論文 - 小松 弘幸
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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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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年
担当区分：筆頭著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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 査読あり
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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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. 医学教育モデル・コア・カリキュラム (令和4年度改訂版) と医師国家試験出題基準との整合 査読あり
小松 弘幸, 山脇 正永, 生坂 政臣, 江頭 正人, 小西 靖彦, 鈴木 敬一郎, 島田 昌一, 野村 理, 松山 泰, 矢野 晴美, 山本 憲, 尾上 剛史, 長谷川 仁志, 高見 秀樹, 岡崎 仁昭
医学教育 54 ( 2 ) 157 - 163 2023年4月
担当区分：筆頭著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本医学教育学会
今回改訂では, 医学教育モデル・コア・カリキュラム (コアカリ) の資質・能力「専門知識に基づいた問題解決能力 (PS) 」と医師国家試験出題基準との整合性を図った. 出題基準「必修の基本的事項」の『主要疾患・症候群』とコアカリ別表1の基本疾患, 「医学総論」の『症候, 診察, 検査, 治療』とコアカリ別表2の各項目, 「医学各論」の疾患とコアカリPS-02項目の疾患を対応させた. コアカリ収載疾患は「国試出題基準の改訂に向けた研究」の出題レベル分類表による評価結果を用いて妥当性を検証し, 約690疾患を選定した. コアカリ疾患数への初めての言及と基本疾患 (約200) の提示により, 医学部で学修すべき疾患の検討が今後深まることを期待する.
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A digest from evidence-based clinical practice guideline for IgA nephropathy 2020 査読あり
Suzuki H., Kikuchi M., Koike K., Komatsu H., Matsuzaki K., Takahashi K., Ichikawa D., Okabe M., Obata Y., Katafuchi R., Kihara M., Kohatsu K., Sasaki T., Shimizu A., Nakanishi K., Fukuda A., Miyazaki Y., Muto M., Yanagawa H., Suzuki Y., Fujimoto S., Furuichi K., Okada H., Narita I.
Clinical and Experimental Nephrology 25 ( 12 ) 1269 - 1276 2021年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Clinical and Experimental Nephrology
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Distinct characteristics and outcomes in elderly-onset IgA vasculitis (Henoch-Schonlein purpura ) with nephritis: Nationwide cohort study of data from the Japan Renal Biopsy Registry (J-RBR) 査読あり
Komatsu H, Fujimoto S, Maruyama S, Mukoyama M, Sugiyama H, Tsuruya K, Sato H, Soma J, Yano J, Itano S, Nishino T, Sato T, Narita I, Yokoyama H.
PLOS ONE 2018年5月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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医学生の臨床実習後の臨床能力自己評価と学習方略に関する9大学合同調査 査読あり
小松弘幸, 石川和信, 首藤太一, 阿部恵子, 藤崎和彦, 吉田素文, 大槻眞嗣, 泉美貴, 鈴木敬一郎, 石川鎮清, 廣橋一裕
医学教育 47 ( 4 ) 271 - 279 2016年11月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Clinical Manifestations of Henӧch-Schӧnlein purpura nephritis and IgA nephropathy: comparative analysis of data from the Japan Renal Biopsy Registry (J-RBR) 査読あり
Komatsu H，Fujimoto S, Yoshikawa N, Kitamura, H, Sugiyama H, Yokoyama H
Clinical and Experimental Nephrology 20 ( 4 ) 552 - 560 2016年8月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria 査読あり
Komatsu H, Sato Y, Miyamoto T, et al.
Clinical and Experimental Nephrology 20 ( 1 ) 94 - 102 2016年2月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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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．
小松弘幸
宮崎県医師会医学会誌 2016年
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Long-term survival of patients with IgA nephropathy after dialysis therapy. 査読あり
Komatsu H, Kikuchi M, Nakagawa H, Fukuda A, Iwakiri T, Toida T, Sato Y, Kitamura K, Fujimoto S
Kindey and Blood Pressure Research 37 ( 6 ) 649 - 655 2013年12月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Tonsillectomy Delays Progression of Advanced IgA Nephropathy to End-Stage Kidney Disease 査読あり
Komatsu Hiroyuki,Fujimoto Shouichi,Kikuchi Masao,Sato Yuji,Kitamura Kazuo
Renal Failure 34 ( 4 ) 449 - 454 2012年4月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Recent therapeutic strategies improve renal outcome in patients with IgA nephropathy 査読あり
Komatsu H, Fujimoto S, Hara S, Fukuda A, Fukudome K, Sato Y, and Yamada K, Kitamura K
American Journal of Nephrology 30 ( 1 ) 19 - 25 2009年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Effect of tonsillectomy plus steroid pulse therapy on clinical remission of IgA nephropathy: A controlled study 査読あり
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Kitamura K
Clin J Am Soc Nephrol 3 2008年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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‘Point of no return (PNR)’ in progressive IgA nephropathy: Significance of blood pressure and proteinuria management up to PNR. 査読あり
Komatsu H, Fujimoto S, Sato Y, Hara S, Morita S, Yamada K, Eto T
Journal of Nephrology 18 ( 12 ) 690 - 695 2005年12月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Multivariate analysis of prognostic factors and effect of treatment in patients with IgA nephropathy 査読あり
Komatsu H, Fujimoto S, Hara S, Nakao H, Sato Y, Yamada K, Eto T
Renal Failure 27 ( 1 ) 51 - 59 2005年1月
担当区分：筆頭著者 記述言語：英語 掲載種別：研究論文（学術雑誌）
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Relationship between serum IgA/C3 ratio and progression of IgA nephropathy. 査読あり
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Eto T
Internal Medicine 43 ( 11 ) 1023 - 1028 2004年11月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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宮崎大学医学部附属病院・臨床研修プログラム 「内科合同研修コース」の取り組み 査読あり
宮内俊一、森林耕平、小田康晴、鈴木翔、谷口智明、樋口和宏、木許恭宏、大平洋明、緑川沙樹、後藤智子、小松弘幸
宮崎県医師会医学会誌 48 ( 2 ) 209 - 214 2024年9月
担当区分：最終著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）