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Faculty of Medicine Center for the Support and Development of Medical Professionals Department of Clinical Education |
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KOMATSU Hiroyuki
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Degree 【 display / non-display 】
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Doctor of Philosophy in Medicine ( 2005.3 University of Miyazaki )
Research Areas 【 display / non-display 】
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Life Science / Nephrology
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Life Science / Medical management and medical sociology / 医学教育学
Papers 【 display / non-display 】
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Komatsu H., Fujimoto S., Sato Y., Yasuda T., Yasuda Y., Matsuzaki K., Hirano K., Kawamura T., Yokoo T., Suzuki Y., Maruyama S.
Clinical and Experimental Nephrology 28 ( 12 ) 1272 - 1281 2024.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical and Experimental Nephrology
Background: The effects of tonsillectomy combined with steroid pulse (TSP) therapy for IgA nephropathy (IgAN) are little known. Therefore, we examined the effects of TSP therapy on the kidney outcomes of IgAN in a large, nationwide cohort study in Japan. Methods: Between 2002 and 2004, 632 IgAN patients with ≥ 0.5 g/day proteinuria at diagnosis were divided into three groups with mild (0.50–0.99 g/day; n = 264), moderate (1.00–1.99 g/day, n = 216), or severe (≥ 2.00 g/day; n = 153). Decline in kidney function and urinary remission were compared among the three groups after TSP therapy, corticosteroid (ST) therapy, or conservative therapy during a mean follow-up of 6.2 ± 3.3 years. 10.6% and 5.9% of patients in the ST and conservative therapy group underwent tonsillectomy. Results: The rate of urinary remission at the final observation was significantly higher in the TSP therapy group than in the ST or conservative therapy groups (mild proteinuria: 64%, 43%, and 41%; moderate proteinuria: 51%, 45%, and 28%; severe proteinuria: 48%, 30%, and 22%, respectively). In contrast, the rate of a 50% increase in serum creatinine was lower in groups TSP therapy, than ST or conservative therapy (mild proteinuria: 2.1%, 10.1% and 16.7%; moderate proteinuria: 4.8%, 8.8% and 27.7%; severe proteinuria: 12.0%, 28.9% and 43.1%, respectively). In multivariate analysis, TSP therapy significantly prevented a 50% increase in serum creatinine levels compared with conservative therapy in groups with moderate and severe proteinuria (hazard ratio, 0.12 and 0.22, respectively). Conclusion: TSP significantly increased the rate of proteinuria disappearance and urinary remission in IgAN patients with mild-to-moderate urinary protein levels. It may also reduce the decline in kidney function in patients with moderate-to-severe urinary protein levels.
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Nomura O., Komatsu H., Matsuyama Y., Onoue T., Ikusaka M., Okazaki H., Konishi Y.
Medical Teacher 46 ( sup1 ) S61 - S66 2024
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Medical Teacher
Background: Discrepancies existed between the medical knowledge sections of the Model Core Curriculum for Medical Education (MCC) and the Guidelines for the National Examination for Medical Practitioners (GNEMP) in Japan. These discrepancies have been one of the underlying factors hindering the development of learner-centered medical education in the country. The project team responsible for the ‘Problem-Solving’ section of the MCC aimed to address discrepancies between the disease lists in the MCC and the GNEMP. Method: We refined the disease list for the 2022 revision of the MCC using a three-phase process: (a) procedure development, (b) selection, and (c) adjudication. First, we developed a scoring system for sifting and prioritizing diseases in the GNEMP, selecting those that met our scoring criteria. An expert adjudication panel then finalized the list of diseases through discussion. Results: Among the 1,456 diseases identified in the GNEMP, 781 met the selection criteria. The adjudication panel selected 56 of these diseases to be newly added to the 2022 MCC, resulting in a total of 691 diseases. Conclusions: The list of diseases defined as required medical knowledge in the MCC was finalized through dialogue among medical education stakeholders, effectively minimizing discrepancies between the MCC and GNEMP.
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Current treatment status of IgA nephropathy in Japan: a questionnaire survey Reviewed
Matsuzaki K., Suzuki H., Kikuchi M., Koike K., Komatsu H., Takahashi K., Narita I., Okada H.
Clinical and Experimental Nephrology 27 ( 12 ) 1032 - 1041 2023.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical and Experimental Nephrology
Background: In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan. Methods: A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021. Results: A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to “always” or “often.” Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the “Clinical Guidelines for IgA nephropathy in Japan, 3rd version” and the “Oxford classification” were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the “Clinical Guidelines for IgA nephropathy in Japan, 3rd version” was referred to for risk stratification. The prescription rate of renin–angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5–1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5–1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use. Conclusion: Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan.
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Yano Y., Nagasu H., Kanegae H., Nangaku M., Hirakawa Y., Sugawara Y., Nakagawa N., Wada J., Sugiyama H., Nakano T., Wada T., Shimizu M., Suzuki H., Komatsu H., Nakashima N., Kitaoka K., Narita I., Okada H., Suzuki Y., Kashihara N.
Nephrology 2023.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Nephrology
Aim: Among patients with Immunoglobulin A (IgA) nephropathy, we aimed to identify trajectory patterns stratified by the magnitude of haematuria and proteinuria using repeated urine dipstick tests, and assess whether the trajectories were associated with kidney events. Methods: Using a nationwide multicentre chronic kidney disease (CKD) registry, we analysed data from 889 patients with IgA nephropathy (mean age 49.3 years). The primary outcome was a sustained reduction in eGFR of 50% or more from the index date and thereafter. During follow-up (median 49.0 months), we identified four trajectories (low-stable, moderate-decreasing, moderate-stable, and high-stable) in both urine dipstick haematuria and proteinuria measurements, respectively. Results: In haematuria trajectory analyses, compared to the low-stable group, the adjusted hazard ratios (HRs) (95% confidence interval [CI]) for kidney events were 2.59 (95% CI, 1.48–4.51) for the high-stable, 2.31 (95% CI, 1.19–4.50) for the moderate-stable, and 1.43 (95% CI, (0.72–2.82) for the moderate-decreasing groups, respectively. When each proteinuria trajectory group was subcategorized according to haematuria trajectories, the proteinuria group with high-stable and with modest-stable haematuria trajectories had approximately 2-times higher risk for eGFR reduction ≥50% compared to that with low-stable haematuria trajectory. Conclusion: Assessments of both haematuria and proteinuria trajectories using urine dipstick could identify high-risk IgA nephropathy patients.
DOI： 10.1111/nep.14250
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4. Alignment of the 2022 Revision of the Model Core Curriculum for Medical Education in Japan with the‘Standards of the National Medical Practitioners Qualifying Examination' Reviewed
Komatsu Hiroyuki, Yamawaki Masanaga, Ikusaka Masatomi, Eto Masato, Konishi Yasuhiko, Suzuki Keiichiro, Shimada Shoichi, Nomura Osamu, Matsuyama Yasushi, Gomi Harumi, Yamamoto Akira, Onoue Takeshi, Hasegawa Hitoshi, Takami Hideki, Okazaki Hitoaki
Igaku Kyoiku / Medical Education (Japan) 54 ( 2 ) 157 - 163 2023.4
Authorship：Lead author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Society for Medical Education
In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.
Books 【 display / non-display 】
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エビデンスに基づくIgA腎症診療ガイドライン2020
成田一衛、藤元昭一、鈴木祐介、小松弘幸、他（ Role： Contributor）
東京医学社 2020.8
Total pages：78 Responsible for pages：43-45，55-58 Language：Japanese Book type：Scholarly book
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IgA腎症の病態と治療
富野康日己、川村哲也、鈴木祐介、他（ Role： Joint editor）
中外医学社 2019.11
Language：Japanese Book type：Scholarly book
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日常診療の中で学ぶプロフェッショナリズム
宮田靖志、小泉俊三、他（ Role： Joint editor）
カイ書林 2018.7
Language：Japanese Book type：Scholarly book
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エビデンスに基づくCKD腎症診療ガイドライン2018
岡田浩一、安田宣成、他（CKD診療ガイド・ガイドライン改定委員会）（ Role： Joint editor）
東京医学社 2018.6
Language：Japanese Book type：Scholarly book
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エビデンスに基づくIgA腎症診療ガイドライン2017
藤元昭一、鈴木祐介、佐々木環、湯澤由紀夫、片渕律子、後藤眞、小松弘幸、鈴木仁、板野精之、高橋和男、酒巻裕一、渡辺博文、福田顕弘（ Role： Joint editor）
東京医学社 2017.6
Total pages：130 Responsible for pages：64-68, 79-81, 121-127 Language：Japanese Book type：Scholarly book
MISC 【 display / non-display 】
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第1回宮崎県病院内メディカルラリー開催
小松弘幸
日州医事 ( 825 ) 19 - 21 2018.5
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (other) Publisher：宮崎県医師会
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平成29年度「All Miyazaki研修医スタートアップセミナー＆ウェルカムパーティ」開催報告
小松弘幸
日州医事 ( 814 ) 24 - 26 2017.6
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (other) Publisher：宮崎県医師会
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平成28年度「宮崎県内視鏡外科アニマルラボセミナーin佐土原」開催報告
小松弘幸
日州医事 ( 807 ) 30 - 33 2016.11
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (other) Publisher：宮崎県医師会
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IgA腎症の現状と宮崎大学の取り組み Invited
小松弘幸
宮崎県医師会医学会誌 40 ( 2 ) 95 - 102 2016.9
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal)
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医師養成制度変革の現状と宮崎大学医療人育成支援センターの使命・挑戦 Invited
小松弘幸
宮崎県医師会医学会誌 40 ( 2 ) 87 - 94 2016.9
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal)
Presentations 【 display / non-display 】
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Impact of tonsillectomy on renal survival in patients with IgA nephropathy. International conference
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Eto T
ASN Renal Week 2003, 36th Annual Meeting (San Diego, CA, USA) American Society of Nephrology
Event date： 2003.11.12 - 2003.11.17
Language：English Presentation type：Poster presentation
Venue：San Diego, CA, USA
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Serum IgA/C3 ratio in patients with IgA nephropathy:The marker of the histological severity and treatment efficacy. International conference
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Eto T
ASN Renal Week 2003, 36th Annual Meeting (San Diego, CA, USA) American Society of Nephrology
Event date： 2003.11.12 - 2003.11.17
Language：English Presentation type：Poster presentation
Venue：San Diego, CA, USA
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Significance of ‘Point of No Return’ in progressive IgA nephropathy. International conference
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Eto T
ASN Renal Week 2004, 37th Annual Meeting (St. Louis, Missouri, USA) American Society of Nephrology
Event date： 2004.10.27 - 2004.11.1
Language：English Presentation type：Poster presentation
Venue：St. Louis, Missouri, USA
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A prospective cohort study on the effect of tonsillectomy combined with steroid pulse on IgA nephropathy. International conference
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Eto T
ASN Renal Week 2005, 38th Annual Meeting (Philadelphia, Pennsylvania, USA) American Society of Nephrology
Event date： 2005.11.8 - 2005.11.13
Language：English Presentation type：Poster presentation
Venue：Philadelphia, Pennsylvania, USA
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A repeat biopsy study on the effect of tonsillectomy combined with steroid pulse therapy on IgA nephropathy. International conference
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Eto T
ASN Renal Week 2006, 39th Annual Meeting (San Diego, California, USA) American Society of Nephrology
Event date： 2006.11.14 - 2006.11.19
Language：English Presentation type：Oral presentation (general)
Venue：San Diego, California, USA
Grant-in-Aid for Scientific Research 【 display / non-display 】
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AIによる対話技術を活用した模擬患者アバターでの仮想空間医療面接教育基盤の創生
Grant number：24H00170 2024.04 - 2029.03
独立行政法人日本学術振興会 科学研究費補助金 基盤研究(A)
Authorship：Coinvestigator(s)