decreased urinary potassium excretion, of the drug suppression of aldosterone secretion, and a direct inhibitory action on the apical Na+ conductance in collecting ducts. We have seen two cases of nafamostat mesilate associated-hyperkalaemia, which indicated that extrarenal potassium imbalance might play a role in inducing hyperkalaemia. Methods: To examine the effect of nafamostat mesilate on potassium transport in erythrocytes in vitro, (RbCl)-Rb-86 uptake was measured in red blood cells from eight healthy volunteers. Results: Nafamostat mesilate and a metabolite, 6-amidino-2-naphthol, at concentrations of 10(-4) and 10(-3) M, respectively, significantly, suppressed potassium influx whilst another metabolite, p-guanidinobenzoic acid, had no effect. The inhibitory action of nafamostat mesilate was not affected by various inhibitors. Conclusion: Nafamostat mesilate and its metabolite, 6-amidino-2-naphthol, suppressed potassium influx in erythrocytes by inhibition of a Na-K ATPase dependent pathway, which was not inhibited by amiloride, barium, nor by frusemide (furosemide).

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  • 腎臓科  (自治医科大学附属さいたま医療センター)

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