Affiliation |
Faculty of Medicine College Hospital Department of Kidney Internal Medicine |
Title |
Assistant Professor |
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Papers 【 display / non-display 】
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Skin ulcers triggered by calciphylaxis in hemodialysis patients: Two case reports Reviewed
Fukunaga Shin, Baba Akiko, Tokura Ken, Yamada Kazuhiro, Sato Yuji, Fujimoto Shouichi
Nihon Toseki Igakkai Zasshi 50 ( 4 ) 255 - 260 2017
Language:Japanese Publishing type:Research paper (scientific journal) Publisher:The Japanese Society for Dialysis Therapy
Case 1: This case involved a 43-year-old female patient (original renal disease: diabetic nephropathy, hemodialysis duration: 5 years). She was admitted to our hospital to undergo treatment for right foot gangrene. At the time of her hospitalization, we detected multiple painful nodules on her abdominal region, which gradually progressed to multiple painful skin ulcers. The diagnosis was made based on a skin biopsy, which showed the typical findings of calciphylaxis (annular calcium deposition in the media of the small arteries). She was treated by adjusting her calcium (Ca) and phosphorus (P) levels and administering topical treatment and intravenous antibiotics; however, she ultimately died of sepsis. Case 2: This case involved a 42-year-old female patient (original renal disease: diabetic nephropathy, hemodialysis duration: 3 years). She was admitted to our hospital to undergo treatment for an intractable skin ulcer of the left toe. The diagnosis was made based on the pathological findings of a sample obtained during a local operation, which showed the typical findings of calciphylaxis. She was treated by discontinuing her warfarin therapy, adjusting her Ca and P levels, and administering topical treatment. Thereafter, her calciphylaxis lesion successfully improved. Calciphylaxis is a potentially fatal complication of end-stage renal disease and is characterized by medial calcification and intimal proliferation of the small arteries. Given that calciphylaxis is a rare disease, it is not easily recognized. However, calciphylaxis can cause intractable skin ulcers, so it should be considered during the differential diagnosis of hemodialysis patients with skin ulcers.
DOI: 10.4009/jsdt.50.255
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Effects of uroguanylin on natriuresis in experimental nephrotic rats
Baba A., Fujimoto S., Kikuchi M., Kita T., Kitamura K.
Nephrology 14 ( 1 ) 80 - 85 2009.2
Language:Japanese Publishing type:Research paper (scientific journal) Publisher:Nephrology
Aim: Uroguanylin, isolated from human and opossum urine, is a candidate intestinal natriuretic hormone that controls the sodium and water balance between the intestine and the kidneys. Levels of immunoreactive (ir)-uroguanylin in the plasma and urine are increased in rats and humans with nephrotic syndrome, which is physiologically characterized by sodium retention with massive proteinuria. The present study evaluates the effect of natriuresis induced by uroguanylin on nephrotic rats. Methods: Normal rats and rats rendered nephrotic by injections of puromycin aminonucleoside (PAN) were treated with uroguanylin (0.5 nmol/h, delivered by an osmotic pump) or with vehicle during the sodium retention phase. All rats consumed the same quantity of sodium. Results: Uroguanylin did not increase urinary excretion of sodium and water in normal rats, but significantly increased urinary sodium excretion during the sodium retention phase in nephrotic rats (untreated vs uroguanylin-treated nephrotic rats in mmol/mmol creatinine; 2.92 ± 0.65 vs 8.93 ± 2.53 on day 6, P < 0.05; 3.55 ± 0.47 vs 10.37 ± 1.73 on day 7, P < 0.01; 14.88 ± 2.32 vs 24.47 ± 2.86 on day 8, P < 0.05). Plasma levels of ir-uroguanylin in uroguanylin-treated nephrotic rats on day 6 were significantly increased compared with those in uroguanylin-treated control and untreated nephrotic rats. Conclusion: Uroguanylin increased urinary sodium excretion in rats with PAN-induced nephrosis, and might be useful for treating sodium retention in patients with nephrotic syndrome. © 2008 The Authors.
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An elderly male patient with central nervous system lupus undergoing hemodialysis
FUKUDA Akihiro, SATO Yuji, IWATSUBO Shuji, BABA Akiko, TATSUMOTO Mariko, NISHIURA Ryosuke, YAMADA Kazuhiro, HARA Seiichiro, FUJIMOTO Shouichi, ETO Tanenao
Nihon Naika Gakkai Zasshi 95 ( 6 ) 1109 - 1111 2006.6
Language:Japanese Publishing type:Research paper (scientific journal) Publisher:The Japanese Society of Internal Medicine
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BABA Akiko, HARA Seiichiro, SATO Yuji, YAMADA Kazuhiro, FUJIMOTO Shouichi, ETO Tanenao
The Japanese Journal of Nephrology 47 ( 8 ) 882 - 886 2005
Language:Japanese Publishing type:Research paper (scientific journal) Publisher:Japanese Society of Nephrology
We describe three female patients (ages 40, 62 and 63 y) with nephrotic syndrome due to membranous nephropathy complicated by Sjögren's syndrome (SS). The patients satisfied the criteria for SS, but not those for systemic lupus erythematosus (SLE). All of them developed nephrotic syndrome, and light immunofluorescence as well as electron microscopy of renal biopsy specimens revealed membranous nephropathy. Two were positive for the SS-A antibody, and the other was positive for the SS-B antibody. Two were complicated with primary biliary cirrhosis (PBC) and autoimmune thyroiditis, whereas the other was complicated with interstitial pneumonia, but not with either PBC or autoimmune thyroiditis. Prednisolone (PSL) with or without cyclophosphamide improved the nephrotic syndrome in two of the patients. In conclusion, some patients with SS might become complicated with nephrotic syndrome due to membranous nephropathy if another systemic autoimmune disease exists.