腎臓学と治療学ジャーナル

Background: Success rates after in-hospital cardiopulmonary resuscitation have been reported to be worse in patients with renal failure. However, renal failure was not well characterized in these reports, and rarely incorporated estimates of glomerular filtration rates.

Objective: We reviewed all on-site adult cardiac arrests at our institution during an 8-year period. Cardiopulmonary resuscitation success was defined as survival to discharge. Renal function was considered impaired if a pre-arrest estimate of glomerular filtration rate was less than 60 ml per min per 1.73 m2.

Results: Cardiopulmonary resuscitation was successful in 31 (7.7%) of 402 patients. Renal impairment predated cardiac arrest in 73.6% patients, was the most common of the examined pre-arrest morbidities, but did not associate with cardiopulmonary resuscitation success rates (OR=0.92, 95%CI 0.40-2.12).

Conclusions: Pre-cardiac arrest renal impairment, defined using estimates of glomerular filtration rate of less than 60 ml per min per 1.73 m2, was surprisingly common but did not significantly influence cardiopulmonary resuscitation success rates.

Background: This study evaluates the effects of the selective estrogen receptor modulators (SERMs), raloxifen, on renal function in post- menopausal women with type 2 diabetes mellitus.

Methods: Thirty-seven post-menopausal women with Type 2 diabetes and diabetic nephropathy included in a 4-month, double-blind, placebo-controlled trial. 18 patients received 60 mg raloxifene per day and 19 patients received placebo. Baseline and end-study body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), HbA1C, lipid profiles and serum creatinine (Cr) were measured. Albumin/creatinin ratio (ACR) and GFR were calculated for all the participants.

Results: Mean ACR log was decreased significantly in the raloxifene group (2.4 ± 0.63 μg/mg vs. 1.89 ± 0.8 μg/ mg; P=0.009), but slight-non-significant changes in the placebo group were seen (2.16 ± 0.53 vs. 2.12 ± 0.83; P=0.8). In addition, compared with placebo, raloxifene resulted in no significant changes in GFR, HbA1C, lipid profiles and BMI. After considering variables like age, sex, duration of diabetes, duration of menopause, BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP) as confounding factors the improving effect of raloxifene on ACR remained significant.

Conclusion: These results suggest that raloxifene may limit the progression of albuminuria in post-menopausal women with diabetes; further studies in a larger population may be warranted.

Sympathetic activation, hypertension, hyperlipidemia, and immunosuppressive treatment are risk factors for vascular damage in children with glomerulopathies.

Aim: To perform pulse wave analysis in children with glomerulopathies.

Material and Methods: We studied 33 children (22♂, 11♀) aged 13.3 ± 3.9 years with glomerulopathies: Henoch-Schonlein nephropathy 9 patients, IgA nephropathy 7 patients, membranoproliferative glomerulonephritis 4 patients, mesangioproliferative glomerulonephritis 3 patients, minimal change disease 3 patients, focal segmental glomerulosclerosis (FSGS) 3 patients, and other nephropathies 4 patients. We evaluated age at the disease onset, development of hypertension, body mass index (BMI) Z-score, selected biochemical variables, glomerular filtration rate (ac. to Schwartz formula), and pulse wave parameters determined using a SphygmoCor device (AtCor Medical, Australia): aortic systolic pressure (AoSP), diastolic pressure (AoDP) and pulse pressure (AoPP), augmentation pressure (AP), augmentation index (AIx), augmentation index corrected for heart rate of 75 beats per minute (AIx-75HR) [%], and an index of myocardial oxygen supply and demand, subendocardial viability ratio (SEVR) [%]. The control group included 20 healthy children matched for age and gender.

Results: Children with glomerulopathies showed trends for higher mean AP (P=0.08) and AIx (P=0.07), and a significantly higher mean AIx-75HR (P<0.05). Patients with hypertension (n=13) showed higher mean AoDP (P<0.05) and AIx-75HR (P<0.05) compared to normotensives (n=20). Six (18.2%) overhydrated patients had significantly (P<0.05) higher diastolic peripheral and aoritc diastolic blood pressure, as well as aortic systolic blood pressure than 27 (81.8%) normovolemic children. In 33 children, AoSP and AoDP correlated positively with proteinuria (r=0.44, P<0.05; and r=0.57, P<0.05, respectively); AoDP showed negative correlations with albumin (r=-0.42, P<0.05), total protein (r=- 0.36, P<0.05), calcium level (r=-0.47, P<0.05). AoPP correlated positively with BMI Z-score (r=0.43, P<0.05), and SEVR negatively with total cholesterol level (r=-0.43, P<0.05).

Conclusions: i. Patients with glomerulopathies show increased arterial stiffness compared to their healthy peers. ii. In children with glomerulonephritis, hypertension is a risk factor for increased aortic stiffness, and hypercholesterolemia may be a risk factor for future myocardial ischemia. iii. Overhydration in children with glomerulonephritis can increase peripheral and central blood pressure without influencing arterial stiffness.

Objective: To describe a possible association between Graves’ disease and nephrotic syndrome secondary to membranous nephropathy and to review the literature related to renal diseases in patients with Graves’ disease.

Methods: The clinical, laboratory, and renal biopsy findings in a patient with Graves’ disease and membranous nephropathy are discussed.

Results: 50 Y, Male, non diabetic, non hypertensive, diagnosed to have Grave’s disease treated with antithyroid drugs, radioactive Iodine in recent past presented to us with edema since 2months, fever on/off since 2 months, and diarrhoea 20 days back. Investigations revealed nephrotic proteinuria, microscopic hematuria, normal serum creatinine, viral serology (HIV, HCV, HBsAg) were negative, ultrasound abdomen-showed normal sized kidneys, serum TSH was low (<0.05miu/ml), T3 was normal (1.74ng/ml), T4 was high (12.62mcg/dl), anti-microsomal (anti-thyroid-peroxidase) antibody was high (55 IU/ml), C3 was 74mg/dl, ANA, ANCA were negative, serum protein electrophoresis was normal. A renal biopsy showed membranous nephropathy (secondary). He was treated with steroids, diuretics, angiotensin converting enzyme inhibitors (ACEI), statins, and later, found to be in process of remission. But subsequently he lost for follow-up.

Conclusions: To the best of our knowledge, this is one of few reports of the occurrence of membranous nephropathy in a patient with Graves’ disease in the absence of any other immunologic disorder known to be associated.