Palmoplantar pustulosis and IgA nephropathy

We present a case of IgA nephropathy complicated with palmoplantar pustulosis. The skin lesion improved with tonsillectomy. The purposes of this article were to aid physicians in understanding that (a) IgA nephropathy should be considered in patients with palmoplantar pustulosis and (b) patients with these diseases should be referred to otolaryngology specialists for tonsillectomy.

Anti-glomerular basement membrane disease accompanied by systemic lupus erythematosus presenting central nervous system involvement

We report a case of rapidly progressive glomerulonephritis caused by anti-glomerular basement membrane (GBM) disease accompanied by systemic lupus erythematosus (SLE) presenting central nervous system involvement in a 32-year-old Japanese male. He was admitted to our hospital because of a 3-week history of fever and rapidly failing renal function requiring hemodialysis (HD). Laboratory tests showed anti-GBM antibody elevation with a value of 16,385 units/ml. On day 85, he had generalized tonic-clonic seizure. Brain magnetic resonance T2 Flair imaging showed multiple high intensity lesions in a broad area. We made a diagnosis of central nervous system involvement in SLE based on positivity for antinuclear and anti-DNA antibodies, hypocomplementemia, and discoid skin rash. After combined therapy consisting of plasma exchange, HD, and steroid pulse, the patient made a good recovery without any residual neurological sequelae, though kidney dysfunction requiring maintenance HD remained. Anti-GBM antibody finally became undetectable on the 144th hospital day.

Stable neutral radicals of planar N2O2-type dipyrrin platinum complexes: hybrid radicals of the delocalized organic π-orbital and platinum d-orbital

Neutral radicals of N2O2-dipyrrin platinum complexes were synthesized by the reaction of dipyrrin ligands with PtCl2(cod) and successive one-electron oxidation. The radicals are very stable even under aerobic and ambient conditions. X-ray crystallographic analysis revealed the stacking array of the planar dipyrrin complex moieties. The ESR signals were broadened and significantly downfield shifted. The absorption spectra exhibited NIR bands. These results indicated a delocalized radical character with a contribution by the platinum d-orbital.

Optimal blood pressure in patients with peripheral artery disease following endovascular therapy

This study examined the associations between blood pressure (BP) and event incidence to define optimal BP after endovascular therapy (EVT) in patients who underwent EVT. BP was monitored every 6 months for 5 years, and the patients were divided into two groups by average BP: ≥ 140/90 mmHg and < 140/90 mmHg. The association of BP with several events was examined. Although no significant differences in total mortality were observed between the groups, restenosis rates were significantly higher among patients who did not achieve target BP (36.2%) than among those who did (18.2%) (p < 0.01). The percentage of patients with glycosylated haemoglobin > 7.0% was significantly higher among those who did not achieve target BP in the restenosis group (42.9%) than in the other group (10.8%) (p < 0.01). In the restenosis group, there was a significantly higher percentage of patients taking metformin (p < 0.01) than in the other group. Metformin seemed to be administered to patients with more severe diabetes mellitus. In conclusion, it is important to manage hypertension and diabetes to prevent restenosis after EVT.

[The Impact That SPECT Collection Angle and Collection Orbit Gives to an Image: Myocardial Digital Phantom Study]

PURPOSE

We evaluated the effect that collection angle and collection orbit condition gave to an image quantitatively by simulating the single photon emission computed tomography (SPECT) system.

METHOD

Using the Software Package of the Nuclear Medicine Data Processor for Research, we performed making of the myocardial digital phantom, three ways of different simulation of the collection angle and collection orbit, and making of reference of the uniform picture element level. We calculated NMSE for uniformity evaluation and calculated myocardial thickness full width at half maximum (FWHM) for a spatial resolution evaluation.

RESULTS

360 degrees circular orbit collection had best uniformity. 180 degrees noncircular orbit collection had best spatial resolution.

CONCLUSION

By using the digital phantom, we focused on only collection angle and collection orbit condition, and focused on two indexes of the uniformity and the spatial resolution and were able to show a quantitative index.

Urinary angiotensin-converting enzyme 2 in hypertensive patients may be increased by olmesartan, an angiotensin II receptor blocker

BACKGROUND

Angiotensin-converting enzyme 2 (ACE2) is highly expressed in the kidney and converts angiotensin (Ang) II to Ang-(1-7), a renoprotective peptide. Urinary ACE2 has been shown to be elevated in patients with chronic kidney disease. However, the effects of antihypertensive agents on urinary ACE2 remain unclear.

METHODS

Of participants in the Tanno-Sobetsu cohort study in 2011 (n = 617), subjects on no medication (n = 101) and hypertensive patients treated with antihypertensive agents, including the calcium channel blockers amlodipine and long-acting nifedipine; the ACE inhibitor enalapril; and the Ang II receptor blockers losartan, candesartan, valsartan, telmisartan, and olmesartan, for more than 1 year (n = 100) were enrolled, and urinary ACE2 level was measured.

RESULTS

Glucose and hemoglobin A1c were significantly higher in patients treated with enalapril, telmisartan or olmesartan than in the control subjects. Urinary albumin-to-creatinine ratio (UACR) was significantly higher in patients treated with enalapril than in the control subjects. Urinary ACE2 level was higher in the olmesartan-treated group, but not the other treatment groups, than in the control group. Urinary ACE2 level was positively correlated with systolic blood pressure (r = 0.211; P = 0.003), UACR (r = 0.367; P < 0.001), and estimated salt intake (r = 0.260; P < 0.001). Multivariable regression analysis after adjustment of age, sex, and the correlated indices showed that the use of olmesartan was an independent predictor of urinary ACE2 level.

CONCLUSIONS

In contrast with other antihypertensive drugs, olmesartan may uniquely increase urinary ACE2 level, which could potentially offer additional renoprotective effects.

Tubulointerstitial nephritis and uveitis syndrome complicated by IgA nephropathy and Graves' disease: a case report

Introduction

Tubulointerstitial nephritis and uveitis syndrome is a disorder characterized by a combination of acute tubulointerstitial nephritis and uveitis. Immunoglobulin A nephropathy is defined by the presence of immunoglobulin A deposits in glomerular mesangial areas. In this report, we describe a rare case of tubulointerstitial nephritis and uveitis syndrome complicated by immunoglobulin A nephropathy and Graves’ disease, which was successfully treated with corticosteroids. To the best of our knowledge, this is the first time such a case has been documented since tubulointerstitial nephritis and uveitis syndrome was first described.

Case presentation

A 64-year-old Japanese woman presented with tubulointerstitial nephritis and uveitis syndrome accompanied by immunoglobulin A nephropathy and Graves’ disease. She had renal dysfunction, proteinuria, and hematuria. Two weeks after her admission, she developed anterior chamber uveitis. She received corticosteroids, resulting in significant clinical improvement.

Conclusion

Tubulointerstitial nephritis and uveitis syndrome is a relatively uncommon cause of tubulointerstitial nephritis. Clinicians should recognize that tubulointerstitial nephritis and uveitis syndrome with immunoglobulin A nephropathy can occur in the presence of Graves’ disease. Additionally, this report may provide important clues in terms of the management of a concomitant case of these diseases.

Abstract 550: Plasma Angiotensin-(1-12) Level Is Elevated And Correlates With Proteinuria In Patients With Chronic Kidney Diseases

Angiotensin-(1-12) [Ang-(1-12)], C-terminally extended form of Ang I, is an alternative precursor of Ang II. Although angiotensinogen, a precursor of both Ang I and Ang-(1-12), is reportedly one of markers of kidney disease, little is known about role of Ang-(1-12) in pathological status especially in human. To address this issue, we measured plasma and urinary Ang-(1-12) by enzyme immunoassay in 4 healthy volunteers and 15 patients with biopsy-proven chronic kidney diseases (CKD). CKD group included minor glomerular abnormality (n=3), IgA nephropathy (n=8), minimal change nephritic syndrome (n=4). Ang-(1-12) level was 55-fold higher in urine than in plasma (Figure; 4.12±1.55 vs 0.075±0.006 ng/mL, P<0.05). Neither plasma Ang-(1-12) nor urinary Ang-(1-12) was correlated with blood pressure. Plasma Ang-(1-12) was positively correlated with urinary protein and tended to be negatively correlated with estimated glomerular filtration ratio (eGFR; Figure). Plasma Ang-(1-12) was higher in the CKD group than in the control (Figure; 0.083±0.006 vs 0.045±0.005 ng/mL, P<0.01). On the other hand, urinary Ang-(1-12) was correlated with neither urinary protein nor eGFR. Urinary Ang-(1-12) tended to be higher in the CKD group than in control (4.94±1.9 vs 1.05±0.6 ng/mL, respectively). The present study showed for the first time that plasma Ang-(1-12) level is elevated in patients with CKD and suggests that increased plasma Ang-(1-12) plays a nephropathic role.

The impact of elevation of serum uric acid level on the natural history of glomerular filtration rate (GFR) and its sex difference

BACKGROUND

The impact of elevation of the serum uric acid level (SUA) on the natural history of glomerular filtration rate (GFR) remains controversial.

METHODS

If elevation of SUA is a result, rather than a cause, of a decline in GFR, the relationship between SUA and GFR should be the same in the same population over years except for shifts by age-dependent reduction of GFR. We tested this hypothesis using data from two cohorts and a group of allopurinol-treated patients.

RESULTS

In Cohort 1 consisting of urban residents aged 40.6 ± 9.0 years (n = 3 446), SUA was inversely correlated with estimated GFR (eGFR) in both men and women, and the slope of the SUA-eGFR relationship was steeper in women than in men. The slopes of the regression lines became significantly steeper after a 6-year interval in both sexes, and the change in the slope was larger in women. A similar sex difference in the SUA-eGFR relationship and 6-year change in the slope were observed in Cohort 2 consisting of rural town residents aged 61.7 ± 12.2 years (n = 404). Multiple regression analyses showed that explanatory factors of eGFR after a 6-year interval were age and SUA at baseline in both cohorts, and partial regression coefficients of SUA were more negative in women than in men. The SUA-eGFR relationship in allopurinol-treated patients (n = 346, 63.5 ± 13.3 years old) was similar to that in Cohort 2.

CONCLUSIONS

The results indicate that elevation of SUA accelerates the yearly decline in eGFR and that women are more susceptible to urate-induced decline in eGFR.

Abstract 604: Renin Independent Ang-(1-12) Production in both the Systemic and Coronary Circulation

Although angiotensin-(1-12) [Ang-(1-12)] is recognized as an alternate precursor for Ang

II, the biochemical pathways by which the substrate is released from

angiotensinogen (Aogen) are not yet described.

We examined the role of renin on Ang-(1-12) formation from synthetic icosapeptide

[Ang-(1-20)] in the systemic and coronary circulation of Wistar Kyoto rats

(WKY). In experiment 1, rats underwent bilateral

nephrectomy (BNX) or sham operation.

After 48 hours, rats were assigned to sham+saline, sham+Ang-(1-20), or

BNX+Ang-(1-20). Ang-(1-20) (20 nmol/kg/min)

or saline was infused for 15 minutes. At

the end of the study blood was collected for measuring Ang-(1-12), Ang I and

Ang II by RIA. Ang-(1-20) infusion increased

arterial pressure in both sham and BNX compared to sham+saline (P<0.001). Plasma Ang-(1-12), Ang I, and Ang II were significantly

higher in sham+Ang-(1-20) compared to sham+saline. BNX+Ang-(1-20) showed significant increase in

Ang I and a tendency for augmented Ang-(1-12) and Ang II compared to sham+saline

(Figure). In experiment 2, the hearts extracted

from WKY were mounted on Langendorff apparatus.

After recovery, 10 nmol or 100 nmol of Ang-(1-20), or 100 nmol of

Ang-(1-20) with WFML-1 (a rat renin inhibitor) were perfused in the coronary

circulation. Buffer was recirculated

after addition of Ang-(1-20) and WFML-1.

Perfusate was collected at 0, 5, 15, 30, and 60 min for measurement of angiotensins

by RIA. The 100 nmol of Ang-(1-20)

increase Ang-(1-12), Ang I, and Ang II compared to 10 nmol both in the absence

and in the presence of WFML-1 (Figure).

We conclude that Ang-(1-12) is cleaved from Aogen by an enzyme that is

not renin in both systemic and coronary circulation.

A case report of the anti-glomerular basement membrane glomerulonephritis with mesangial IgA deposition

A 46-year-old Japanese male with a past medical history of microscopic hematuria presented with nausea, vomiting, and abdominal pain for which he had been diagnosed with rapidly progressive glomerulonephritis with a peak serum creatinine of 6.6 mg/dL and anti-glomerular basement membrane antibody of 214 EU. Light microscopy showed cellular crescent formation, and immunofluorescence illustrated both linear staining of IgG along the glomerular basement membrane and granular staining of IgA and C3 in the mesangial area; however, the PAS staining of mesangial expansions and mesangial proliferations were not observed. Clinical and histological findings suggested anti-glomerular basement membrane glomerulonephritis with mesangial IgA deposition, suggesting IgA nephropathy, a rare condition.