SummaryChronic kidney disease (CKD) is a major and serious risk factor for cardiovascular disease (CVD). Continuous hypoxia due to hypoperfusion in peritubular capillaries is one of the factors aggravating CKD, but evaluation of perfusion in this region is difficult using clinically available imaging methods. Since the second-generation ultrasound contrast agent Sonazoid TM has a stable shell, it enables visualization of the renal vasculature for a long period of time. We therefore evaluated changes in contrast-enhanced ultrasound (CEUS) imaging with Sonazoid TM in CKD patients.Sonazoid TM was used in 85 CKD patients and 5 control subjects, and images were recorded for 10 minutes. Time-intensity curves were generated from the images of 62 time points in both cortex and medulla.In control samples, contrast enhancement spread from the hilar portion to the periphery along the direction of arterial flow, and renal cortex and medulla were then enhanced in sequence. Enhancement was maximal soon after, then gradually decreased, but was still visible at 600 seconds. In CKD patients, renal contrast enhancement was attenuated in both cortex and medulla. On time-intensity curves, the attenuation of enhancement was composed of delayed rising, reduction of peak, and acceleration of decay in both cortex and medulla with progression of renal dysfunction. No side effects of the contrast agent were observed in any subjects.The attenuation of renal contrast enhancement observed in CKD patients appears to reflect disturbance of perfusion in peritubular capillaries. CEUS with Sonazoid TM is a useful and safe means of visualizing the renal microvasculature. (Int Heart J 2010; 51: 176-182)

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A 77-year-old man with a history of hypertension, prostate hyperplasia, and urolithiasis was admitted for acute kidney injury caused by hypercalcemia. Neck ultrasonography showed a large cyst adjacent to the right lower thyroid lobe. Although a 99m technetium sestamibi scan was negative, an extremely high intracystic intact parathyroid hormone level suggested that the cyst had a parathyroid origin and that a functional parathyroid cyst was present. Immunohistochemical staining for the calcium-sensing receptor (CaSR) after right lower parathyroidectomy revealed CaSR-positive cells lining the cyst, indicating that the functional parathyroid cyst had originated from the hemorrhagic degeneration of a parathyroid adenoma.

Background In chronic kidney disease (CKD), patients’ adherence to prescriptions for diet and for medications might depend on the degree to which they have hope that they will enjoy life, and that hope could vary with the stage of CKD. The aims of this study were to quantify both the association of CKD stage with health-related hope (HR-Hope), and the association of that hope with psychological and physiological manifestations of adherence. Methods This was a cross-sectional study involving 461 adult CKD patients, some of whom were receiving dialysis. The main exposure was HR-Hope, measured using a recently-developed 18-item scale. The outcomes were perceived burden of fluid restriction and of diet restriction, measured using the KDQOL, and physiological manifestations of adherence (systolic and diastolic blood pressure [BP], and serum phosphorus and potassium levels). General linear models and generalized ordered logit models were fit. Results Participants at non-dialysis stage 4 and those at stage 5 had lower HR-Hope scores than did those at stage 2 or 3 (combined). Those at non-dialysis stage 5 had the lowest scores. HR-Hope scores of participants at stage 5D were similar to those of participants at stage 4, but they were lower than the scores of participants at stage 2 or 3 (combined). Higher HR-Hope scores were associated with lower perceived burdens of fluid restriction and of diet restriction (adjusted ORs per ten-point difference were 0.82 and 0.84, respectively). Higher HR-Hope scores were associated with lower systolic BP (adjusted mean difference in systolic BP per ten-point difference in HR-Hope scores was − 1.87 mmHg). In contrast, HR-Hope scores were not associated with diastolic BP, serum phosphorus levels, or serum potassium levels. Conclusions Among CKD patients, HR-Hope is associated with disease stage, with psychological burden, and with some physiological manifestations of adherence.