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Abstract

Y. Mori, H. Yamashita, Y. Umeda,Y.U. Uchiyama-Tanaka, A. Nose,N. Kishimoto, Y. Kijima, T. Nagata,M. Mori, H. Matsubara, H. Yoshida and T. Iwasaka

¹Department of Medicine II, Kansai Medical University, Osaka, and
²Department of Clinical Laboratory Medicine, Fukui Medical University,
Fukui, Japan
An otherwise healthy 20-year-old woman presented with an erythematous rash on her face as well as arthralgia and anemia. She also had systemic edema, proteinuria and hypertension. Laboratory data on admission showed hypocomplementemia, human parvovirus B19 (HPV) DNA and both immunoglobulin (Ig) M and IgG antibodies to HPV in her serum. Renal biopsy specimens showed features of endocapillary glomerulonephritis under light microscopy. Electron microscopy showed massive subendothelial electron-dense deposits. No cause was probable other than immune complex-mediated glomerulonephritis associated with HPV infection. In a review of this and similar cases reported in the literature, several characteristic features come to light: female dominance, onset in the second or third decade of life, hypocomplementemia, histologic renal endocapillary and/or mesangioproliferative glomerulonephritis with subendothelial deposits and spontaneous recovery.

Abstract

N. Kishimoto, Y. Mori, T. Nishiue, Y. Shibasaki, O. Iba, A. Nose, Y. Uchiyama-Tanaka, H. Masaki, H. Matsubara and T. Iwasaka

¹Renal Division and ²Cardiovascular Center, Department of Medicine II, Kansai Medical University, Osaka, Japan
Background: An accessible non-invasive method for evaluating renal regional blood flow in real time is highly desirable in the clinical setting. Recent progress in ultrasonography with microbubble contrast has allowed quantification of regional blood flow in animal models. Aims: Goal of this study was to establish a convenient contrast-enhanced harmonic ultrasonography (CEHU) method for evaluating renal cortical blood flow in humans. Methods: We carried out intermittent second harmonic imaging in 9 healthy volunteers. Pulse interval was progressively decreased from 4 s ? 0.2 s during continuous venous infusion of the microbubble contrast agent. Results: Pulse interval versus CEHU-derived acoustic intensity plots provided microbubble velocity (MV) and fractional vascular volume (FVV) during renal cortical perfusion in humans. Low-dose dopamine infusion (2 mg/min/kg) resulted in a significant increase in MV which correlated well with the increase in total renal blood flow (RBF) determined by a conventional study of p-aminohippurate clearance (CPAH) (r = 0.956, p < 0.0001). Although FVV was not significantly increased, alterations in CEHU-derived renal cortical blood flow calculated by the products of MV and FVV were also correlated with alterations in total RBF (r = 0.969, p < 0.0001). Thus, low-dose dopamine infusion increases renal cortical blood flow observed in CEHU, mainly by increasing MV. Conclusions: The present study shows that renal cortical blood flow in humans can be measured non-invasively by CEHU and that CEHU can be used for quantitatively evaluating changes induced by a therapeutic agent such as dopamine in flow velocity and in FVV.

Abstract

Y. Uchiyama-Tanaka, Y. Mori, N. Kishimoto, A. Nose, Y. Kijima, T. Nagata, Y. Umeda, H. Masaki, H. Matsubara and T. Iwasaka

Renal Division and ²Cardiovascular Center, Department of Medicine II, Kansai Medical University, Osaka, Japan
We describe the case of a 51-year-old man with hepatitis C virus (HCV) infection and a 3-month history of facial edema. Laboratory tests upon admission for renal biopsy showed normal renal function and normocomplementemia. Serum HCV antibody (Ab) and cryoglobulin were positive. Renal biopsy specimens showed features of membranous glomerulonephritis. The likely cause was immune complex-mediated glomerulonephritis associated with HCV infection. Reports of similar cases in the literature show the normocomplementemia and negative or slightly positive cryoglobulins observed in our case as well as seropositivity for circulating immune complexes containing HCV RNA. In our case, electron microscopic examination of the subepithelial glomerular lesions revealed massive virus-like particles within unusual multilayers of electron-dense deposits (EDDs), suggesting the existence of HCV in the glomeruli. In the addition to the unique histopathological feature the presence of La/SS-B antibody in his serum indicated an abnormal immune response associated with HCV. We advise him to undergo the therapy with new type of IFN such as pegIFN-a2a and/or anti-viral agent like ribavirin to achieve clinical and histopathological improvement.

Abstract

T. Matsuo, Y. Mori, T. Hashimoto, M. Tajima, T. Okado, Y. Tsukamoto, Y. Kobayashi and S. Sasaki

Abstract

N. Kishimoto, Y. Mori, H. Yamahara, Y. Kijima, A. Nose, Y. Uchiyama-Tanaka, T. Tokoro, T. Nagata, Y. Umeda, N. Takahashi, H. Yoshida and H. Matsubara

¹Division of Cardiology and Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, ²Department of Medicine II, Kansai Medical University, Osaka, and ³Division of Nephrology, University of Fukui Hospital, Fukui, Japan
Renal deterioration often occurs in cases of infectious endocarditis (IE), but, IE- associated nephritis with rapidly progressive glomerulonephritis (RPGN) is rare. Patients with severe infection (e.g., IE) sometimes show positivity for cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA). Therefore, diagnosis and treatment are very difficult in cases of RPGN with IE and positivity for C-ANCA. Such cases are rare, only 12 have been reported in the English literature. Herein, we describe the case of a 50-year-old man who presented with RPGN with IE and tested positively for C-ANCA. He was referred to our hospital because of leg edema, purpura and renal dysfunction. Laboratory tests revealed serum creatinine elevation and positivity for C-ANCA and proteinase 3-specific (PR3)-ANCA. RPGN and acute renal failure were diagnosed. Hemodialysis and steroid therapy were started. Streptococcus oralis was isolated by blood culture. Transthoracic echocardiography revealed grade III mitral valve insufficiency with two vegetations. Therefore, IE was diagnosed. The steroid therapy was stopped, and antibiotic therapy was begun. Because there was no improvement, surgical therapy was performed. The operation was successful, but the patient died of brain hemorrhage. Our experience in this case indicates C/PR3-ANCA positive RPGN must be ruled out in patients with infectious disease, particularly IE, together with renal symptoms, and renal biopsy should be performed. Correspondence to:
Y. Mori, MD Division of Cardiology and Nephrology Department of Medicine Kyoto Prefectural University of Medicine 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
Email: [email protected]

Abstract

T. Kusaba, T. Hatta, K. Sonomura, Y. Mori, T. Tokoro, T. Nagata, Y. Umeda, K. Nagata, T. Yasuda, T. Sato, K. Kimura and H. Matsubara

¹Division of Hypertension and Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, ²Division of Internal Medicine II, Kansai Medical University, Osaka, ³Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa and ⁴Division of Cardiology and Vascular Regenerative Medicine, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
Idiopathic nodular glomerulosclerosis (ING) is characterized as diffuse nodular glomerulosclerotic lesions, closely resembling Kimmelstiel-Wilson lesions without diabetic mellitus. We report here three Japanese cases of ING and discuss the previous reports. The patients were 75-, 48- and 84-year-old males with a history of long-term hypertension. Laboratory examination revealed moderate proteinuria and mild renal dysfunction. Diabetes mellitus was excluded by repeated clinical and laboratory investigations. Renal histology revealed nodular glomerulosclerosis, and both afferent and efferent arteriolosclerosis in all patients. In electron microscopy, the glomerular basement membrane was markedly thick in all patients. A low-protein diet and potent anti-hypertensive treatment using angiotensin-converting enzyme inhibitors were initiated in all patients and urinary protein excretion significantly reduced without the progression of renal dysfunction. We reviewed 42 previously reported cases and our three cases. The analysis revealed that common clinical features of ING are being male (82.2%) of relatively advanced age (mean age 61.3 years), with hypertension (82.2%), mild renal dysfunction (mean serum creatinine 2.9 mg/dl) and moderate urinary protein excretion (mean 4.05 g/day). Common histopathological findings of ING are nodular glomerulosclerosis (100%), arterio-arteriolosclerosis (91.2 and 89.7%) and glomerular basement membrane thickening (85.7%). In conclusion, ING is one of the phenotypes of arteriosclerotic renal disease without diabetes mellitus. Severe arterio-arteriolosclerosis may contribute to the progression to glomerular nodular formation in ING. The combination of renin-angiotensin system inhibition and a low protein diet can be beneficial for the reduction of urinary protein excretion.Correspondence to:
T. Kusaba, MD Division of Nephrology and Hypertension Department of Internal Medicine Kyoto Prefectural University of Medicine 456 Kajii-cho, Kamigyo-ku, Kyoto-city, 602-8566 Japan
Email: [email protected]

Abstract

Y. Uchiyama-Tanaka, Y. Mori and H. Matsubara

Department of Medicine, Division of Cardiology and Nephrology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Correspondence to:
Y. Uchiyama-Tanaka, MD, PhD Department of Medicine Division of Cardiology and Nephrology Kyoto Prefectural University of Medicine Kamigyoku, Kyoto 606-8507, Japan
Email: [email protected]

Abstract

T. Ka, T. Inokuchi, Z. Tsutsumi, S. Takahashi, Y. Moriwaki and T. Yamamoto

Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
Objective: To assess the effects of a combination of fenofibrate and losartan on the plasma concentrations and urinary excretion of purine bases in healthy male subjects. Methods: 5 healthy males participated in a fenofibrate plus losartan combination study. The plasma concentrations and urinary excretion of purine bases (hypoxanthine, xanthine, uric acid) were measured before and after administrations of losartan (100 mg o.d.) alone for 2 weeks, losartan and fenofibrate together for 2 weeks and fenofibrate (300 mg o.d.) alone for 2 weeks, which were given consecutively over a 6-week period. Results: Losartan alone significantly reduced the serum uric acid concentration and increased uric acid excretion, whereas the combination of losartan and fenofibrate reduced serum uric acid concentrations further with a concomitant increased uric acid excretion. Fenofibrate alone also reduced plasma uric acid concentration with an increase in urinary excretion, although the effect was weak when compared with the combination treatment. The plasma concentrations and urinary excretion of oxypurines remained unchanged throughout the entire study. Conclusion: A combination of fenofibrate and losartan demonstrated an additive urate-lowering effect which may be beneficial in the treatment of patients with gout and hypertriglyceridemia.Correspondence to:
Y. Moriwaki, MD Division of Endocrinology and Metabolism Department of Internal Medicine Hyogo College of Medicine Mukogawa-cho 1-1 Nishinomiya, Hyogo 663-8501, Japan
Email: [email protected]

Abstract

Y. Moriwaki, T. Kobayashi, T. Inokuchi, A. Yamamoto, S. Takahashi, T. Ka, Z. Tsutsumi and T. Yamamoto

Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
Sucrose is divided by α-glucosidase into fructose and glucose, which are considered to raise plasma uric acid concentration through purine degradation and/or decreased uric acid excretion. Aims: We investigated the effect of acarbose, an α-glucosidase inhibitor, on the increased plasma concentration of uric acid caused by sucrose. Methods: 6 healthy males were studied. After an overnight fast, sucrose at 1.5 g/kg was ingested. Urine was collected 1 hour before sucrose ingestion and then twice at 1-hour intervals after ingestion. Blood was taken twice, at the midpoint of each 1-hour period. 2 weeks later, the same protocol was followed, with acarbose at 100 mg added at the beginning of the sucrose ingestion. Results: Sucrose ingestion raised the plasma concentration of uric acid by 10%, whereas with the addition of acarbose the rise in plasma concentration of uric acid was reduced (p < 0.01) without changes in urinary uric acid excretion and fractional uric acid clearance. Urinary excretion and fractional clearance of oxypurines were unchanged in both experiments. Conclusions: Acarbose is considered to alleviate the rise in plasma concentration of uric acid induced by sucrose by inhibiting its absorption since no changes in uric acid excretion and fractional clearance were observed.Correspondence to:
Y. Moriwaki, MD; Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo, 663-8501, Japan
Email: [email protected]

Abstract

T. Kusaba, T. Hatta, T. Kimura, K. Sonomura, S. Tanda, N. Kishimoto, H. Kameyama, M. Okigaki, Y. Mori, N. Ishigami, T. Mizuno, M. Nakagawa and H. Matsubara

¹Division of Hypertension and Nephrology, ²Division of Cardiology and Vascular Regenerative Medicine, Department of Medicine, and ³Research Institute for Neurological Diseases and Geriatrics, Department of Neurology and Gerontology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary systemic arteriopathy presenting with migraines, mood disorders, focal neurologic deficits, recurrent ischemic attacks and dementia in young adults. The genesis of this disease relates to missense mutation of the Notch3 gene. We report here a newly identified CADASIL patient and discuss unique vascular lesions observed in the kidney. A 64-year-old female was admitted to our hospital for the investigation of proteinuria, hematuria and progressive neurological abnormalities. Her mother and brother died of cerebral infarction at a relatively young age despite a lack of apparent risk factors for arteriosclerosis. Over the past 4 months before admission, she had suffered from frequent transient ischemic attacks despite appropriate antiplatelet therapy. Blood examination revealed mild renal insufficiency and urinalysis revealed moderate protein excretion and dysmorphic hematuria. Magnetic resonance imaging of the brain revealed multiple infarcts and leukoencephalopathy. Histopathological analysis of the kidney revealed focal segmental mesangial proliferation, the loss and degeneration of arterial medial smooth muscle cells and arterial intimal thickening. Immunofluorescence analysis of glomeruli revealed IgA deposition in the mesangial area. Electron microscope analysis revealed electron-dense deposition also in the mesangial area. In addition, granular osmophilic material (GOM) was observed in the extraglomerular mesangial area and around the vascular smooth muscle cells. Genetic analysis of Notch3 revealed an R141C missense mutation and she was diagnosed with CADASIL complicated with IgA nephropathy. In immunohistological analysis, Notch3 stains were positive in vascular smooth muscle cells of the interlobular arteries and both afferent and efferent arterioles, and weak in the glomerular mesangial area. Antihypertensive treatment using angiotensin II receptor blocker and a low protein diet were initiated, and her urinary protein excretion decreased to 0.2 g/day. However, due to the progression of her neurological abnormalities, she became socially withdrawn. In CADASIL, GOM, abnormal accumulation of Notch3 ectodomain, is thought to induce the degeneration and loss of vascular smooth muscle cells and subsequent intimal thickening. Analysis of our cases provided that these morphological abnormalities were also observed in the CADASIL patient kidney.Correspondence to:
T. Kusaba, MD Division of Nephrology and Hypertensio Department of Internal Medicine Kyoto Prefectural University of Medicine 456 Kajii-cho Kamigyo-ku Kyoto-city, 602-8566, Japan
Email: [email protected]

Abstract

C.M. Anas¹, R. Hattori¹, Y. Morita², Y. Matsukawa¹, T. Komatsu¹, Y. Yoshino¹, S. Maruyama², Y. Yuzawa², S. Matsuo² and M. Gotoh¹

¹Department of Urology, Nagoya University Graduate School of Medicine, and ²Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Background: This study was made to present our experience and results with transperitoneal laparoscopic-assisted renal biopsy (LARB) in Nagoya University Hospital as a good alternative for open renal biopsy. Methods: 21 patients (14 male, 7 female, mean age 58 years, range 21 – 83 years) were unsuitable for percutaneous renal biopsy. Therefore, they underwent laparoscopic-assisted renal biopsy. The kidney was approached transperitoneally via three ports, cortical tissue was obtained using a 16-gauge gun-mounted semiautomatic biopsy needle. Hemostasis was obtained by applying pressure on the renal puncture using gauze until bleeding had been stopped (range 5 – 20 min). Results: Adequate cortical tissue and accurate diagnoses were obtained in all patients. Mean operative time was 83 min (range 65 – 120 min) and mean estimated blood loss was 5.5 ml (range 1 – 10 ml). There were no intraoperative complications: no open conversion, blood transfusions or gross hematuria. All patients walked about freely and could tolerate regular food on the first postoperative day. The only postoperative complication was a hernia formation at the place of trocar insertion 3 months after the operation in one patient who previously underwent multiple surgery for 3 arterial grafts and appendicitis. Conclusions: LARB is a safe and accurate procedure for obtaining cortical biopsies with minimal blood loss. Although LARB remains a surgical procedure which requires general anesthesia, LARB to date may be considered as a good alternative to open renal biopsy for patients in whom a closed percutaneous approach is either a relative or absolute contraindication.Correspondence to:
Dr. C. Mujeeb Anas, MD, PhD candidate; Department of Urology, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
Email: [email protected]

Abstract

T. Tsuchiya¹, S. Ito¹, Y. Yamaguchi², Y. Moriyama¹, H. Ehara¹ and T. Deguchi¹

¹Department of Urology, Gifu University School of Medicine, Gifu, and ²Department of Pathoology, Kashiwa Hospital, Jikei University School of Medicine, Kashiwa, Japan
We experienced two cases of steroid pulse therapy combined with tonsillectomy for recurrent IgA nephropathy (IgAN) in a renal allograft. We defined recurrent IgAN in renal allograft as IgA deposits in glomeruli with persistent proteinuria (> 0.5 g/ day) and microscopic hematuria in renal transplant recipients with biopsy-proven IgAN of their native kidneys. We performed steroid pulse therapy following tonsillectomy as therapeutic protocol for recurrent IgAN. The first patient was diagnosed with recurrent IgAN by allograft biopsy 3 years after renal transplantation, and a second patient was diagnosed after one year. The former patient’s proteinuria disappeared 4 months after treatment and the latter patient’s proteinuria disappeared after one month. Tonsillectomy combined with steroid pulse therapy can induce clinical remission in patients with recurrent IgAN after renal transplantation.Correspondence to:
T. Tsuchiya, MD
Department of Urology
Gifu University School of Medicine
1-1 Yanagido, Gifu 501-1194, Japan
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 49 – No. 3/2011 (191-197)

Serum CRP in patients with gout and effects of benzbromarone

C. Okuda, H. Koyama, Z. Tsutsumi, A. Yamamoto, M. Kurajoh, Y. Moriwaki and T. Yamamoto

Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
Objective: C-reactive protein (CRP) is associated with increased risk for myocardial infarction, atherosclerosis, and peripheral artery diseases, while increased serum uric acid level is suggested to be independently associated with an increased risk of cardiovascular mortality. Accordingly, to investigate whether hyperuricemia is associated with serum CRP, we compared serum CRP levels between healthy subjects and patients with gout. In addition, we also examined whether benzbromarone has effects on serum CRP levels in patients with gout and the expression of CRP messenger RNA of CRP in the hepatoma cell line HuH7. Methods: In the first experiment, 40 healthy males and 43 male patients with gout were enrolled, then blood samples were drawn from each after an overnight fast. In the second experiment, 42 male patients with gout were given uric acid-lowering therapy with benzbromarone. Blood samples were drawn after an overnight fast before and 1 year after beginning benzbromarone treatment. In the third experiment, the effects of benzbromarone on IL1beta-induced CRP expression were determined in HuH7 cells. Results: Log serum CRP levels were not significantly different between the patients with gout and healthy subjects, while log serum CRP levels were decreased by 11% after benzbromarone treatment, as compared to the values before treatment (p < 0.01). In addition, log serum adiponectin levels were elevated by 2% after treatment (p < 0.01). Furthermore, our in vitro findings demonstrated that benzbromarone down-regulated IL1beta-stimulated CRP gene expression. Conclusions: These results suggest that hyperuricemia may not contribute to an increase in serum CRP level, while benzbromarone may have a favorable effect on CRP.Correspondence to:
T. Yamamoto, MD
Division of Endocrinology and Metabolism
Department of Internal Medicine
Hyogo College of Medicine
Mukogawa-cho 1-1
Nishinomiya, Hyogo 663-8501, Japan
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 75 – No. 4/2011 (384-388)

A case of Goodpasture syndrome positive for anti-GBM antibody and MPO-ANCA complicated by a variety of serious infections

C. Sakoda¹*, T. Kusaba¹*, T. Adachi², K. Sonomura¹, T. Kimura¹, M. Nakayama¹, N. Kishimoto¹, H. Nakagawa¹, M. Okigaki¹, T. Hatta², H. Matsubara¹ and Y. Mori¹

¹Division of Cardiology and Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, and ²Division of Nephrology, Omihachiman Community Medical Center, Shiga, Japan
A 62-year-old female was admitted to our hospital for investigation of acute progressive renal insufficiency and a systemic inflammatory reaction, despite treatment with several antibiotics. Laboratory data revealed severe renal insufficiency and positive titers for the myeloperoxidase anti-neutrophil cytoplasmic and anti-glomerular basement membrane antibodies. The deterioration of her general status did not allow us to perform the renal biopsy. Although corticosteroid therapy, hemodialysis, and plasma exchange were concomitantly initiated, pulmonary hemorrhage occurred several days after admission. Mechanical ventilation support was provided and continuous hemodiafiltration was carried out, following which the respiratory failure improved immediately. However, she developed clinical depression and suicidal behavior under the intensive therapy. Therefore, plasma exchange was discontinued and corticosteroid was tapered as quickly as possible. Four months after admission, platelet transfusion and short-term mechanical ventilation support improved the pulmonary hemorrhage; however, her mental status deteriorated despite psychiatric consultation and treatment with a tranquilizer. Thereafter, severe and serious systemic infection due to various pathogens including Staphylococcus aureus, Cytomegalovirus, Pneumocystis jiroveci, Pseudomonas aeruginosa, and Bacteroides recurred, and she died from systemic invasive aspergillosis (IA). We suspected severe immunosuppression caused by various factors, such as predonisolone administration, chronic renal failure on maintenance hemodialysis, depression, and malnutrition due to chronic inflammation and granulocytopenia as a side effect of ganciclovir. When treating rapidly progressive glomerulonephritis, immunosuppressive status should be carefully monitored regarding not only the dosage of therapeutic regimen but also the mental health status and nutrition of the patient.Correspondence to:
C. Sakoda, MD
Division of Cardiology and Nephrology
Department of Medicine
Kyoto Prefectural University of Medicine
465 Kajii-cho, Kawaramachi-Hirokoji
Kamigyo-ku Kyoto 602-8566, Japan
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 49 – No. 6/2011 (366-370)

Effects of bovine milk ingestion on urinary excretion of oxypurinol and uric acid

M. Kurajoh, T. Ka, C. Okuda, A. Yamamoto, Z. Tsutsumi, H. Koyama, Y. Moriwaki and T. Yamamoto

Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
Objective: Although allopurinol is a xanthine oxidase inhibitor, its overall effect may be due to the action of oxypurinol, a metabolite of allopurinol and another xanthine oxidase inhibitor, since the biological half-life of oxypurinol is longer than that of allopurinol. Oxypurinol shares a renal transport pathway with uric acid and ingestion of bovine milk increases the urinary excretion of uric acid. Therefore, we investigated whether its ingestion promotes the urinary excretion of oxypurinol. Subjects/methods: Bovine milk (15 ml/kg body weight) was administered to 6 healthy subjects who took allopurinol (300 mg) 12 h prior to ingestion. In addition, a control experiment was performed with the same subjects using the same protocol, except for the ingestion of water instead of bovine milk. Blood and urine samples were collected before and after bovine and water ingestion. Results: In the bovine milk ingestion experiment, the urinary excretion values of oxypurinol and uric acid were increased by 18% and 38%, respectively, and the fractional excretion values of oxypurinol and uric acid were increased by 20% and 40%, respectively, whereas those did not change in the control experiment. In addition, the concentration of alanine and sum of concentrations of amino acids were increased by 16% and 20%, respectively, in the bovine milk ingestion experiment. Conclusion: These results suggest that bovine milk ingestion promotes the urinary excretion of oxypurinol as well as uric acid by increasing amino acid concentration.Correspondence to:
T. Yamamoto, MD
Division of Endocrinology and Metabolism
Department of Internal Medicine
Hyogo College of Medicine
Mukogawa-cho 1-1
Nishinomiya, Hyogo 663, Japan
Email: [email protected]

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