Selective induction of human renal interstitial progenitor-like cell lineages from iPSCs reveals development of mesangial and EPO-producing cells

Recent regenerative studies using human pluripotent stem cells (hPSCs) have developed multiple kidney-lineage cells and organoids. However, to further form functional segments of the kidney, interactions of epithelial and interstitial cells are required. Here we describe a selective differentiation of renal interstitial progenitor-like cells (IPLCs) from human induced pluripotent stem cells (hiPSCs) by modifying our previous induction method for nephron progenitor cells (NPCs) and analyzing mouse embryonic interstitial progenitor cell (IPC) development. Our IPLCs combined with hiPSC-derived NPCs and nephric duct cells form nephrogenic niche- and mesangium-like structures in vitro. Furthermore, we successfully induce hiPSC-derived IPLCs to differentiate into mesangial and erythropoietin-producing cell lineages in vitro by screening differentiation-inducing factors and confirm that p38 MAPK, hypoxia, and VEGF signaling pathways are involved in the differentiation of mesangial-lineage cells. These findings indicate that our IPC-lineage induction method contributes to kidney regeneration and developmental research.

Anti-glomerular basement membrane glomerulonephritis concurrent with membranous nephropathy and acute tubular interstitial nephritis in a lung cancer patient treated with pembrolizumab

Immune checkpoint inhibitors (ICIs) have become the standard treatment for many types of cancer and have improved patient prognosis. However, ICIs upregulate the immune system against tumors, leading to immune-related adverse events (irAEs). Kidney irAEs are less common, and most of them are acute tubulointerstitial nephritis (ATIN). However, there has been a recent increase in recognition of glomerular disease related to ICI therapies. We report the case of a 65-year-old man with lung adenocarcinoma who was treated with pembrolizumab (a monoclonal antibody targeting programmed cell death protein-1 [PD-1]). Pembrolizumab was discontinued after seven cycles due to the development of destructive thyroiditis. Within three months of discontinuing the pembrolizumab treatment, the patient developed rapid progressive glomerulonephritis (RPGN), liver dysfunction, and dysgeusia. The patient underwent renal biopsy and was diagnosed with crescentic glomerulonephritis due to anti-glomerular basement membrane (GBM) antibodies complicated with membranous nephropathy (MN) and ATIN. Treatment with systemic corticosteroids resulted in a favorable clinical response. Various ICI-associated glomerular diseases have been described; however, this is the first reported case of anti-GBM glomerulonephritis associated with MN and ATIN following ICI treatment.

Author Correction: Development of new method to enrich human iPSC-derived renal progenitors using cell surface markers

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Cell Therapy Using Human Induced Pluripotent Stem Cell-Derived Renal Progenitors Ameliorates Acute Kidney Injury in Mice

Acute kidney injury (AKI) is defined as a rapid loss of renal function resulting from various etiologies, with a mortality rate exceeding 60% among intensive care patients. Because conventional treatments have failed to alleviate this condition, the development of regenerative therapies using human induced pluripotent stem cells (hiPSCs) presents a promising new therapeutic option for AKI. We describe our methodology for generating renal progenitors from hiPSCs that show potential in ameliorating AKI. We established a multistep differentiation protocol for inducing hiPSCs into OSR1+SIX2+ renal progenitors capable of reconstituting three-dimensional proximal renal tubule-like structures in vitro and in vivo. Moreover, we found that renal subcapsular transplantation of hiPSC-derived renal progenitors ameliorated the AKI in mice induced by ischemia/reperfusion injury, significantly suppressing the elevation of blood urea nitrogen and serum creatinine levels and attenuating histopathological changes, such as tubular necrosis, tubule dilatation with casts, and interstitial fibrosis. To our knowledge, few reports demonstrating the therapeutic efficacy of cell therapy with renal lineage cells generated from hiPSCs have been published. Our results suggest that regenerative medicine strategies for kidney diseases could be developed using hiPSC-derived renal cells.

SIGNIFICANCE

This report is the first to demonstrate that the transplantation of renal progenitor cells differentiated from human induced pluripotent stem (iPS) cells has therapeutic effectiveness in mouse models of acute kidney injury induced by ischemia/reperfusion injury. In addition, this report clearly demonstrates that the therapeutic benefits come from trophic effects by the renal progenitor cells, and it identifies the renoprotective factors secreted by the progenitors. The results of this study indicate the feasibility of developing regenerative medicine strategy using iPS cells against renal diseases.

Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report

Introduction

Refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation is rarely reported and has a poor prognosis in general (a median survival of 1.6 months). Moreover, the optimum treatment for this condition is still undecided. This is the first report on the successful use of vincristine, adriamycin and dexamethasone chemotherapy for refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis without cardiac decompensation.

Case presentation

We report the case of a 68-year old Japanese male with systemic immunoglobulin light chain amyloidosis presenting with bilateral pleural effusion (more severe on the right side) in the absence of cardiac decompensation that was refractory to diuretic therapy. The patient was admitted for fatigue, exertional dyspnea, and bilateral lower extremity edema. He had been receiving intermittent melphalan and prednisone chemotherapy for seven years. One month before admission, his dyspnea had got worse, and his chest radiograph showed bilateral pleural effusion; the pleural effusion was ascertained to be a transudate. The conventionally used therapeutic measures, including diuretics and thoracocentesis, failed to control pleural effusion. Administration of vincristine, adriamycin, and dexamethasone chemotherapy led to successful resolution of the effusion.

Conclusion

Treatment with vincristine, adriamycin, and dexamethasone chemotherapy was effective for the refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation and appears to be associated with improvement in our patient's prognosis.

Early diagnosis and treatment may prevent the development of complications in an adult patient with glycogen storage disease type Ia

Type Iota(a) glycogen storage disease (GSD Iota(a)) is caused by the deficiency of glucose-6-phosphatase activity, which results in metabolic disorder and organ failure, including renal failure. GSD Iota(a) patients are generally diagnosed at a median age of 6 months. However, we report a 20-year-old Japanese female with newly diagnosed GSD Iota(a) . The renal disorder of GSD Iota(a) is considered to be produced by glomerular hyperfiltration, TGF-beta expression which is induced by renin-angiotensin-aldosterone system (RAS) and uric acid, and the increase in both small dense LDL and modified LDL which is characteristic of GSD Iota(a) as well as hypertriglyceridemia. With the administration of intensive therapies, including angiotensin type 1-receptor blocker and some lipid lowering drugs, along with traditional dietary therapy, daily proteinuria of the patient improved from 2.1 g to 0.78 g. Although the patients of GSD Iota(a) should receive an early and accurate diagnosis and effective therapies before the age of 1 year, the combination of traditional dietary therapies and intensive therapies may have therapeutic potential for the complications of adult patients. In this report, we describe the management of renal disease and the characteristic features of this metabolic disorder.

[A case of renal capsular leiomyoma]

A 50-year-old woman was admitted for the treatment of retroperitoneal tumor. Enhanced comtuted tomography showed a low density mass between the left kidney and psoas muscle. Magnetic resonance imaging revealed a high intensity and homogeneous mass on T1-weighted sequence, and a low intensity and heterogeneous mass on T2-weighted sequence. Surgical exploration revealed that the tumor was adherent to the left kidney and en bloc excision of the tumor and the left kidney was performed. Histopathological diagnosis was leiomyoma originating from the renal capsule.

[A case of asynchronous quadruple cancer arising from the prostate, stomach, rectum and urinary bladder]

Herein, we report a case of quadruple cancer arising from the prostate, stomach, rectum and urinary bladder. A 92-year-old man was admitted to our hospital on March, 1996, with complaints of macroscopic hematuria and micturition pain. He had a history of prostate cancer (no details) at the age of 67, and subtotal gastrectomy for gastric cancer (tubular adenocarcinoma, conclusive stage Ia) at the age of 89. He underwent a polypectomy for rectal cancer (well-differentiated adenocarcinoma)2 at the age of 90. There was no evidence of local recurrence or metastasis of these three carcinomas. Cystoscopy revealed multiple papillary tumors which were resected transurethrally. At the same time transrectal needle biopsy of prostate was performed. Pathology revealed transitional cell carcinoma G2 of urinary bladder and well differentiated adenocarcinoma of prostate. The postoperative course was uneventful and the patient has been doing well without recurrence of bladder cancer during the follow-up period of six months.

[Study on clinical effects of tosufloxacin (TFLX) and the long-term low dose therapy for the prophylaxis of recurrent urinary tract infection]

Forty five patients with complicated urinary tract infections were treated with tosufloxacin (TFLX) in the initial antibacterial treatment. Excellent and moderate responses were obtained in 39 patients (86.7%). No side effects were seen. Clinical efficacy and safety of long-term preventive administration of TFLX (150mg, a day) were also examined in 39 patients who showed an excellent or a moderate response in the initial treatment. The period of the administration ranged from 28 to 112 days (average; 55 days). The rate of preventing recurrence of urinary tract infection was 92.3% on the last day of treatment. These findings suggested that TFLX was useful not only in treating the patients with complicated urinary tract infections but also in preventing recurrence of urinary tract infection.

[Testicular tumor following orchiopexy: a case report]

Herein we report a 26-year-old patient in whom seminoma developed in the testicle which had been fixed 9 years earlier. Thirty five of such cases in the Japanese literature are reviewed.

[Primary carcinoma of the male urethra: report of two cases]

Two cases of primary carcinoma of male urethra are reported. Case 1: A 31-year-old male, who complained of urethral bleeding, was admitted to our clinic in April, 1982. A rice size papillary tumor was found at the fossa navicularis in the glans, and resected by electric knife. Histologically, the tumor was well differentiated squamous cell carcinoma. Case 2: A 37-year-old man, who complained of urethral bleeding, was admitted to our clinic in July, 1985. A tumor was found at the fossa navicularis in the glans and resected. Histologically, the tumor was well differentiated squamous cell carcinoma confined to mucosa. These two cases have not shown any signs of recurrence. Including these cases, 135 cases of primary carcinoma of urethra in the literature in Japan are reviewed.

[Clinical observation of urolithiasis in Mie University Hospital]

The urinary tract calculus patients seen at our Department between January, 1974 and December, 1983 were reviewed to determine the trend of urolithiasis. The urinary tract calculus patients accounted for 10.1% of all the outpatients. Recurrent calculus diseases were seen in 16.9% of male patients and in 12.1% of female patients. The frequency of recurrence was very high in the patients in their forties. Upper urinary tract calculi were seen most frequently in the patients in their forties. We could expect spontaneous passage of stone for at least 6 months in the case of a middle-sized stone (less than 6 X 10 mm). The percentage of calcium oxalate-containing stone was 73.2% in male patients and the percentage of phosphate-containing stones was 81.6% in female patients. Hypercalciuric patients were seen in 34.0% of the calculus inpatients. Urinary bacterial culture revealed positive in 33.0% of the calculus inpatients.

[A case of soft vesical calculi]

A case of soft vesical calculi is reported. A 72-year-old male, visited our clinic complaining of discharge of white muddy substance. KUB film revealed calcification in the vesical region. Urinalysis showed UTI, and culture of urine was positive for Proteus mirabilis. Thereafter, the patient suffered from discharges of similar calculi several times. Two of three infrared spectroscopic charts showed mixture of calcium phosphate and ammonium hydrogen urate and that of the remaining disclosed magnesium ammonium phosphate. An alcian blue-PAS double staining of this calculus revealed the presence of acid and neutral glycosaminoglycans, and bacterial colonies. These calculi were thought to be different from the so called 'matrix calculi'.

[Two cases of triple primary neoplasm and two cases of quadruple primary neoplasm including bladder cancer]

Two cases of triple primary neoplasm and two cases of quadruple primary neoplasm including transitional cell carcinoma (TCC) of bladder are reported. The first case was a 70-year-old male who had bladder cancer, occult cancer of prostate (adenocarcinoma) and highly differentiated adenocarcinoma of pancreas. He died of cachexy. The second case was a 69-year-old male. This case was also triple primary neoplasm including bladder cancer, squamous cell carcinoma (SCC) of penis and SCC of larynx. The third case was a 78-year-old male who had bladder cancer, adenocarcinoma of prostate similar to that of the first case, adenocarcinoma of stomach, and SCC of lung. He died of obstructive jaundice and renal failure owing to massive metastases of gastric cancer. The fourth case was a 78-year-old male who had four primary neoplasms such as bladder cancer, branchiogenic epithelial carcinoma, SCC of buccal mucosa and adenocarcinoma of rectum.

[Six cases of spontaneous peripelvic extravasation from the renal pelvis]

The diagnosis and management of 6 patients with spontaneous non-traumatic urinary extravasation are reported. It is important to distinguish extravasation of the fornical backflow type from that owing to frank rupture of the diseased renal pelvis. In Japan, 26 cases of spontaneous peripelvic extravasation and 29 cases of spontaneous pelvic rupture have been reported. Most of them were caused by calculous ureteral obstruction. Many of the cases of spontaneous peripelvic extravasation could be managed conservatively, and many of the cases of spontaneous pelvic rupture often required surgical treatment due to the patient's clinical condition, the persistence of obstruction or extravasation, or the presence of complication of extravasation such as urinoma or abscess. All of our 6 cases were managed conservatively and had no complications.

[Antegrade pyelography]

Percutaneous antegrade pyelography under ultrasonic real-time guidance was performed in 18 cases of obstructive hydronephrosis, which were poorly visualized the renal collecting system on excretory urography and in which or retrograde pyelography could not be performed successfully. This technique was safe, accurate and easy, and provided significant diagnostic information in these cases. With the patient under local anesthesia an 18 gauge spinal needle was inserted into the renal pelvis. Approximately 10-20 ml fluid were withdrawn from the renal pelvis for cytology and culture. After the injection of contrast medium radiograms were obtained in adequate positions. Delayed films were obtained when indicated. In 8 cases pelvic and/or ureter tumor was diagnosed. In two cases congenital anomalies were diagnosed, one had complete obstruction at the ureteropelvic junction and the other had complete obstruction at the ureterovesical junction. In the other three cases ureter ligation and in 5 cases ureter stenosis were diagnosed. The quality of the aspirated urine was dark-red in 6 cases, positive cytology, in 6 cases, all of which had pelvic and/or ureter tumors. No severe complications were observed.

[Retention cyst of the prostate gland: report of a case]

A 55-year-old man was admitted to our hospital because of pollakisuria and dysuria. Rectal examination revealed a normal prostate and did not show fluctuation or tenderness. Cystography and cystoscopic examination revealed a lesion projecting into the bladder cavity. An echogram showed an irregular internal echo at the left lobe of the prostate, but prostatic biopsy revealed benign prostatic hypertrophy. Transvesical removal of the prostatic cyst was performed. The cyst was about 3 cm in diameter and filled with yellow fluid (5.8 ml). The fluid contained no sperm and its acid phosphatase and zinc levels were high. The cystic wall was lined by cubo-collumnar cells and partly by flattened epithelium.

[A case of preputial calculi]

A case of a 73-year-old patient with preputial calculi is presented. The patient visited our hospital complaining of consciousness loss. It was impossible to place a catheter because of complete phimosis. Palpatory examination suggested the presence of stones in preputial cavity. Dorsal incision was made. After pus discharge nine small stones were extirpated. Ammonium hydrogen urate (96%) and calcium phosphate (4%) were found in these stones with infrared spectroscopic analysis. Bacteriodes ureolytcus and Peptostreptcoccus asaccharolyticus were isolated from urine specimen.

[Plasma oxalate concentration in calcium oxalate stone formers]

A sensitive, simplified method for plasma oxalate determination by gas chromatography is described. After deproteinizing the plasma with 3N HC1 and 20% sulfosalicylic acid, the oxalate was methylated, extracted and analysed by gas chromatography. This method has three advantages i.e., smaller sample size (plasma 5.0 ml), rapidity (takes less than 3 hours) and accuracy. The recovery rate of oxalate added to plasma was 91.42 +/- 11.31% (SD) and the coefficient of variation of replicate determinations was 4.18%. The minimum detectable concentration of oxalate was 0.3 micrograms/ml (oxalate peak was higher than 5 mm). The mean oxalate concentration under fasting conditions from 16 healthy subjects was 1.37 +/- 0.39 micrograms/ml (SD), while that from 31 calcium oxalate stone formers was 1.45 +/- 0.39 micrograms/ml (SD). There was no significant difference in plasma oxalate concentration between the two groups. The dietary influence of oxalate on plasma and urinary oxalate was investigated in 5 healthy subjects and 5 calcium oxalate stone formers. When 100 g spinach (total oxalate 545.5 mg, soluble oxalate 381.5 mg) was given, the increase of plasma oxalate concentration was more prominent in stone formers; in stone formers it increased to 142% of control value at 2 hours (p less than 0.05) after spinach loading, to 163% at 4 hour (p less than 0.01) and to 232% at 6 hours (p less than 0.01); while in healthy subjects increased to 119% at 2 hours (ns) after loading, to 144% at 4 hours (p less than 0.05) and only to 167% at 6 hours (p less than 0.01). Urinary oxalate excretion increased promptly between 1 and 2 hours after loading in both groups, reaching peak levels between 2 and 4 hours after loading in healthy subjects and between 4 and 6 hours or later in stone formers. The mean renal clearance of oxalate was 18.0 ml/min in 6 healthy subjects and 19.0 ml/min in 4 calcium oxalate stone formers. There was no significant difference in oxalate clearance between the two groups. The mean ratio of oxalate/creatinine clearance was 0.22 for stone formers, which was equal to that for healthy subjects.