腎臓学と治療学ジャーナル

It is our immense pleasure to publish Volume 4 Issue 1 of the Journal of Nephrology and Therapeutics. In our previous issue, wide spectrums of topics were covered in the form of original research articles, case reports and review articles. In our Volume 3 Issue 3, Ranganathan et al. published an original research article that focused on the safety and impact of probiotics in stage III and IV Chronic kidney disease patients. Probiotics are now present in increasing frequency in various foods in our daily lives and with the current consumer advertising, it seems that the general population is likely convinced of the positive role of probiotics in various health issues.

Phenyramidol is a moderately effective, non-narcotic analgesic and muscle relaxant. It acts by interneuronal block in the spinal cord and brain stem. The clearance of the drug becomes in the liver via glucuronidation. Conjugated form of the drug is excreted through the kidneys [1]. It is not available in the US or, with the exception of Turkey, in Europe. It is widely used for musculo-skeletal pain such as acute lumbago and chronic back pain in the Asia and Turkey, with or without NSAÄ°Ds. It rarely causes gastrointestinal discomfort and there are some reported cases of hepatotoxicity [2]. To the best of our knowledge, nephrotoxicity has not been reported yet. Herein, we reported a case of Acute Tubular Necrosis (ATN) possibly due to the use of phenyramidol for backache.

The most common insult to donor kidneys destined for transplantation is Acute Tubular Necrosis (ATN). The extent of ATN will affect post-transplant function and is a significant risk factor for long-term graft function and survival. Optical Coherence Tomography (OCT) is a rapidly emerging imaging modality that can function as a type of “optical biopsy”, providing non-invasive images of tissue morphology in situ and in real-time. In this paper, we review studies that support the use of OCT and Doppler based OCT (i.e., DOCT) to image the renal microstructure and blood flow of human donor kidneys. We conclude that OCT/DOCT imaging of donor kidneys prior to and following transplantation can provide transplant surgeons with a means for predicting ATN and post-transplant renal function.

Background: Simultaneous pancreas/kidney transplants require a long graft survival and recipient with to achieve more benefits than risks. In order to access the risk for this procedure, we evaluate the risk factors of death receptor with one year postoperatively in 292 simultaneous pancreas/kidney transplants evaluated 22 variables.
Materials and Methods: Twenty-two variables were selected for the study, nine from receivers, eight from donors and five variables related to the surgical procedure. To determine the survival of patients, we evaluated dates of transplants, the latest consultation and dates of deaths. All independent variables were compared with the dependent variable: patient lost in a year. Those with statistical significance through univariate analyzes, were also analyzed by multiple logistic regression technique in an attempt to develop a mathematical model capable of predicting 1-year patient loss.
Results: Relatively to the loss of patient in one year, the multivariate analysis identified body mass index receptor (p ≤ 0.008) and induction therapy (negative factor p ≤ 0.008) as independent risk factors.
Conclusion: Based on the results of this research can be concluded that the independent variables related to one year loss of receptor are: body mass index of the donor and induction therapy.

Despite major advances in the understanding of the molecular mechanisms of thrombosis and the development of effective thrombolytic agents, arterial thrombosis remains a formidable clinical problem. A new class of direct thrombin inhibitors (aptamers), has been described recently. Aptamers, single-stranded oligonucleotides with a length of 30-60 nucleotides, exhibit high affinity and specificity towards any defined recognition target (protein). Aptamers are antibody analogs in terms of both specificity and affinity, with an apparent advantage of the former to being reproduced by anautomated chemical synthesis. Aptamers are routinely selected by SELEX technology (Systematic Evolution of Ligands by Exponential enrichment), which is thoroughly discussed elsewhere. The DNA aptamers to thrombin have a very highly ordered tertiary structure (G-quadruplex). A great number of the DNA aptamers to thrombin with sophisticated structure have been designed and widely investigated as potential thrombin inhibitors using traditionalmedicine tests (TT, PT, APPT). In this manuscript we suggest the different structures of aptamers, based on RE31 structure, so-called G-quadruplex, which are bound to short and long duplex. The RE31 aptamer had being previously shown to have an order of magnitude prolonged thrombintime in comparison to 15TBA aptamer. The purpose of the present study was to investigate the trunked aptamers to thrombin structures by CD spectroscopy and estimate the stability of the thrombin complexes with aptamers using electrophoresis in polyacrilamide gels. Our findings clearly show that both G-quadruplex and duplex domains of RE31 as well as trunked aptamers are strong effectors of aptamer complex stability. Using a set of oligonucleotide models derived from RE31 sequence, we have shown that the attached duplex domain of trunked aptamers retains the antiparallel unimolecular G-quadruplex topology seen for 15TBA.

Epidemiologic studies show a worldwide diabetic epidemic. Diabetes mellitus is associated with a reduced life
span due to macro vascular and micro vascular complications. Thus, diabetic nephropathy, which is the major cause of morbidity and mortality for patients with either type 1 diabetes mellitus or type 2 diabetes mellitus, is a public health care problem. Blood pressure control is a proven intervention to prevent progression of diabetic nephropathy and to reduce cardiovascular events in patients with diabetes mellitus. Establishment of optimal blood pressure targets, advantages of one class of drugs over another as well as time of initiation of  antihypertensive therapy are those important questions that appear before every doctor. This review addresses these issues.

Acute Antibody Mediated Rejection (ABMR) in kidney transplantation is a severe complication that frequently occurs after transplantation and is due either to pre-transplant Donor-Specific Antibodies (DSAs) or to de novo DSAs. New techniques to detect DSAs in the recipient serum and advances in the assessment of graft pathology have allowed us to recognize this entity in recent years.

The treatment of ABMR is a multistep process consisting of the desensitization of the patients with preformed
antibodies to prevent acute ABMR: in cases of acute ABMR, the antibodies are removed from the serum and anti-B cells immunosuppressants are used.

Proteinuria is a significant complication affecting renal transplant recipients. It is linked to cardiovascular events,
a premature death and graft loss. The prevalence of proteinuria is close to 40% of renal transplant recipients per year. The causes of proteinuria are multiple: glomerular disease, anti-HLA class II antibodies, various medications and tubulointerstitial disease of the graft. It is very important to evaluate the cause of proteinuria, to reduce proteinuria and cardiovascular risk.

Inflammation of vasculature involving small to medium vessels associated with antineutrophil cytoplasmic antibodies or ANCA are collectively referred to as ANCA vasculitidis. In majority of such disorders there are few or no immune deposits and hence the term- “pauci immune vasculitis”. The three main conditions included in this group include microscopic polyangiitis, Granulomatosis with polyangiitis (GPA) - formerly known as Wegener’s granulomatosis, and Eosinophilic Granulomatosis with Polyangiitis (EGPA)-formerly known as Churg-Strauss Syndrome. There have been several advances in the last two decades in the classification, understanding of the pathogenesis and management of these conditions. To provide an update on the classification, pathology and pathogenesis and therapeutic advances for management of ANCA vasculitis is the focus of this in depth review.

IgA Nephropathy (IgAN) is a very common glomerulonephritis worldwide, especially in Asia, which is an important cause of progressive kidney disease with 25–30% of patients developing end-stage renal disease within 20 years of diagnosis. IgA nephropathy can be in different age bracket onset, but mainly in adults. The treatment of primary IgA nephropathy we mentioned in this article is only for adults. The optimal treatment for IgAN remains poorly defined. The current treatment depends on the assessment of proteinuria, blood pressure, estimated Glomerular Filtration Rate (eGFR) and pathological features, including antiproteinuric and antihypertensive therapy, corticosteroids, immunosuppressive agents, fish oil and tonsillectomy. Compounded by the relative lack in IgAN of Randomized Controlled Trials (RCTs),
there is no consensus on the use of corticosteroids, immunosuppressive agents, fish oil and tonsillectomy for treatment. The treatment of primary IgA Nephrology was reviewed from these aspects in this article.