Yasuhiro Akai

Yasuhiro Akai
Nara Medical University · Department of Internal Medicine I

About

117
Publications
6,112
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3,941
Citations
Citations since 2017
37 Research Items
1458 Citations
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250

Publications

Publications (117)
Article
Association of preoperative regular use of anti-adrenergic agents with postoperative acute kidney injury (AKI) and with trajectory of kidney function after AKI is still unknown. In a retrospective cohort study, adults undergoing non-cardiac surgery under general anesthesia were included. Obstetric or urological surgery, missing data, or preoperativ...
Article
Full-text available
Patient data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) are used to assess the effect of biguanide administration on rates of lactic acidosis (LA) in hospitalized diabetes mellitus (DM) patients. In this retrospective cohort study (from April 2013 to March 2016), we compare DM inpatients prescr...
Article
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Background Prognosis of nephrotic syndrome has been evaluated based on pathological diagnosis, whereas its clinical course is monitored using objective items and the treatment strategy is largely the same. We examined whether the entire natural history of nephrotic syndrome could be evaluated using objective common clinical items. Methods Machine...
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Previous studies reported conflicting results regarding an association between serum albumin concentration and the cumulative incidence of remission of proteinuria in adult patients with minimal change disease (MCD). The present study aimed to clarify the clinical impact of serum albumin concentration and the cumulative incidence of remission and r...
Article
Background The relationship between kidney function at 3 months after acute kidney injury (AKI) and kidney function prognosis has not been characterized. Methods This retrospective cohort study included adults who underwent non-cardiac surgery under general anesthesia. Exclusion criteria included obstetric or urological surgery, missing data, and...
Article
Background: Minimal change disease (MCD) is characterized by a nephrotic syndrome usually steroid-sensitive and a high incidence of relapse of proteinuria. Previous cohort studies have reported conflicting results regarding the association between the time to remission and incidence of relapse. Methods: This multicenter prospective cohort study...
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Importance: The Simple Postoperative AKI Risk (SPARK) index is a prediction model for postoperative acute kidney injury (PO-AKI) in patients undergoing noncardiac surgery. External validation has not been performed. Objective: To externally validate the SPARK index. Design, setting, and participants: This single-center retrospective cohort stu...
Article
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Background A dose of 0.5–1 mg/kg/day of prednisolone (PSL) is administered for the initial treatment of minimal change disease (MCD). However, little is known about the optimal PSL dose for the initial treatment of MCD. Methods We conducted a retrospective multicenter cohort study of treatment-naive adult patients with MCD diagnosed by renal biops...
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Introduction This study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes. Research design and methods This retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals w...
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Background This study was conducted to investigate whether acute kidney injury (AKI) is an independent predictor of anemia and whether anemia following AKI is a mediator of mortality after AKI. Methods This is a retrospective cohort study. Adults with noncardiac surgery from 2007 to 2011 were included. Obstetric or urological surgery, missing data...
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Introduction: There are fewer reports about whether the presence of hematuria affects the progression of chronic kidney disease in patients with diabetic nephropathy. We analyzed whether microscopic hematuria in diabetic nephropathy is a risk factor for end-stage kidney disease (ESKD). Research design and methods: The present study was a retrosp...
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Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type....
Article
Background The aim of the present study was to clarify the prevalence of immunosuppressive drug use and outcomes in elderly and non-elderly patients with primary membranous nephropathy (MN) in nationwide real-world practice in Japan.Patients and methodsBetween 2009 and 2010, 374 patients with primary nephrotic syndrome were enrolled in the cohort s...
Article
Aims Diabetic nephropathy, a pathologically diagnosed microvascular complication of diabetes, is a strong risk factor for cardiovascular events, which mainly involve arteries larger than those affected in diabetic nephropathy. However, the association between diabetic nephropathy pathological findings and cardiovascular events has not been well stu...
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Background Despite recent advances in immunosuppressive therapy for patients with primary nephrotic syndrome, its effectiveness and safety have not been fully studied in recent nationwide real-world clinical data in Japan.MethodsA 5-year cohort study, the Japan Nephrotic Syndrome Cohort Study, enrolled 374 patients with primary nephrotic syndrome i...
Article
Background: Little is known about the association between pre-operative proteinuria and post-operative acute kidney injury (AKI) in noncardiac surgery. Methods: This is a retrospective cohort study. Adults who underwent noncardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University Hospital were included. Those with obs...
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This retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non–cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obstetric surgery, missing data, and pre-operative dia...
Article
Background Little is known about the association between intra-operative fluid balance (IFB) and post-operative acute kidney injury (AKI) in non-cardiac surgery. Methods This is a retrospective cohort study. Adults who underwent non-cardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University Hospital were included. Those...
Article
Background Acute kidney injury (AKI) is associated with higher mortality and cardiovascular events. However, association between AKI and non-cardiac events such as infection or malignancy is largely unknown. Methods This is a retrospective cohort study. Inclusion criteria were adults who underwent non-cardiac surgery from 2007 to 2011 at Nara Medi...
Data
Figure S1 ¦ Flowchart of the analysis set and reproducibility analysis set in the phase 3 study. Figure S2 ¦ Flowchart for the implementation analysis set in the phase 3 study. Table S1 ¦ Domain scores and Cronbach's α coefficients. Table S2 ¦ Reproducibility analysis test. Table S3 ¦ Intraclass correlation coefficient.
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We report the case of a 45-year-old female with generalized morphea (GM), who exhibited positivity for the anti-centromere antibody (Ab). She frequently developed multiple sclerotic skin lesions, whose histological findings were compatible with morphea. She demonstrated favorable responses to topical and oral steroids. Cases of GM associated with s...
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Aims/Introduction Although patient self‐efficacy is known to affect adherence to therapy, no available tool measures self‐efficacy of insulin therapy administration while addressing the entire therapeutic process and management. In light of this, we developed the “Insulin Therapy Self‐efficacy Scale (ITSS)”. Materials and Methods Development of th...
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In the original publication, second author's name was incorrectly published as Hiroki Shin. The correct name should read as 'Koki Shin'.
Article
Background: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods: Between 2009 and 2010, 380 patients with primar...
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Introduction: To measure the burden of pharmacotherapy on patients with type 2 diabetes mellitus (T2DM), we developed the Diabetes Treatment Burden Questionnaire (DTBQ), a patient-administered questionnaire composed of 18 questions, and evaluated its reproducibility and validity. Methods: We enrolled 240 patients with T2DM under pharmacotherapy...
Article
Paroxysmal nocturnal hemoglobinuria is a rare clonal hematopoietic stem cell disorder characterized by intravascular hemolysis, hemoglobinuria, and inflammatory thrombotic state. Intravascular hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) can lead to acute and chronic renal injury through hemoglobin-mediated toxicity. A 32-year-old pregnan...
Conference Paper
Background In the treatment of patients with rheumatoid arthritis (RA), glucocorticoids (GCs) with csDMARDs remain an important treatment option given their capacity to increase clinical, structural and functional efficacy. On the other hand, it is reported that GCs usage even at low dosage significantly deteriorated functional capacity in patients...
Article
Technique failure remains a frequent cause of peritoneal dialysis (PD) withdrawal. Many post-commencement predictors of PD technique failure have been identified, while predialysis predictors have remained unclear. The aim of this study was to identify predialysis indices for technique failure in PD patients. We recruited 206 consecutive PD patient...
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Aims/introduction: To compare the treatment satisfaction of four classes of oral hypoglycemic agents (OHAs): dipeptidyl peptidase-4 (DPP-4) inhibitors, α-glucosidase inhibitors (αGI), biguanides (BG), and sulfonylureas (SU), which are common initial treatments for type 2 diabetes mellitus patients in Japan, and to identify the best OHA in terms of...
Article
Autosomal-dominant polycystic kidney disease (ADPKD) is the most prevalent cystic kidney disease, with approximately half of the patients reaching end-stage renal disease by the age of 60. Tolvaptan prevents renal cyst growth by inhibiting intracellular cyclic AMP and is recommended for patients with ADPKD. Reports of thrombotic complications with...
Article
Approximately 200 patients with diabetes annually develop end-stage kidney disease due to progression of diabetic kidney disease in Nara, Japan. We performed a survey to assess the current status of diabetic kidney disease in Nara. We recruited 38,766 patients with diabetes (mean age, 68 ± 13 years; Male, 57 %) from August 2013 to July 2014 in 171...
Article
Background Certolizumab pegol (CZP) is a PEGylated Fab' fragment of a humanized anti-TNF antibody and it brings rapid improvement of the signs and symptoms of RA. Musculoskeletal ultrasound (US) has been proved to be useful at assessing synovitis precisely in patients with RA. There are few reports, however, that verify the early response to CZP in...
Article
Background: Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family that acts as a pleiotropic cytokine capable of stimulating angiogenesis and accelerating atherogenesis. Soluble fms-like tyrosine kinase-1 (sFlt-1) antagonizes PlGF action. Higher levels of PlGF and sFlt-1 have been associated with cardiovascula...
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Background: Low-dose aspirin is widely recommended for patients at high risk for cardiovascular disease (CVD); however, it remains uncertain whether long-term treatment adversely affects renal function in patients with diabetes. We investigated whether long-term low-dose aspirin affects renal dysfunction in patients with diabetes. Methods: We co...
Article
Background: Placental growth factor (PlGF), a member of the vascular endothelial growth factor (VEGF) family, has recently emerged as a predictor of survival and cardiovascular risk. Along with others, we have shown an independent association between PlGF and cardiovascular events in CKD patients, but not much is known about patients receiving dia...
Article
Background Disease activity score (DAS) 28 and simplified disease activity index (SDAI) and clinical disease activity index (CDAI) are often used for clinical assessment, and these criteria dose not include assessment of joints in the feet. Residual synovitis of the MTP joints and various factors such as inflammatory marker, drugs and weght-bearing...
Article
To evaluate the subclinical articular involvement in patients with primary Sjögren's syndrome (pSS) using musculoskeletal ultrasound (MSUS), and to correlate the findings with laboratory results and clinical manifestations. Forty-eight consecutive patients with pSS were enrolled. The bilateral MCP, PIP, and IP joints were examined using MSUS, and t...
Article
Placental growth factor (PlGF) contributes to atherogenesis through vascular inflammation and plaque destabilization. High levels of PlGF may be associated with mortality and cardiovascular disease, but the relationship between PlGF level and adverse outcomes in patients with CKD is unclear. We conducted a prospective cohort study of 1351 consecuti...
Article
A 24-year-old man was admitted to our hospital for persistent proteinuria. He was born with a low birth weight but had grown up uneventful until the age of 20 when he was found to have proteinuria. Because his body mass index was 30.9 kg/m2 at that time, he was diagnosed as obesity-related nephropathy. However, weight reduction and administration o...
Article
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Systemic reactive AA amyloidosis is a life-threatening complication of chronic inflammatory diseases. Anti-interleukin-6 receptor, tocilizumab (TCZ), has been shown to improve clinical symptoms of patients with AA amyloidosis, accompanied with regression of the amyloid deposition. We report a case of AA amyloidosis evaluated by histology of multipl...
Article
Background: It is important to establish glycemic markers which reflect accurate glycemic status in advanced chronic kidney disease (CKD) patients; however, adequate glycemic markers have not been established. We evaluated the accuracy of glycemic markers in non-dialysis CKD patients. Patients and methods: 139 non-dialysis CKD patients with diab...
Article
Background Achieving remission is essential for avoiding joint destruction and disability in patients with rheumatoid arthritis (RA). Tumor necrosis factor inhibitors (TNFi) therapies represent an important advancement in therapy for RA. However, there remains a proportion of patients who do not improve despite TNFi therapies. Recently, Terao et al...
Article
Background Bisphosphonates are the first-line therapy for osteoporosis treatment though the long-term persistence and adherence to bisphosphonates remain low (1-2). This medication noncompliance has serious consequences as it is associated with higher morbidity and mortality (3-6). Objectives To explore patient preferences for the osteoporosis medi...
Article
Background Musculoskeletal ultrasound (MSUS) is useful in monitoring rheumatoid arthritis (RA) and is emphasized its high sensitivity for detecting synovitis and good correlation with clinical disease activity indices, such as Disease Activity Score (DAS28) and Simplified Disease Activity Index (SDAI). While power Doppler ultrasound (PDUS) is widel...
Article
Aims/Introduction Patients with diabetic nephropathy (DN) typically show varying degrees of proteinuria and renal impairment. Because these clinical signs are frequently observed in other glomerulopathies, renal biopsy is required to make a definitive diagnosis of DN. We carried out the present study to evaluate the significance of renal biopsy for...
Article
Recently, plasma globotriaosylsphingosine (lyso-Gb3) has attracted attention as a biomarker of Fabry disease. However, we found a subset of Fabry disease patients who did not show any increase in the plasma lyso-Gb3 concentration, although other patients exhibited apparent enhancement of it. This subset predominantly exhibited the clinical phenotyp...
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Simple hepatic cysts are usually asymptomatic and are not associated with impaired hepatic function. However, complications, such as obstructive jaundice, rupture, intracystic haemorrhage and infection, can occur. The authors describe the case of a 82-year-old man with fever and elevated C-reactive protein. A repeat contrast-enhanced abdominal CT s...
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Hypercalciuria is one of the early manifestations of diabetic nephropathy. We explored here the role of α-Klotho, a protein expressed predominantly in distal convoluted tubules that has a role in calcium reabsorption. We studied 31 patients with early diabetic nephropathy and compared them with 31 patients with IgA nephropathy and 7 with minimal ch...
Article
We previously reported that fibroblast-specific protein 1 (FSP1) is a marker of epithelial-mesenchymal transition (EMT) in tubulointerstitial fibrosis. The EMT-like changes observed in podocytes are reportedly associated with podocyte detachment which may cause focal glomerulosclerosis. In cross-sectional studies, we analyzed podocyte expression of...
Article
Fibroblast-specific protein 1 (FSP1)-expressing cells accumulate in damaged kidneys, but whether urinary FSP1 could serve as a biomarker of active renal injury is unknown. We measured urinary FSP1 in 147 patients with various types of glomerular disease using ELISA. Patients with crescentic GN, with or without antinuclear cytoplasmic antibody-assoc...
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Type 2 diabetes accompanied by renal damage is a strong risk factor for atherosclerotic events. The purpose of this study was to investigate the efficacy of low-dose aspirin therapy on primary prevention of atherosclerotic events in patients with type 2 diabetes and coexisting renal dysfunction. The Japanese Primary Prevention of Atherosclerosis Wi...
Article
A 52-year-old woman was admitted to our hospital for treatment of nephrotic syndrome. Funduscopic findings showed fundal hemorrhage and soft exudates, and serologic analysis showed a monoclonal serum component that was identified as Bence Jones protein-k type. A bone marrow biopsy showed diffuse proliferation of atypical plasma cells, while a renal...
Article
Renal dysfunction is commonly accompanied by a worsening of atherosclerosis; however, the underlying molecular mechanism is not fully understood. We examined the role played by soluble fms-like tyrosine kinase-1 (sFlt-1), an endogenous antagonist of the proatherogenic cytokine placental growth factor (PlGF), in the worsening of atherosclerosis in p...
Article
Depletion of glomerular podocytes is an important feature of progressive diabetic nephropathy. Although the most plausible explanation for this podocyte depletion is detachment from the glomerular basement membrane after cellular apoptosis, the mechanism is unclear. Fibroblast-specific protein 1 (FSP1; encoded by the S100A4 gene) is a member of the...
Article
A 50-year-old woman was admitted for active rheumatoid arthritis (RA). She was found to have RA 1 year prior to this admission. Past history was unremarkable and she had no family history for rheumatic diseases. As nonsteroidal anti-inflammatory drug (NSAID) and methotrexate were not effective, etanercept was started (25 mg, twice a week). Mild ele...
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Chronic hypoxia accelerates renal fibrosis. The chief mediator of the hypoxic response is hypoxia-inducible factor 1 (HIF-1) and its oxygen-sensitive component HIF-1alpha. HIF-1 regulates a wide variety of genes, some of which are closely associated with tissue fibrosis. To determine the specific role of HIF-1 in renal fibrosis, we generated a knoc...
Article
SUMMARYTGF-β1 is involved in the pathogenesis of glomerular sclerosis. We studied the intraglomerular expression of TGF-β1 mRNA in patients with glomerulonephritis using competitive polymerase chain reaction (PCR). This method is sensitive enough to quantify cDNA copies of mRNA present in small amounts of samples. Renal biopsy specimens were obtain...
Article
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Corticosteroids are frequently used to treat patients with active IgA nephropathy (IgAN); however, there have been few reports describing factors that are predictive of the response to corticosteroid treatment. The purpose of this study is to determine the extent to which fibroblast-specific protein 1-positive (FSP1(+)) cells are predictive of cort...
Article
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Hypoxia has been proposed as an important microenvironmental factor in the development of tissue fibrosis; however, the underlying mechanisms are not well defined. To examine the role of hypoxia-inducible factor-1 (HIF-1), a key mediator of cellular adaptation to hypoxia, in the development of fibrosis in mice, we inactivated Hif-1alpha in primary...
Article
Fractalkine (Fkn) is a chemokine that affects cells expressing its receptor, CX3CR1, including CD16-positive (CD16+) monocytes/macrophages (CD16+ Mos). The relationship of levels of glomerular Fkn expression and infiltration by CD16+ Mos with the severity and diversity of glomerular lesions in human lupus nephritis is not known. Retrospective cross...
Article
Our objective was to investigate the plasma levels of brain and atrial natriuretic peptides (BNP and ANP, respectively) in patients with septic shock/severe sepsis and to study the association of BNP and ANP levels with hemodynamic parameters, severity of the disease, and prognosis of those patients. This is a prospective case series study of 22 pa...
Article
A 49-year-old woman with a history of chronic hepatitis C virus infection and Hashimoto disease was admitted to our hospital because of proteinuria, hematuria, purpura, and edema in the lower extremities. Laboratory data on admission revealed proteinuria (0.2 g/day), microscopic hematuria (3+) with RBC casts, renal dysfunction(serum creatinine 1.4...
Article
Full-text available
Ischemic acute renal failure is a frequent clinical problem in hospitalized patients and is associated with significant mortality. Hypoxia-inducible factor 1 (HIF-1) mediates cellular adaptation to hypoxia by regulating biological processes important for cell survival, which include glycolysis, angiogenesis, erythropoiesis, apoptosis, and prolifera...
Article
A 69-year-old man was admitted to our hospital for evaluation of increasing edema. The laboratory findings showed that he had nephrotic syndrome. CT scan and MRI demonstrated a solid mass with a diameter of 4.0 cm in the upper pole of the left kidney. Total left nephrectomy was performed on twenty-eighth day after admission. The histopathology of t...
Article
We report a case of hypokalemic nephropathy associated with primary Sjögren's syndrome (SS). The patient presented with profound and persistent hypokalemia secondary to distal renal tubular acidosis (RTA). A renal biopsy exhibited tubular degeneration, marked interstitial fibrosis and intense macrophage infiltration. Hypokalemia has been reported t...
Article
Background: There is little direct evidence that fibroblasts are involved in the progression of the renal interstitial fibrosis in human glomerulonephritis. With the availability of a new specific marker for fibroblasts, we determined the presence of fibroblasts in kidneys with IgA nephropathy (IgAN) and correlated their numbers with various clini...