BackgroundThe study aim was, for the first time, to conduct a multicenter randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgA nephropathy (IgAN).MethodsPatients with biopsy-proven IgAN, proteinuria and low serum creatinine were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were urinary protein excretion and the disappearance of proteinuria and/or hematuria.ResultsDuring 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria (odds ratio 2.98, 95% CI 1.01–8.83, P = 0.049), but did not identify an independent factor in achieving the disappearance of hematuria or clinical remission.ConclusionsThe results indicate tonsillectomy combined with steroid pulse therapy has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Although the antiproteinuric effect was significantly greater in combined therapy, the difference was marginal, and its impact on the renal functional outcome remains to be clarified.

US evaluation of AVFs in HD patients is a simple method to predict the risks of thrombosis and fistula dysfunction. Qa, ferritin, transferrin saturation, and warfarin use might be associated with VEs.

Background. Although there have been many reports on clinicopathological studies of IgAN, information is limited regarding the long-term evolution of a renal histology by analysing samples obtained not only during normal renal function but also after the establishment of an impaired renal function in individual patients. Methods. We analysed 18 pairs of serial biopsy specimens from 18 patients with IgA nephropathy (IgAN) in whom the first renal biopsies were performed while normal renal function was still present and the second biopsies were performed after impaired renal function was established. The glomerular density (GD, number of non-sclerotic glomeruli per renal cortical area) and mean glomerular area (MGA) were compared between the specimens. Results. The GD at the first biopsy of each patient showed a striking variation (1.3-5.2/mm 2 ). As a whole, the GD decreased (2.7 ± 1.2 versus 1.4 ± 0.7/mm 2 ) and the MGA increased (19.7 ± 4.2 × 10 3 versus 23.5 ± 4.5 × 10 3 mm 2 ) between the biopsies, respectively. The degrees of change in the GD and the MGA between the biopsies differed remarkably among the individuals. The patients with a high GD in the first biopsy progressed slowly, but showed a large decrease in the GD and a large increase in the MGA between the biopsies, respectively. The patients with a low GD, who already had enlarged glomeruli in the first biopsy, tended to progress rapidly. Conclusions. Our results suggest that both the nephron number and glomerular enlargement play a crucial role as compensatory mechanisms against renal functional deterioration in progressive IgAN. The GD during normal renal function may determine these compensatory changes and thereby make it possible to predict the renal prognosis in IgAN.

Isolated tracheal and bronchial strip-chain preparations of the rat were used to study the effect of temperature on electrically or acetylcholine-induced contraction. The preparations were suspended in the organ bath containing Krebs bicarbonate solution for isometric tension recording. A decrease of bath temperature from 37 degrees C to 20 degrees C (cooling) had no effect on basal tone but augmented the contractile responses of the trachea and bronchus caused by stimulation of intramural cholinergic nerves (0.5-5 Hz) or acetylcholine (3 mumol/l-0.3 mmol/l). Cooling-induced augmentation of the contractile response to acetylcholine was not affected by pretreatment of the tissue with physostigmine (0.1 mumol/l) or tetrodotoxin (0.3 mumol/l). The affinity of acetylcholine for the tracheal muscarinic receptors at 20 degrees C, determined from its dissociation constant (KA), was not significantly different from that at 37 degrees C. On the other hand, acetylcholine-induced contraction of trachea which was incubated with isosmotic K+- rich Krebs solution and with Ca-free, EGTA (0.1 mmol/l) containing Krebs solution were both augmented at 20 degrees C. Caffeine or vanadate, each at a lower concentration than the threshold for causing contraction by itself, augmented the contractile responses of the trachea to acetylcholine (1 mumol/l-0.3 mmol/l). These potentiating effects of caffeine and vanadate were greater at 20 degrees C then 37 degrees C. From these observations, it is concluded that increased responsiveness of the rat airway smooth muscle to acetylcholine with lowered temperature may involve the acceleration of Ca release from intracellular storage sites, inhibition of Ca extrusion from the cell and or the inhibition of Ca reuptake by intracellular storage sites.

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BackgroundA simpler method for detecting atherosclerosis obliterans is required in the clinical setting. Laser Doppler flowmetry (LDF) is easy to perform and can accurately detect deterioration in skin perfusion. We performed LDF for hemodialysis patients to determine the correlations between blood flow in the lower limbs and peripheral arterial disease (PAD).MethodsThis retrospective study included 128 hemodialysis patients. Patients were categorized into the non-PAD group (n = 106) and PAD group (n = 22), 14 early stage PAD patients were included in the PAD group. We conducted LDF for the plantar area and dorsal area of the foot and examined skin perfusion pressure (SPP) during dialysis.ResultsSPP-Dorsal Area values were 82.1 ± 22.0 mmHg in the non-PAD, and 59.1 ± 20.3 mmHg in PAD group, respectively (p < 0.05). The LDF-Plantar blood flow (Qb) values were 32.7 ± 15.5 mL/min in non-PAD group and 21.5 ± 11.3 mL/min in PAD group (p < 0.001). A total of 21 non-PAD patients underwent LDF before and during dialysis. The LDF-Plantar-Qb values were 36.5 ± 17.6 mL/min before dialysis and 29.6 ± 17.7 mL/min after dialysis (p < 0.05). We adjusted SPP and LDF for PAD using logistic regression, SPP-Dorsal-Area and LDF-P were significantly correlated with PAD (p < 0.05). The receiver-operating characteristic curve analysis indicated cut-off values of 20.0 mL/min for LDF-Plantar-Qb during dialysis.ConclusionLDF is a simple technique for sensitive detection of early-stage PAD. This assessment will help physicians identify early-stage PAD, including Fontaine stage II in clinical practice, thereby allowing prompt treatment.

The long-term administration of low-dose eplerenone was effective and safe for the treatment of non-diabetic CKD patients who showed persistent proteinuria in spite of therapy with RAS inhibitors.

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