Original
Renal biopsy in patients aged 80 years and older: a single-center experience in Japan
Ayumi Omokawa, Atsushi Komatsuda, Mizuho Nara, Takashi Fujiwara, Ryuta Sato, Masaru Togashi, Shin Okuyama, Ken-ichi Sawada and Hideki Wakui
Price
42.00 $
Volume 77 (2012) p. 461 - 467
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (461-467)
Renal biopsy in patients aged 80 years and older: a single-center experience in Japan
Ayumi Omokawa, Atsushi Komatsuda, Mizuho Nara, Takashi Fujiwara, Ryuta Sato, Masaru Togashi, Shin Okuyama, Ken-ichi Sawada and Hideki Wakui
Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
Background: There is a paucity of data on renal biopsy in a large number of the very elderly (age ≥ 80 years) worldwide. Methods: Clinicopathological features in 73 patients aged ≥ 80 years were evaluated and compared with control groups of 172 patients aged 60 – 61 years and 128 patients aged 70 – 71 years. Results: The common indications for biopsy in the very elderly were nephrotic syndrome (NS), followed by proteinuria without NS and/or hematuria, and acute kidney injury (AKI). Histological diagnoses were considered to potentially modify treatment in 57 cases (78.1%): the most frequent diagnosis was membranous nephropathy, followed by minimal change disease, and various other diseases. There were no biopsy procedure-related serious complications. Clinical assessment of treatments was evaluated in 38 of 54 patients with AKI and/or NS. Improvement in renal dysfunction or NS was observed in 24 of 30 (80%) patients who received immunosuppressive therapy. There were statistically significant differences in the disease spectrum between the very elderly and control groups. Conclusions: This is the first report of renal biopsy findings in a relatively large number of Japanese very elderly patients. Histological observations are useful aids in estimating the prognosis and therapy selection for renal disorders, even in the very elderly.Correspondence to:
Ayumi Omokawa, MD
Department of Hematology, Nephrology, and
Rheumatology
Akita University Graduate School of Medicine
1-1-1 Hondo, Akita City, Akita 010-8543, Japan
Email: [email protected]
Nephrology Education
Proliferative glomerulonephritis with monoclonal IgG deposits in a patient with autoimmune hemolytic anemia
Takashi Fujiwara, Atsushi Komatsuda, Hiroshi Ohtani, Masaru Togashi, Ken-ichi Sawada and Hideki Wakui
Price
42.00 $
Volume 79 (2013) p. 494 - 497
Abstract
Clinical Nephrology, Vol. 79 – No. 6/2013 (494-498)
Proliferative glomerulonephritis with monoclonal IgG deposits in a patient with autoimmune hemolytic anemia
Takashi Fujiwara1, Atsushi Komatsuda1, Hiroshi Ohtani2, Masaru Togashi1, Ken-ichi Sawada1 and Hideki Wakui1
1Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, and 2Department of Nephrology and Dialysis, Akita Kumiai General Hospital, Akita, Japan
A 25-year-old woman was admitted because of proteinuria. A renal biopsy showed mesangial/endocapillary proliferative glomerulonephritis with IgG2-κ deposits. Electron microscopy showed immune complex-type deposits. She also had Coombs-positive hemolytic anemia, anticardiolipin antibodies, and antinuclear antibodies. Middle-dose steroid therapy led to improvement of proteinuria and hemolytic anemia. Six years later, she developed crescentic glomerulonephritis with IgG2-κ deposits during pregnancy. Middle-dose steroid therapy improved renal dysfunction. This is an exceptional case of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID), a recently described rare dysproteinemia-related glomerulonephritis, associated with autoimmune disease. This case also suggests that crescentic glomerulonephritis can be superimposed on PGNMID.Correspondence to:
Atsushi Komatsuda, MD
Department of Hematology, Nephrology, and Rheumatology
Akita University Graduate School of Medicine
1-1-1 Hondo, Akita City, Akita 010-8543, Japan
Email: [email protected]
Nephrology Education
Membranoproliferative glomerulonephritis with unusual deposits of parallel arrangement striated structure: a new pathological entity?
Kensei Yahata, Yuko Kikuchi, Mitsuteru Koizumi, Koichi Seta, Hideki Wakui, Atsushi Komatsuda, and Akira Shimizu
Price
42.00 $
Volume 89 (2018) p. 123 - 129
Abstract
Clinical Nephrology, Vol. 89 – No. 2/2018 (123-129)
Membranoproliferative glomerulonephritis with unusual deposits of parallel arrangement striated structure: a new pathological entity?
Kensei Yahata1, Yuko Kikuchi1, Mitsuteru Koizumi1, Koichi Seta1, Hideki Wakui2, Atsushi Komatsuda3, and Akira Shimizu4
1Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, 2Department of Life Science, Akita University Graduate School of Engineering Science, Akita, 3Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, and 4Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
A 71-year-old male with a past history of lower limb arteriosclerosis obliterans developed nephrotic syndrome and renal dysfunction. Renal biopsy showed diffuse global endocapillary proliferative lesions with infiltration of mononuclear cells and occasional foam cells. An irregular double contour of the glomerular basement membrane and global mild-to-moderate mesangial proliferative lesions were observed, indicating membranoproliferative glomerulonephritis. Congo red staining was negative. Routine immunofluorescence studies showed no obvious immunoglobulin or complement depositions. Electron microscopy showed endocapillary proliferative lesions and infiltration of macrophages with abundant lysosomes. Irregular subepithelial, subendothelial, and mesangial electron-dense deposits were observed in glomeruli. In these electron-dense deposits, parallel arrangement striated structures were detected. All known disease entities with Congo red-negative and immunoglobulin-negative glomerular deposits were pathologically excluded. The glomerular lesion in our case might be a new disease entity.
Correspondence to:
Kensei Yahata, MD
Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa Mukaihata-cho, Fushimi-ku,
Kyoto 612-8555, Japan
Email: kenseiyahata@
yahoo.co.jp
case studies
Disappearance of a thrombotic microangiopathy-like glomerular lesion in a patient with a placental site trophoblastic tumor after hysterectomy
Masato Sawamura, Atsushi Komatsuda, Mizuho Nara, Masaru Togashi, Hideki Wakui, and Naoto Takahashi
Volume 6 (2018) p. 27 - 30
Abstract
Clinical Nephrology – Case Studies, Vol. 6/2018 (27-30)
Disappearance of a thrombotic microangiopathy-like glomerular lesion in a patient with a placental site trophoblastic tumor after hysterectomy
Masato Sawamura1, Atsushi Komatsuda1, Mizuho Nara1, Masaru Togashi1, Hideki Wakui2, and Naoto Takahashi1
1Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, and 2Department of Life Science, Akita University Graduate School of Engineering Science, Akita, Japan
A 32-year-old woman presented with amenorrhea after a normal childbirth and subsequently developed nephrotic syndrome. Renal biopsy showed a thrombotic microangiopathy (TMA)-like glomerular lesion with deposits of immunoglobulins, complements, and fibrinogen. Increased serum levels of the beta subunit of human chorionic gonadotropin, abnormal uterine findings from imaging studies, and endometrial biopsy findings suggested gestational trophoblastic disease. She was diagnosed with a placental site trophoblastic tumor (PSTT) after hysterectomy and, following treatment, her proteinuria disappeared. Follow-up renal biopsy showed the disappearance of the TMA-like lesion. To our knowledge, this is the first case report of the pathological remission of renal disease associated with PSTT.Correspondence to:
Dr. Atsushi Komatsuda, Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, Akita 010-8543, Japan
Email: [email protected]
case studies
Membranous nephropathy with solitary polyclonal IgA deposition: A case report and literature review
Masato Sawamura, Atsushi Komatsuda, Hajime Kaga, Ayano Saito, Tadashi Yasuda, Hideki Wakui, Kensuke Joh, and Naoto Takahashi
Volume 7 (2019) p. 60 - 65
Abstract
Clinical Nephrology – Case Studies, Vol. 7/2019 (60-65)
Membranous nephropathy with solitary polyclonal IgA deposition: A case report and literature review
Masato Sawamura1, Atsushi Komatsuda1, Hajime Kaga1, Ayano Saito1, Tadashi Yasuda2, Hideki Wakui3, Kensuke Joh4, and Naoto Takahashi1
1Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 2Department of Internal Medicine, Honjo Daiichi Hospital, 3Department of Life Science, Akita University Graduate School of Engineering Science, Akita, and 4Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
A 60-year-old man presented with nephrotic syndrome (NS). Light microscopy of renal biopsy specimens showed minor glomerular abnormalities, while immunofluorescence microscopy revealed solitary polyclonal granular IgA deposition along the glomerular capillary walls. Electron microscopy showed small amounts of electron-dense deposits in the subepithelial area, but not in the mesangial area. In this patient, apparent underlying disease was not found during the 3-year follow-up, and low-dose prednisolone was effective in the treatment of NS. To our knowledge, there is only one case report of membranous nephropathy with clinicopathological features similar to our case.Correspondence to:
Atsushi Komatsuda, MD, Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, Akita 010-8543, Japan
Email: [email protected]
Original
Long-term prognosis of monoclonal immunoglobulin-associated glomerular diseases with non-organized deposits: A report of 38 cases from a Japanese single center
Mizuho Nara, Atsushi Komatsuda, Masato Sawamura, Fumito Abe, Hajime Kaga, Ayano Saito, Masaya Saito, Chihiro Imaizumi, Hiroshi Nanjo, Hideki Wakui, and Naoto Takahashi
Price
42.00 $
Volume 98 (2022) p. 135 - 145
Abstract
Clinical Nephrology, Vol. 98 – No. 3/2022 (135-146)
Long-term prognosis of monoclonal immunoglobulin-associated glomerular diseases with non-organized deposits: A report of 38 cases from a Japanese single center
Mizuho Nara1, Atsushi Komatsuda2, Masato Sawamura1, Fumito Abe1, Hajime Kaga1, Ayano Saito1, Masaya Saito1, Chihiro Imaizumi1, Hiroshi Nanjo3, Hideki Wakui4, and Naoto Takahashi1
1Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, 2Department of Internal Medicine, Ogachi Central Hospital, Yuzawa, 3Division of Clinical Pathology, Akita University Hospital, Akita, and 4Department of Life Science, Graduate School of Engineering Science, Akita University, Akita, Japan
Monoclonal immunoglobulin (MIg)-associated glomerular diseases with non-organized deposits are rare disorders. They have recently been categorized into light chain deposit disease (LCDD), light and heavy chain deposit disease (LHCDD), heavy chain deposit disease (HCDD), proliferative glomerulonephritis with MIg deposits (PGNMID) and its light chain only variant (PGNMID-LC), and membranous glomerulopathy with light chain-restricted deposits (MG-LC). In our Japanese cohort of more than 9,500 patients who underwent renal biopsy (1979 – 2020), we evaluated clinicopathological features and long-term outcomes in 38 patients with MIg-associated glomerular diseases with non-organized deposits: LCDD (n = 9), LHCDD (n = 8), HCDD (n = 5), PGNMID-membranoproliferative glomerulonephritis (MPGN) (n = 7), PGNMID-LC (n = 2), and MG-LC (n = 7). In patients with LCDD, a low estimated glomerular filtration rate (eGFR) at biopsy, a high detection rate of urinary MIgs, a high incidence rate of multiple myeloma, and sever tubulointerstitial and vascular lesions were significant clinicopathological characteristics. Median duration of follow-up in each group was 42 – 114 months. Most patients were treated with steroid-based therapy. Patients with LCDD, LHCDD, HCDD, and MG-LC were recently treated with bortezomib-based therapy. Renal survival rate was significantly shorter for LCDD than of PGNMID and MG-LC. Patient survival rate was significantly longer for MG-LC than HCDD and PGNMID. Major causes of death were pulmonary and cardiovascular complications. Among disease groups, significant differences were observed in eGFR at biopsy, detection rates of urinary MIgs, incidence rates of multiple myeloma, severities of tubulointerstitial and vascular lesions, and long-term outcomes.
Correspondence to:
Mizuho Nara, MD
Department of Hematology, Nephrology, and Rheumatology
Akita University Graduate School of Medicine
1-1-1 Hondo, Akita City, Akita 010-8543, Japan
Email: [email protected]
