Seborrheic dermatitis (SD) is a chronic inflammatory dermatologic condition in which erythema and itching develop on areas of the body with sebaceous glands, such as the scalp, face and chest. The inflammation is evoked directly by oleic acid, which is hydrolyzed from sebum by lipases secreted by skin microorganisms. Although the skin fungal genus, Malassezia, is thought to be the causative agent of SD, analysis of the bacterial microbiota of skin samples of patients with SD is necessary to clarify any association with Malassezia because the skin microbiota comprises diverse bacterial and fungal genera. In the present study, bacterial microbiotas were analyzed at non-lesional and lesional sites of 24 patients with SD by pyrosequencing and qPCR. Principal coordinate analysis revealed clear separation between the microbiota of non-lesional and lesional sites. Acinetobacter, Corynebacterium, Staphylococcus, Streptococcus and Propionibacterium were abundant at both sites. Propionibacterium was abundant at non-lesional sites, whereas Acinetobacter, Staphylococcus and Streptococcus predominated at lesional sites; however, the extent of Propionibacterium colonization did not differ significantly between lesional and non-lesional sites according to qPCR. Given that these abundant bacteria hydrolyze sebum, they may also contribute to SD development. To the best of our knowledge, this is the first comprehensive analysis of the bacterial microbiotas of the skin of SD patients.

Abbreviations ACEI Angiotensin converting enzyme inhibitor AKI Acute kidney injury ARB Angiotensin receptor blocker BMI Body mass index BP Blood pressure CCB Calcium channel blocker CKD Chronic kidney disease CVD Cardiovascular disease eGFR Estimated glomerular filtration rate ESKD End-stage kidney disease MRB Mineralocorticoid receptor blocker QOL Quality of life RAS Renin angiotensin system Levels of evidence A High: We are confident that the true effect lies close to that of the estimate of the effect. B Moderate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. C Low: The true effect may be substantially different from the estimate of the effect. D Very low: The estimate of the effect is very uncertain and might often be far from the true effect. None Grade of recommendation 1 "We recommend" 2 "We suggest" None Chapter 1. Diagnosis and definition of chronic kidney disease CQ1-1: How can we diagnose CKD? Statement: CKD is defined as the presence of either of the conditions listed below lasting for more than 3 months. (Level: None, Grade: 1) (1) Findings suggesting kidney damage, i.e., abnormal findings in blood or urinary tests, imaging studies or pathological evaluations. In particular, evidence of proteinuria ≥ 0.15 g/gCr (albuminuria ≥ 30 mg/gCr) is important. (2) GFR < 60 mL/min/1.73 m 2 In clinical practice, eGFR is calculated by the following GFR equation adjusted for the Japanese: eGFR (mL/min/1.73 m 2) = 194 x Cr-1.094 x Age-0.287 (x 0.739 if female) Note: We recommend that serum creatinine (Cr) value (mg/dL) should be evaluated by the enzymatic assay method and rounded off to 2 decimal places. The Japanese GFR equation is applicable to adults aged 18 years or older. CQ 1-2: How can we evaluate the severity of CKD? Statement: We recommend that CKD severity should be evaluated by cause, GFR category, and degree of proteinuria/ Japanese Society of Nephrology published Evidence-based Clinical Practice Guidelines for CKD 2018 (in Japanese) in the Journal of Japanese Society of Nephrology (in press). This is the English digest version of the above guidelines.

BackgroundChronic kidney disease (CKD) is a significant public health problem. Strategy for its early detection is still controversial. This study aims to assess the cost-effectiveness of population strategy, i.e. mass screening, and Japan’s health checkup reform.MethodsCost-effectiveness analysis was carried out to compare test modalities in the context of reforming Japan’s mandatory annual health checkup for adults. A decision tree and Markov model with societal perspective were constructed to compare dipstick test to check proteinuria only, serum creatinine (Cr) assay only, or both.ResultsIncremental cost-effectiveness ratios (ICERs) of mass screening compared with do-nothing were calculated as ¥1,139,399/QALY (US $12,660/QALY) for dipstick test only, ¥8,122,492/QALY (US $90,250/QALY) for serum Cr assay only and ¥8,235,431/QALY (US $91,505/QALY) for both. ICERs associated with the reform were calculated as ¥9,325,663/QALY (US $103,618/QALY) for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥9,001,414/QALY (US $100,016/QALY) for mandating serum Cr assay and applying dipstick test at discretion.ConclusionsTaking a threshold to judge cost-effectiveness according to World Health Organization’s recommendation, i.e. three times gross domestic product per capita of ¥11.5 million/QALY (US $128 thousand/QALY), a policy that mandates serum Cr assay is cost-effective. The choice of continuing the current policy which mandates dipstick test only is also cost-effective. Our results suggest that a population strategy for CKD detection such as mass screening using dipstick test and/or serum Cr assay can be justified as an efficient use of health care resources in a population with high prevalence of the disease such as in Japan and Asian countries.

HRQOL decreases with progression of CKD stage and/or presence of anemia, undernutrition, hypertension, diabetes, or history of CVD.

Oral prednisolone dose <0.8 mg/kg/day with or without cyclophosphamide as an initial treatment could improve patient survival in older Japanese AAV/RPGN patients. However, maintenance treatment avoiding relapse should be established to improve renal outcomes.