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Abstract

Y. Yang, K. Ohta, M. Shimizu, A. Nakai, Y. Kasahara, A. Yachie and S. Koizumi

¹Department of Pediatrics, Graduate School of Medical Science, and ²Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
Aim: IgA nephropathy associated with heavy proteinuria is considered a more progressive form of this disease. In this report, we describe the favorable clinical effect of combination therapy with low doses of an angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) in the chronic stage of pediatric IgA nephropathy associated with heavy proteinuria. Patients: We initially used ACEI for seven children with IgA nephropathy and heavy proteinuria who did not achieve remission with the routine treatment including steroids. Results: With ACEI therapy alone, only three patients showed an antiproteinuric response. In one of the three patients, the proteinuria decreased by half, but was still over 1 g/day. In the other four patients, the proteinuria did not decrease. In these five patients, of whom one partial was a responder and four were non-responders for ACEI, ARB was added, and in marked contrast to ACEI therapy alone, the antiproteinuric effect was significantly augmented (p < 0.01). The antiproteinuric response induced by combination therapy was not accompanied by blood pressure changes. Urinary low-molecular protein and N-acetyl-b-D-glucosaminidase (NAG) levels tended to decrease after both ACEI alone and combination therapy. Conclusion: These data indicate that inhibition therapy of the angiotensin system not only decreases proteinuria levels but also protects renal tubular cells. Moreover, there were no obvious side effects associated with this therapy during the follow-up period of our clinical trial. In conclusion, this report shows that the combination of low doses of ACEI and ARB might provide marked antiproteinuric and long-term renoprotective effects in pediatric IgA nephropathy, with this approach appearing to be both well-tolerated and safe.
Correspondence to:
Dr. K. Ohta Department of Pediatrics Graduate School of Medical Science Kanazawa University 13-1 Takaramachi Kanazawa, Ishikawa 920-8641, Japan
Email: [email protected]

Abstract

Y. Yang, K. Ohta, M. Shimizu, A. Nakai, Y. Kasahara, A. Yachie and S. Koizumi

Abstract

P.-F. Chiou, C.-C. Chang, Y.-K. Wen and Y. Yang

Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
Background: In the hemodialytic population, infections are the second leading cause of death; access infections account for a large proportion of this mortality. The antibiotic lock technique has been applied to infected tunneled catheters as rescue or prophylaxis medication to reduce infection rates. In addition, application of topical antibiotic ointments to tunneled and non-tunneled catheters also prevents exit site infections. Methods: 17 patients with 25 catheters participated in our study from March 2004 – February 2005. The catheter lock comprised of mixed cefazolin (5 mg/dl) with heparin (2,500 IU/ml) and mupirocin was topically applied to the area (2 × 2 cm) surrounding the catheter exit site. Results: The catheter infection rate was reduced from 12.7 times/1,000 catheter days to 5.02 times/1,000 catheter days in patients with jugular vein catheters. The total catheter-related infection rate was 14.9 times/1,000 catheter days in the control group and 4.1 times/1,000 catheter days in the study group. The reduction in catheter infections was more evident in a subgroup of non-diabetic patients, and in those with femoral catheters. Conclusion: The use of antibiotic lock and topical antibiotics significantly reduces the incidence of temporary catheter-related infections, especially in non-diabetic patients and in those with femoral catheters. Correspondence to:
Dr. C.-C. Chang
Division of Nephrology
Department of Internal Medicine
Changhua Christian Hospital
135, Nan-Shiao Street
Changhua, Taiwan, R.O.C.
Email: [email protected]

Abstract

W.C. Lin, Y. Yang, Y.K. Wen and C.C. Chang

¹Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, ²Institute of Environmental Health, China Medical University College of Public Health, Taichung, Taiwan
Objective and methods: There is a growing interest in the safety and efficacy of percutaneous kidney biopsy for outpatients in Taiwan. We conducted a retrospective study for patients receiving the biopsy in 2002 and 2003. Complication and mortality associated with the biopsy were compared between 147 inpatients and 183 outpatients who had been judged to need no hospitalization. All biopsies were performed using the ultrasound guidance and an automated spring-loaded biopsy device. Results: There were no death and no significant difference in complication rates between the two groups. No delayed gross hematuria, delayed pain, fever or biopsy site bleeding developed in outpatients, who were followed-up by telephone contacts for 1 – 5 days after they had been discharged. Both outpatients and inpatients with hematoma were younger than those without (p < 0.05). Template bleeding time was longer for inpatients with hematuria compared with inpatients without (12.0 vs. 5.8 minutes in average, p = 0.036), but not for outpatients (4.5 vs. 6.0 minutes in average, p = 0.282). There were moderate differences in platelet count between outpatients with hematuria and those without (p = 0.057), and in serum creatinine between inpatients with hematuria and those without (p = 0.069). Conclusion: The outpatient renal biopsy appears to be equally as safe and efficient as the inpatient biopsy. However, we suggest checking template bleeding time and platelet count before biopsy for patients with clinical bleeding tendency, such as patients with a serum creatinine level over 4 mg/dl (approaching CKD stages IV, V) due to a higher risk of prolonged bleeding time. Outpatient biopsy with a 6-hour inpatient observation can be considered as a medically adequate procedure.Correspondence to:
Y. Yang, MD, Director

Division of Nephrology

Department of Internal Medicine

Changhua Christian Hospital

135 Nansiao Street

Changhua 500, Taiwan
Email: [email protected]

Abstract

J.-W. Chang¹,³, H.-L. Tsai²,³, H.-H. Wang¹,³ and L.-Y. Yang¹,³

¹Department of Pediatrics, ²Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, ³Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
Background: Acute renal failure (ARF) is an important cause of morbidity and mortality in children. Here, we investigate etiology, comorbidities, outcome and risk factors associated with mortality in these children with ARF. Methods: We retrospectively reviewed the characteristics of 58 children with ARF diagnosed between January 1997 and December 2006 at a single institute. Factors including age, sex, clinical features and laboratory parameters were compared between survivors and non-survivors. Results: ARF was secondary to extrarenal causes in 79.3% of cases. Sepsis (18.9%), hematooncologic disease (18.9%) and cardiovascular disease (18.9%), were the main causes of ARF. Primary renal disease due to acute glomerulonephrits, nephrotic syndrome, hemolytic uremic syndrome and obstructive uropathy accounted for 20.7% of the cases. The overall mortality rate was 51.7%. There were no significant differences between survivors and non-survivors in gender and changes in the peak levels of calcium, phosphorous and uric acid levels. The mortality rate was significantly higher when ARF occurred in younger children (p = 0.019), secondary to systemic disease (p = 0.038, odds ratio 4.3; 95% confidence interval (CI) 1.0, 17.9), sepsis (p < 0.001, odds ratio 19.7; 95% CI 5.1, 76.4), use of ventilator (p < 0.001, odds ratio 35; 95% CI 6.7, 182.7), multiple organ failure (p < 0.001) and non-use of renal replacement therapy (p = 0.018, odds ratio, 3.6; 95% CI interval 1.2, 10.6) on univariate analysis. Multiple logistic regression analysis revealed that sepsis (p = 0.011, odds ratio, 11.3; 95% CI 1.7, 73.0) and numbers of organ failures (p = 0.001, odds ratio 8.14; 95% CI 2.5, 26.7) were independently associated with mortality. Conclusion: This study found that sepsis and number of organ failures were independent predictors of mortality in children with ARF.Correspondence to:
L.-Y. Yang, MD, PhD; Department of Pediatrics, Veterans General Hospital, No. 201, Section 2, Taipei, 11217, Taiwan
Email: [email protected]

Abstract

A.W. Davidoff¹, M.D. Hill², S.C. Cramer³, Y. Yang¹ and A. Moore¹

¹Stem Cell Therapeutics Corp., ²University of Calgary, Calgary, Alberta, Canada and ³Departments of Neurology and Anatomy & Neurobiology, University of California, Irvine, CA, USA
The current study was designed to compare blood and cerebrospinal fluid (CSF) pharmacokinetic characteristics of two forms of human chorionic gonadotropin (hCG): Pregnyl^®, derived from human urine, and Ovitrelle^® a recombinant form. Two separate groups, each with six older male human subjects, were dosed with either form of the drug at 10,000 IU intramuscularly (IM), and followed over a 36-hour period. No significant difference in the serum level of hCG was observed for either preparation of hCG (Peak serum conc.: 316 ± 53 vs. 270 ± 60 at 12 hours, 311 ± 38 vs. 321 ± 60 IU/l at 24 hours; AUC: 10,053 ± 1,268 vs. 8,793 ± 1,768, Pregnyl and Ovitrelle, mean ± SD, respectively). Additionally, both forms of circulating hCG distributed to the central nervous system (CNS) as manifest by an increased number of subjects whose CSF samples showed detectable levels of hCG in their CSF over a 36-hour period. Similarly, there was no significant difference between the two forms when distribution to the CSF was compared at 36 hours (2.0 and 1.2 IU/l; range 1.9 – 2.1 and 1 – 1.4 IU/l for Pregnyl and Ovitrelle, resp.). This preliminary study in normal human volunteers suggests that the two forms of hCG tested, Ovitrelle^® and Pregnyl^®, when administered IM, distribute in a similar fashion into the circulation and CSF. Consequently, we conclude that these two drugs demonstrate no statistical significant difference with respect to the CSF.Correspondence to:
Dr. A.W. Davidoff, PhD
Stem Cell Therapeutics Corp., Suite 1000
1520- 4th St. SW
Calgary, T2R 1H5, Canada
Email: [email protected]

Abstract

J.-W. Chang¹,³, H.-L. Tsai²,³ and L.-Y. Yang¹,³

¹Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ²Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, and ³Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
An 18-year-old female had received a 2 HLA incompatible renal transplant 10 years before. She initially presented with septic arthritis and osteomyelitis caused by Salmonella enterica co-infected with Staphylococcus aureus of her left knee with development of secondary septic arthritis of the right knee and left shoulder. This was complicated by a recurrent subcutaneous abscess and intermittent high fever. The infection was successfully treated with a combination of a prolonged course of antibiotics, twice joint washout and debridement, repeat aspiration, hyperbaric oxygen therapy and a total withdrawal of immunosuppressant resulting in good joint function and preservation of normal renal graft function. In our experience, it was possible to keep stable renal graft function in spite of complete withdrawal of immunosuppressants for 12 months in a recipient with 2 HLA mismatches.Correspondence to:
L.-Y. Yang MD, PhD
Department of Pediatrics
Veterans General Hospital, No. 201, Section 2
Shih-Pai road, Taipei, 11217 Taiwan
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 75 – Suppl. 1/2011 (S75-S78)

Tubulointerstitial nephritis and uveitis syndrome (TINU) with Fanconi’s syndrome

Y.-H. Yao¹,⁴, C.-C. Lin¹, Y.-M. Chung²,⁴, A.-H. Yang³,⁴, S.-Y. Li¹,⁴, C.-C. Lin¹,⁴, Y.-P. Lin¹,⁴, W.-C. Yang¹,⁴ and C.-Y. Yang¹,⁴

¹Division of Nephrology, Department of Medicine, ²Department of Ophthalmology, ³Department of Pathology, Taipei Veterans General Hospital, and ⁴School of Medicine, National Yang-Ming University, Taipei, Taiwan
We report a 57-year-old woman with concurrent tubulointerstitial nephritis and uveitis syndrome (TINU) and Fanconi’s syndrome. She presented with sudden onset of bilateral ocular pain, blurred vision, acute renal failure, glucosuria and proteinuria. Slit lamp examination revealed acute bilateral anterior uveitis. Tubulointerstitial nephritis was confirmed by kidney biopsy. Laboratory examination revealed normoglycemic glucosuria, proteinuria, normal anion-gap metabolic acidosis, phosphaturia, urinary uric acid wasting and kaliuresis leading to hypokalemia. Her vision and renal function improved gradually after systemic steroid therapy. There have been rare reports of TINU syndrome which had features of Fanconi’s syndrome. The prevalence of TINU syndrome may be underestimated, and its association with Fanconi’s syndrome requires further investigation.Correspondence to:
C.-Y. Yang, MD
Division of Nephrology
Department of Medicine
Taipei Veterans General Hospital, No. 201, Section 2
Shih-Pai Road, Taipei 11217, Taiwan
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 49 – No. 6/2011 (382-387)

Tardive dyskinesia in the treatment of schizophrenia: the findings of the Research on Asian Psychotropic Prescription Pattern (REAP) survey (2001 – 2009)

Y.-T. Xiang¹,², C.-Y. Wang², T.-M. Si³, E.H.M. Lee¹, Y.-L. He⁴, G.S. Ungvari⁵, H.F.K. Chiu¹, S.-Y. Yang⁶, M.-Y. Chong⁷, C.-H. Tan⁸, E.-H. Kua⁸, S. Fujii⁹, K. Sim¹⁰, K.H. Yong¹⁰, J.K. Trivedi¹¹, E.-K. Chung¹², P. Udomratn¹³, K.-Y. Chee¹⁴, N. Sartorius¹⁵ an

¹Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, ²Beijing
Anding Hospital, Capital Medical University, ³Institute of Mental Health, Peking University,
Beijing, ⁴Shanghai Mental Health Center, Shanghai, China, ⁵The University of
Notre Dame Australia/Marian Center, Perth, Australia, ⁶Taipei City Hospital, Taipei,
⁷Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung
University, Taiwan, ⁸National University of Singapore, Singapore, ⁹Hyogo Institute for
Traumatic Stress (HITS), Kobe, Japan, ¹⁰Institute of Mental Health, Bangkok View,
Singapore, ¹¹Department of Psychiatry, C.S.M. Medical University UP (erstwhile K.G.
Medical University) Lucknow, India, ¹²National Seoul Hospital, Seoul, Korea,
¹³Prince of Songkla University, Songkhla, Thailand, ¹⁴Department of Psychiatry and
Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital,
Malaysia, ¹⁵University of Geneva, Geneva, Switzerland, and ¹⁶School of Human
Sciences, Seinan Gakuin University Fukuoka, Japan
Objective: The aim of the study was to survey the frequency of tardive dyskinesia (TD) in patients with schizophrenia and its demographic and clinical correlates in selected Asian countries. Method: A total of 6,761 hospitalized schizophrenia patients in nine Asian countries and territories were examined from 2001 to 2009. TD was evaluated as “present” or “absent” according to the clinical judgment of experienced psychiatrists. The patients’ socio-demographic and clinical characteristics and the prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. Results: The frequency of TD in the whole sample was 5.0% with wide variations between countries (0 – 14.9%). Multiple logistic regression analysis showed that the following variables were independently associated with TD: study time, study site, older age, male gender, more severe negative and extrapyramidal symptoms and less anticholinergic drugs. Conclusions: A generally low frequency of TD in Asian schizophrenia patients with inter-ethnic variations was recorded. It is unclear whether the low prevalence of TD compared with Western data is real or the result of it being insufficiently recognized.Correspondence to:
Dr. Yu-Tao Xiang
Department of Psychiatry
Chinese University of Hong Kong
Ground Floor, Multicentre
Tai Po Hospital
Tai Po, N.T., Hong Kong
Email: [email protected]

Abstract

Nieren- und Hochdruckkrankheiten, Jahrgang 51, Nr. 7/2022, S. 267-288

Mangelernährung in der Schwangerschaft als unabhängiger Risikofaktor für erhöhtes Homocystein, Hyperurikämie, Hypercholesterinämie und Hypertonie der nächsten Generation am Beispiel der chinesischen Hungersnot von 1959 b

Y. Yang¹*, X. Hong¹*, J. Li², M. Xie¹, Y. Dong³, Z. Zou³, C. Zheng¹, C. Reichetzeder⁴, B.K. Krämer⁴, Y. Lv¹ und B. Hocher²#⁴#⁵#⁶

¹Key Laboratory of Molecular Epidemiology of Hunan Province, ²Key Laboratory of Studyand Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, HunanNormal University, Changsha, ³Institute of Child and Adolescent Health, School of PublicHealth, Peking University Health Science Center, Beijing, China, ⁴Fünfte Medizinische Klinik(Nephrologie/Endokrinologie/Rheumatologie), Universitätsklinikum Mannheim, UniversitätHeidelberg, Mannheim, ⁵Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha,China, ⁶Institut für Medizinische Diagnostik, IMD Berlin, Berlin
Eine Hungersnot in der frühen Kindheit wird mit Herz-Kreislauf-Erkrankungen im späteren Leben assoziiert. Ob biochemische Surrogate für Herz-Kreislauf-Erkrankungen, wie Homocystein und Harnsäure, ebenfalls mit der Hungersnot in Verbindung stehen, ist bisher unbekannt. Die Daten stammen aus einer bevölkerungsbezogenen Querschnittstudie in der chinesischen Provinz Hunan, die in den Jahren 1959 – 1961 stark von der Hungersnot betroffen war. Insgesamt wurden 1.150 Erwachsene ausgewählt, die zwischen 1952 und 1964 geboren wurden, und es wurden 5 Kohorten definiert: keine Exposition, fetale, frühkindliche, mittelkindliche und spätkindliche Exposition. Im Vergleich zur Gruppe ohne Hungerexposition hatten die Teilnehmer, die in ihrer fetalen Periode einer Hungersnot ausgesetzt waren, ein höheres Risiko für hohes Homocystein im Erwachsenenalter mit einer OR von 2,21 (95% KI: 1,01 – 4,83), während Hungerexpositionen in der frühen, mittleren oder späten Kindheit nicht signifikant mit hohem Homocystein im Erwachsenenalter assoziiert waren. Ebenso hatten die Teilnehmer der Gruppe mit fetaler Hungerexposition ein 1,59-fach höheres Risiko für Hyperurikämie (OR = 2,59, 95% KI: 1,07 – 5,30) und ein 2,03-fach höheres Risiko für hohes Low-Density-Lipoprotein-Cholesterin (LDL) (OR = 0,03, 95% KI: 1,35 – 6,78) im Erwachsenenalter im Vergleich zu denen ohne Hungerexposition. Darüber hinaus führten wir eine Metaanalyse durch, die 16 Studien über den Zusammenhang zwischen fetaler Hungersnot und Bluthochdruck im Erwachsenenalter umfasste, darunter auch unsere Studie. Die Metaanalyse, die 34.804 Probanden umfasste, zeigte, dass fetale Hungersnot mit einem höheren Risiko für Bluthochdruck im Erwachsenenalter verbunden ist (OR = 1,22, 95% KI: 1,07 – 1,40). Insgesamt ist die fetale Hungerexposition mit einem höheren Risiko für kardio-metabolische Ereignisse wie hohe Homocystein-, Hyperurikämie- und LDL-Werte sowie Bluthochdruck verbunden, was darauf hindeutet, dass Unterernährung während des fetalen Lebens den Stoffwechsel von Homocystein, Harnsäure und LDL im Erwachsenenalter beeinflussen kann.

*Yi-de Yang und Xiu-qin Hong trugen gleichermaßen bei

Erstpublikation in Clinical Nephrology, mit freundlicher Genehmigung der AutorenCorrespondence to:
Prof. Dr. Berthold Hocher
V. Medizinische Klinik (Nephrologie/ Endokrinologie/Rheumatologie)
Universitätsklinikum Mannheim
Universität Heidelberg, Standort Mannheim
Theodor-Kutzer-Ufer 1 – 3
68135 Mannheim
Email: [email protected]

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