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ABSTRACT: Kremezin is an oral adsorbent that attenuates the progression of chronic renal failure by removing uremic toxins and their precursors from the gastrointestinal tract. Previously two clinical studies based on reciprocal serum creatinine levels (1/Scr) have confirmed the efficacy of Kremezin (Kureha Chemical, Tokyo, Japan) in undialyzed patients who had been followed up for 6 months or 1 year. This is the first report to evaluate the therapeutic effects of long-term administration (2 years.) of Kremezin in undialyzed patients.
Kremezin was given to 48 enrolled undialyzed patients with a median Scr level of 4.3 mg/dL. Rates of decline of 1/Scr, as well as the time for Scr level to reach 10 mg/dL, the critical value requiring dialysis, were compared before and after administration of Kremezin.
During the 2-year therapeutic period, 1/Scr gradients were significantly attenuated (P = 0.0083), and the estimated time to dialysis was prolonged from 16.3 +/- 16.3 months to 29.8 +/- 24.1 months (P = 0.002). When the patients were divided into two groups, based on of systolic blood pressure (SBP), defined by the World Health Organization (WHO) classification, a significantly smaller number of patients in the low blood pressure group (SBP < 160 mmHg) were introduced to dialysis (P = 0.0005), and the estimated time to dialysis was significantly extended in the low blood pressure group (P = 0.0125).
In addition to the control of blood pressure in undialyzed patients, Kremezin has additive salutary effects to halt the progressive loss of renal function, resulting in the delay of dialysis.
International Journal of Urology 02/2005; 12(1):7-11. · 1.75 Impact Factor
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ABSTRACT: Recent studies have shown that nitric oxide (NO) synthases, particularly inducible nitric oxide synthase (i-NOS), are induced in acute rejection episodes following heart, liver, pancreas and kidney allotransplantation. Furthermore, tissue and cellular injury has been demonstrated to be mediated by peroxynitrite (ONOO-), a metabolite of NO as well as a potent oxidant. However, a detailed relationship between NO, i-NOS and graft injury in transplantation remains elusive.
The present study used the following models of renal transplantation in rats: allografts (n = 5, Brown-Norway to Lewis [LEW] rats), isografts (n = 5, LEW to LEW) and allografts treated with aminoguanidine (AG), an i-NOS inhibitor (n = 5). Blood urea nitrogen (BUN), serum creatinine (SCr) and urinary and serum nitrosocompounds (NOx) were measured on days 2, 4 and 7 post-transplant. Western blot analysis of i-NOS protein expression and measurement of i-NOS activity were carried out in grafts harvested on Day 7, along with immunohistochemical and histopathological examinations.
In the allograft group, both BUN and SCr levels increased markedly on Day 7, in parallel with a sharp increase in NOx. A band stained by anti-i-NOS antibody was detected at approximately 130 kDa, along with high levels of i-NOS activity and diffusely distributed i-NOS-positive cells (macrophages). Histologically, an acute rejection episode was confirmed (Grade 3 according to Banff classifications). In the AG group, reduced renal function and graft injury were significantly less severe than in the allograft group.
In rat renal allograft acute rejection, markedly increased levels of serum NOx were observed, along with enhanced tissue i-NOS activity, together resulting in graft injury. AG administration suppressed the increase of serum NOx levels, with concomitant mitigation of tissue injury and renal function impairment.
International Journal of Urology 11/2004; 11(10):837-44. · 1.75 Impact Factor
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ABSTRACT: In the present paper, two cases of malignant transformation of renal angiomyolipoma without tuberous sclerosis are reported. Pathological examination revealed that, in both cases, in addition to the areas affected by typical angiomyolipoma, there were areas that contained elevated numbers of perivascular epithelioid cells with prominent nuclear pleomorphism. Immunohistochemical examination revealed that both cases were negative for keratin and epithelial membrane antigen, but were positive for the melanogenesis-related marker HMB-45. Metastatic diseases appeared 40 months after radical nephrectomy in the first case and 18 months in the second case.
International Journal of Urology 06/2003; 10(5):271-3. · 1.75 Impact Factor
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ABSTRACT: A 46-year-old man complaining of transient dysuria. After digital examination and ultrasonography, computed tomography, magnetic resonance imaging and angiography, retrovesical tumor was suspected and tumor resection was performed. There was no adhesion to the adjacent organs, and histopathological diagnosis was a dermoid cyst. The patient is being followed up at our hospital without severe complications and recurrence. This is the third report of retrovesical dermoid cyst in a male in the world.
Hinyokika kiyo. Acta urologica Japonica 04/2003; 49(3):149-51.
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ABSTRACT: A 70-year-old man visited our hospital with the complaint of appetite loss. He had undergone an ileal conduit reconstruction due to bilateral ileo-ureteral stenosis 3 months before. Blood gas analysis showed metabolic acidosis (pH 7.091, pO2 120.5 mmHg, pCO2 20.9 mmHg, HCO3 6.1 mmHg), and blood analysis revealed serum chloride 121 mmol/l (normal range: 99-110). Sodium bicarbonate was immediately administered, his condition improved. We concluded that reabsorption of urine from the ileal conduit due to dehydration had caused hyperchloremic metabolic acidosis. He was given sodium bicarbonate 2 g per day, and his blood gas analysis and serum electrolytes remained within normal limits.
Hinyokika kiyo. Acta urologica Japonica 01/2003; 48(12):757-9.
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ABSTRACT: Since 1996, we have been using a modified Goodwin technique for orthotopic ileal neobladder replacement. We report on the surgical technique and the voiding function of ileal neobladder in 37 patients. A small bowel segment, 50 cm in length, was resected 20 cm proximal to the ileocecal valve. The small bowel loops were then arranged in a U shape. Vodiing function was evaluated in terms of voiding pattern, continence and urodynamic study. The mean follow-up period was 18 months (range 3 to 64). The mean maximum neobladder pressure in the storage phase was 15 cm water at 6 months, 12 at 12 months, and 7 at 24 months. The mean maximal urethral closed pressure was 52 cm water at 6 months, 51.7 at 12 months, and 66 at 24 months. The mean maximal urinary flow rate was 16.2 ml per second at 6 months, 17.6 at 12 months, and 20.8 at 24 months. The mean maximal neobladder capacity was 300 ml at 6 months, 302 ml at 12 months, 382 ml at 24 months. Among the 37 patients, 30 remained completely dry day and night. Three patients were incontinent only during the nighttime, and required only one pad. Four patients were wet day and night, and required 2 pads daily. Our results indicate that the modified Goodwin method appears to be an excellent technique for ileal neobladder replacement following cystectomy and seems successful in producing balanced voiding dynamics.
Hinyokika kiyo. Acta urologica Japonica 08/2002; 48(7):407-13.
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ABSTRACT: A 68-year-old male was admitted to our hospital with a complaint of asymptomatic gross hematuria. On physical examination, a huge mass was palpable in the lower abdomen. Computed tomography revealed a huge mass, 12 x 10 cm in size, in the urinary bladder and no metastatic lesions. The value of serum neuron specific enolase (NSE) was 32 ng/ml (normal range: 0-10 ng/ml). Histopathological and histochemical studies revealed neuroendocrine carcinoma which was positive for NSE, chromogranin A, S-100 and cytokeratin. He underwent neoadjuvant ballon occluded arterial infusion (BOAI) chemotherapy with cisplatin (CDDP). Total cystectomy and ileal conduit formation were performed at the preoperative diagnosis of T3N0M0. Examination of the resected specimen indicated a pathologically complete response and he was discharged. The patient is still alive with no evidence of any recurrence at 3 months after the operation. This case suggests that treatment with combined total cystectomy and neoadjuvant BOAI chemotherapy is effective against neuroendocrine carcinoma of the urinary bladder.
Hinyokika kiyo. Acta urologica Japonica 08/2002; 48(7):423-6.
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ABSTRACT: Although intravesical bacillus Calmette-Guerin (BCG) therapy is very effective in the treatment of and prophylaxis against superficial bladder cancer, its exact mechanism of action is not clear. In this study, the effect of BCG on telomerase activity was examined in the T24 and J82 bladder cancer cell lines, the ACHN human renal cell carcinoma cell line, and the PC-3 human prostate cancer cell line.
T24 and J82 cells were cocultured with BCG for 5 days. Telomerase activity was measured by telomeric repeat amplification protocol. Cell-cycle phase was determined by FACS analysis.
Telomerase activity in all cell lines provided high absorbance. Telomerase activity in BCG-treated T24 and J82 cells was significantly decreased when compared with that in the nontreated cells. On the other hand, telomerase activity did not change in ACHN and PC-3 cells after they had been cocultured with BCG. In BCG-treated T24 cells and J82 cells, apoptotic cells were markedly increased compared with those in the nontreated cells.
These results suggest that the reduction of telomerase activity is related to the mechanism of BCG effects. Possible mechanisms to be considered are either that BCG inhibits telomerase first, or that it induces apoptosis and decreases telomerase activity as a result of this induction.
International Journal of Clinical Oncology 07/2002; 7(3):165-70. · 1.41 Impact Factor
