Fibrillary glomerulonephritis with hypocomplementemia

A 59-year-old man was referred for evaluation of nephrotic syndrome. The patient was diagnosed to have rheumatoid arthritis and had been treated for 10 years. Renal biopsy showed mesangial proliferation with small nodular formations, which were determined as fibrillary deposits (average diameter: 20 nm) by electromicroscopy. Congo-red stain was negative. The laboratory findings revealed hypocomplementemia and lambda type of Bence-Jones protein in urine without other systemic diseases including multiple myeloma. Immunosuppressive therapy did not attenuate the nephrotic-range proteinuria. Such a case of fibrillary glomerulonephritis with hypocomplementemia is rare.     

Previous injuries or scars as risk factors for the development of basal cell carcinoma

Basal cell carcinoma (BCC) is the most common malignant tumour in humans and most occur in elderly people. The pathogenesis of BCC is directly related to exposure to ultraviolet radiation in sunlight, but trauma is also mentioned occasionally. As well as one published series, several single cases have been reported. Our aim in the present study was to assess any possible relation between the development of BCC and trauma in a series of 92 patients, 12 of whom (13%) gave a history of previous injury. These lesions either developed directly after a sharp or blunt injury or in the scar tissue that had resulted from previous surgical incisions, burns, or dog bites. The male:female ratio was higher in the injured group (10:2) than in the uninjured group (44:36), but not significantly so (p?=?0.11). Morphoea‐like basal cell carcinomas were more common in the injured group (n?=?91) (p?=?0.06). We conclude that trauma might be considered as another aetiological agent for BCC.     

Retrospective Analysis of the Relationship between Decline in FEV1 and Abdominal Circumference in Male Smokers: the Takahata Study

Background:Metabolic syndrome (Mets) is reportedly associated with chronic obstructive pulmonary disease (COPD). However, the relationship between abdominal circumference (AC) and decline in FEV₁ has not been elucidated. We aimed to investigate this relationship among male current smokers.Methods:Spirometry was performed on subjects (n = 3,257) ≥ 40 years of age, who participated in a community-based annual health check in Takahata, Japan, from 2004 through 2006 (visit 1). Spirometry was re-evaluated, and AC was assessed in 147 of the male current smokers in 2009 (visit 2). The diagnosis of Mets was based on the criteria used in the Hisayama Study.Results:No significant relationships were observed between AC and spirometric parameters such as % predicted forced vital capacity (FVC), % predicted forced expiratory volume in 1 s (FEV₁) and FEV₁/FVC. However, decline in FEV₁ was significantly correlated with AC. Multivariate logistic regression analysis showed that AC was a significant discriminating factor for decline in FEV₁, independently of age, Brinkman index and change in body mass index from visit 1 to visit 2. At visit 2, there was a greater prevalence of decline in FEV₁ among subjects with Mets (n=17) than among those without Mets. Although there were no differences in % predicted FVC, % predicted FEV₁ or FEV₁/FVC between subjects with or without Mets, the rate of decline in FEV₁ was significantly greater in subjects with Mets than in those without.Conclusions:This retrospective analysis suggested that measuring AC may be useful for discriminating male smokers who show a decline in FEV₁.     

Previous injuries or scars as risk factors for the development of basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common malignant tumour in humans and most occur in elderly people. The pathogenesis of BCC is directly related to exposure to ultraviolet radiation in sunlight, but trauma is also mentioned occasionally. As well as one published series, several single cases have been reported. Our aim in the present study was to assess any possible relation between the development of BCC and trauma in a series of 92 patients, 12 of whom (13%) gave a history of previous injury. These lesions either developed directly after a sharp or blunt injury or in the scar tissue that had resulted from previous surgical incisions, burns, or dog bites. The male:female ratio was higher in the injured group (10:2) than in the uninjured group (44:36), but not significantly so (p = 0.11). Morphoea-like basal cell carcinomas were more common in the injured group (n = 91) (p = 0.06). We conclude that trauma might be considered as another aetiological agent for BCC.     

The association between serum uric acid and renal damage in a community-based population: the Takahata study

Background

Hyperuricemia is a risk factor for end-stage renal disease. This study examined the association between serum uric acid and renal damage in a community-based population.

Methods

In this study 3126 subjects without renal insufficiency were recruited at baseline and were followed for one year. The urinary albumin–creatinine ratio (UACR) and β₂-microglobulin–creatinine ratio (UBCR) in morning spot urine samples were used as indices of either glomerular (UACR) or tubular (UBCR) damage.

Results

The mean value of serum uric acid (mg/dL) was 5.8 ± 1.3 (SD) in men and 4.5 ± 1.1 in women. In cross-sectional analysis the increased serum uric acid levels were accompanied by higher UACR values in both men and women (P < 0.01). In contrast, UBCR values were reduced when uric acid levels increased in both men and women (P < 0.01). Multivariate analysis revealed that albuminuria (UACR ≥ 30 mg/g) was significantly associated with increased uric acid (≥7 mg/dL for men, ≥6 mg/dL for women). High UBCR (≥300 μg/g) was negatively associated with uric acid in men, but not in women, after adjustment for possible confounders. In longitudinal analysis in 1388 subjects multiple linear regression analysis showed that uric acid at baseline was an independent factor for one-year increase of UACR [coefficient 4.80 (95 % confidence interval 0.40–9.33) (mg/g) per 1 mg/dL increase in uric acid, P = 0.033].

Conclusion

This study showed that serum uric acid concentration was positively associated with UACR, suggesting that uric acid may be related to glomerular damage in a community-based population.     

Deoxyspergualin, an immunosuppressant, in patients suffering from nephropathies with crescent formation: an open-label trial to evaluate safety and efficacy

Background Crescent formation in glomeruli means an acute active lesion that develops a rapidly progressive course. Therapies using pulse methylprednisolone, oral corticosteroids, and cyclophosphamide are recommended, but no agreement has been reached on the optimal therapy. There have been no controlled trials, because of the severity of this condition and because withholding treatment would become an ethical issue. Methods We evaluated the safety and efficacy of deoxyspergualin (DSG), an immunosuppressant, in a multicenter, prospective trial of 44 patients with crescent formation in over 10% of glomeruli, who were randomly placed into groups that received daily doses of 0.1 mg/kg (n = 21) and 0.2 mg/kg (n = 23) of DSG, given by a 1-h infusion for 4 weeks, and who were then monitored for 3 months. All patients received DSG in this open-label prospective study. We evaluated the levels of urinary protein and hematuria, and examined renal function after the DSG treatment. Results Urinary protein significantly decreased with each dose after starting the DSG administration and this efficacy was sustained for 2 months after the discontinuation of DSG. In the groups receiving 0.1 mg/kg and 0.2 mg/kg, mean urinary protein levels were 2.1 g/day and 2.3 g/day at the initiation of the DSG administration, 1.4 g/day and 1.6 g/day at week 4, and 1.5 g/day and 1.3 g/day at week 12, respectively. Hematuria was markedly improved by a dose of 0.2 mg/kg and was not exacerbated following the termination of DSG. Exacerbation of renal dysfunction, as measured by creatinine clearance, serum creatinine, and blood urea nitrogen was prevented by both doses of DSG. The most common adverse reaction was reversible neutropenia. Conclusions Short-term treatment with DSG may be effective and tolerated in patients suffering from nephropathies with crescent formation. Participating investigators and study centers in the present trial of deoxyspergualin are listed in the Appendix.     

U-shaped association between body mass index and proteinuria in a large Japanese general population sample

Background

There is little data on the association between body mass index (BMI) and proteinuria.

Methods

This was a cross-sectional cohort study assessing the association between BMI and proteinuria in a large Japanese population. Using a nationwide health check-up database of 212,251 Japanese aged >20 years with no pre-existing cardiovascular diseases (185,183 men, median age 66 years; 127,068 women, median age 65 years), we examined the association between BMI and proteinuria (≥1+ on dipstick).

Results

Subjects were divided into 11 subgroups by BMI grading in 1 kg/m² intervals from 18.5?27.5 kg/m². A BMI of approximately 22 ± 0.5 kg/m² was considered optimal for Japanese; therefore, this subgroup was set as a reference when logistic analysis was applied. Age, waist circumference, height, weight, smoking and drinking habits, use of medications such as antihypertensive, antidiabetic, or antihyperlipidemic, as well as proteinuria, estimated glomerular filtration rate (eGFR), chemistry data, and blood pressure levels were significantly different between subgroups in both genders. The odds ratio for proteinuria showed a U-shape in men and women, even after adjustment for significant covariates such as age, waist circumference, systolic blood pressure, eGFR, fasting plasma glucose, triglyceride, low-density lipoprotein, antihypertensive use, antidiabetic use, antihyperlipidemic use, and lifestyle factors (smoking and drinking). Gender differences were also prominent—a BMI <20.4 kg/m² was significantly associated with proteinuria in men compared to a BMI <18.4 kg/m² in women. On the other hand, a BMI ≥ 25.5 kg/m² was also significantly associated with proteinuria in men compared to a BMI ≥ 22.5 kg/m² in women.

Conclusions

We found that BMI levels were associated with proteinuria in a U-shaped manner and showed marked gender differences. Health guidance should not only focus on higher BMI subjects, but also on thin subjects, in terms of the prevention of chronic kidney disease.     

An angiotensin II type-I receptor blocker,olmesartan medoxomil,attenuates lipid peroxidation in renal injury induced by subtotal nephrectomy

Background Lipid-related oxidative stress, such as that caused by malondialdehyde (MDA), acrolein, and 4-hydroxynonenal (4-HNE), is involved in vascular injury in diabetes and hypertension. Olmesartan medoxomil, a blocker of angiotensin II type-I receptor, is an antihypertensive drug with antioxidant properties. In this study, we examined the involvement of oxidative lipids and the effect of olmesartan on lipid peroxidation in the progressive renal injury induced by renal mass reduction in rats. Methods Rats were treated with vehicle or olmesartan (0.5 mg/kg or 10 mg/kg) for up to 8 weeks after subtotal nephrectomy. The expression of oxidative lipids and the effect of olmesartan on lipid peroxidation were evaluated by Western blotting and immunostaining of renal tissue. Results Immunohistochemical examination revealed that MDA, acrolein, and 4-HNE were scarcely detected in renal cortex in sham-operated rats. On the contrary, these oxidative lipids were observed in injured glomeruli and dilated renal tubules in the ablated kidneys. Western blotting of renal cortical tissue revealed that MDA- or acrolein-bound proteins were mainly detected in the range of 30–90 kDa. Treatment with olmesartan attenuated lipid peroxidation and glomerulosclerosis. The renoprotective and antioxidative effect was higher in rats that received a high dose of olmesartan than in rats in the low-dose group. Conclusions These results indicate that oxidative lipids reflect the progression of renal injury induced by subtotal nephrectomy in rats. Olmesartan may have a renoprotective effect, with attenuation of lipid peroxidation.