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Books: 0	Journals: 2	Articles: 7

Abstract

Clinical Nephrology, Vol. 81 – No. 6/2014 (440-444)

Chaga mushroom-induced oxalate nephropathy

Yuko Kikuchi¹, Koichi Seta¹, Yayoi Ogawa², Tatsuya Takayama³, Masao Nagata³, Takashi Taguchi⁴, and Kensei Yahata¹

¹Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, ²Hokkaido Renal Pathology Center, Sapporo, ³Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, and ⁴Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Chaga mushrooms have been used in folk and botanical medicine as a remedy for cancer, gastritis, ulcers, and tuberculosis of the bones. A 72-year-old Japanese female had been diagnosed with liver cancer 1 year prior to presenting at our department. She underwent hepatectomy of the left lobe 3 months later. Chaga mushroom powder (4 – 5 teaspoons per day) had been ingested for the past 6 months for liver cancer. Renal function decreased and hemodialysis was initiated. Renal biopsy specimens showed diffuse tubular atrophy and interstitial fibrosis. Oxalate crystals were detected in the tubular lumina and urinary sediment and oxalate nephropathy was diagnosed. Chaga mushrooms contain extremely high oxalate concentrations. This is the first report of a case of oxalate nephropathy associated with ingestion of Chaga mushrooms.Correspondence to:
Kensei Yahata, MD
Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa Mukaihatacho, Fushimi-ku, Kyoto 612-8555, Japan
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 87 – No. 1/2017 (51-54)

Thrombotic microangiopathy associated with cetuximab, an epidermal growth factor receptor inhibitor 

Mitsuteru Koizumi, Masahiro Takahashi, Maki Murata, Yuko Kikuchi, Koichi Seta, Kensei Yahata 

Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
Cetuximab is a chimeric human-murine monoclonal antibody that binds competitively and with high affinity to the epidermal growth factor receptor (EGFR) and is used to treat advanced squamous cell carcinoma of the head and neck. After receiving a total of six doses of cetuximab, a 72-year-old male presented with pretibial edema, acne-like skin rash, and nephrotic syndrome. The renal biopsy findings revealed features of thrombotic microangiopathy (TMA), with the expansion of the subendothelial zone, reduplication of the glomerular basement, and swelling of the endothelial cells. Nine weeks after the discontinuation of cetuximab, his pretibial edema had disappeared and proteinuria decreased. To our knowledge, this is the first report in which kidney biopsy revealed evidence of TMA due to cetuximab administration. Our report suggests that it may be prudent to monitor patients receiving cetuximab closely for the possible development of nephrotic syndrome. Correspondence to:
Mitsuteru Koizumi, MD
Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa,  Mukaihata-cho, Fushimi-ku,
Kyoto 612-8555, Japan 
Email: mit-koiz@ rb4.so-net.ne.jp

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

Abstract

Clinical Nephrology, Vol. 90 – No. 5/2018 (357-362)

Idiopathic immune complex-mediated tubulointerstitial nephritis with hypocomplementemia and neutrophil-rich interstitial infiltrates 

Haruka Ikuta¹, Jaegi Shim¹, Masahiro Takahashi¹, Mitsuteru Koizumi¹, Koichi Seta¹, Shigeo Hara², and Kensei Yahata¹

¹Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, and ²Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Hyogo, Japan
A 69-year-old man presented with acute kidney injury, hypocomplementemia, antinuclear antibody, and anti-dsDNA antibody. He had no signs of systemic lupus erythematosus or Sjögren syndrome. He had not begun taking any new drugs in the preceding 6 months. Kidney biopsy revealed 13 glomeruli, 3 with global sclerosis. The remaining glomeruli showed slight mesangial proliferation. The interstitial inflammation was extensive, comprising mainly mature lymphocytes and plasma cells, neutrophils, and a few eosinophils. Remarkable granular and diffuse deposition of IgG and C1q was observed along the tubular basement membranes. Electron microscopy showed electron-dense deposits in the tubular basement membrane. Immunohistochemistry showed only 1 – 4 IgG4-positive plasma cells per high-power field and an IgG4/CD138 ratio of ~ 10%. He was treated with oral prednisolone 35 mg/day, and his kidney function gradually improved. This is a unique case that is not consistent with any known disease entities with immune complex-mediated tubulointerstitial nephritis. 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

Abstract

Clinical Nephrology – Case Studies, Vol. 11/2023 (72-78)

A case of malignant hypertension as a presentation of atypical hemolytic uremic syndrome

Chiaki Omiya¹, Kenichi Koga¹, Keisuke Nishioka¹, Akira Sugawara¹, Yuka Sugawara², Yoko Yoshida², Yoichiro Ikeda², and Kensei Yahata¹

¹Department of Nephrology, Osaka Red Cross Hospital, Osaka, and ²Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
Introduction: Malignant hypertension (mHTN) damages multiple target organs, including the kidneys. mHTN has been regarded as one of the causes of secondary thrombotic microangiopathy (TMA); however, a high prevalence of complement gene abnormalities was recently reported in cohorts of mHTN. Case report: We herein describe a 47-year-old male who presented with severe hypertension, renal failure (serum creatinine (sCr): 11.6 mg/dL), heart failure, retinal hemorrhage, hemolytic anemia, and thrombocytopenia. Renal biopsy findings were consistent with acute hypertensive nephrosclerosis. The patient was diagnosed with secondary TMA associated with mHTN. However, his previous medical history of TMA of unknown origin and family history of atypical hemolytic uremic syndrome (aHUS) suggested as aHUS presenting mHTN, and genetic testing revealed a pathogenic C3 mutation (p.I1157T). The patient required plasma exchange and hemodialysis for 2 weeks and was able to withdraw from dialysis by antihypertensive therapy without eculizumab. Renal function gradually improved to a sCr level of 2.7 mg/dL under antihypertensive therapy for 2 years after the event. There was no recurrence, and renal function was preserved throughout a 3-year follow-up. Discussion: mHTN is a common presentation of aHUS. In cases of mHTN, abnormalities in complement-related genes may be involved in the development of the disease.Correspondence to:
Kenichi Koga, MD, PhD, Department of Nephrology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka-shi, Osaka 543-8555, Japan
Email: [email protected]

Abstract

Clinical Nephrology – Case Studies, Vol. 13/2025 (89-95)

Acute renal cortical necrosis following postpartum hemorrhage – successful discontinuation of peritoneal dialysis: A case report

Chiho Fukushima, Kenichi Koga, Masako Hasebe, Chiaki Omiya, Keisuke Nishioka, and Kensei Yahata

Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
Renal cortical necrosis (RCN) is a rare but severe cause of acute kidney injury primarily observed in obstetric complications. We herein present a case of RCN in a 32-year-old Mongolian primigravida transferred to our hospital with uncontrolled massive postpartum hemorrhage. Contrastenhanced computed tomography revealed ongoing uterine hemorrhage, prompting endovascular intervention for control. It also showed the loss of cortical perfusion in the kidneys, while preserving medullary blood flow, which is consistent with RCN. The patient remained anuric from transfer and required continuous hemodiafiltration followed by intermittent hemodialysis. Renal biopsy on day 23 revealed coagulative necrosis in glomeruli and tubules in the outer cortex, consistent with RCN, while glomeruli in the deeper cortex were spared. Glomeruli in the outer cortex displayed glomerular paralysis. The patient transitioned to peritoneal dialysis (PD) to facilitate infant care at home. Over 6 months, renal function improved, allowing dialysis discontinuation. Four years post-discharge, she remains free of renal replacement therapy, with serum creatinine of 2.67 mg/dL. The present case highlights the potential for gradual renal function improvement in RCN through the recovery of residual nephrons. PD may be a promising modality for patients with RCN.Correspondence to:
Kenichi Koga, MD, PhD, Department of Nephrology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka-shi, Osaka 543-8555, Japan
Email: [email protected]

Abstract

Clinical Nephrology – Case Studies, Vol. 13/2025 (96-102)

Membranous nephropathy in Kimura disease: A case report and literature review on renal biopsy findings

Motoki Murata, Kenichi Koga, Satoshi Yamaoka, Masako Hasebe, Chiho Fukushima, Chiaki Omiya, and Kensei Yahata

Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
Kimura disease (KD) is a chronic benign granulomatous disease. Approximately 20% of patients with KD have renal disease. Membranous nephropathy (MN) is one of the main renal pathologies in KD; however, the underlying mechanism remains unknown. We herein present a 28-year-old male diagnosed with KD after biopsy of a left lower eyelid mass 11 years earlier. He visited our hospital with edema in the lower legs and scrotum. A blood test showed a serum creatinine level of 0.95 mg/dL and serum albumin level of 0.9 g/dL. Urinalysis revealed heavy proteinuria with mild hematuria. Renal biopsy showed spike formation by PAM staining and granular deposits of IgG and C3 in the glomerular basement membrane by direct immunofluorescence microscopy (IF). Electron microscopy revealed subepithelial electron-dense deposits (EDD). IF staining for the phospholipase A2 receptor (PLA2R) was positive in the glomerular basement membrane, leading to a diagnosis of PLA2Rassociated MN. Our literature review on MN in KD included 14 cases, all of which exhibited subepithelial EDD, while subendothelial EDD was absent in 10. PLA2R staining was positive in 2 of the 3 cases examined. The results of this case and the literature review suggest the involvement of autoantibodies against podocyte antigens in the pathogenesis of MN in KD. Further studies are needed on these antigens.Correspondence to:
Kenichi Koga, MD, PhD, Department of Nephrology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka-shi, Osaka 543-8555, Japan
Email: [email protected]

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