Internal medicine
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Review Case Reports
Development of sarcoidosis during etanercept therapy.
This report describes a 65-year-old woman who developed granulomatous lesions consistent with sarcoidosis during etanercept therapy for rheumatoid arthritis. Hilar and mediastinal lymphadenopathy and multiple nodules in both lung fields developed 21 months after administration of etanercept. ⋯ Etanercept was discontinued, which resulted in symptomatic relief, improvement of oxygenation and radiologic findings. There is substantial evidence of tumor necrosis factor-alpha involvement in the induction and maintenance of granuloma formation; however, we should keep in mind that granulomatous disease, such as sarcoidosis, can develop during treatment with a tumor necrosis factor-alpha blocking agent, such as etanercept.
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Comparative Study
Risk factors for progression in patients with early-stage chronic kidney disease in the Japanese population.
Chronic kidney disease (CKD) is an important worldwide health problem. The incidence of end-stage renal disease (ESRD) is increasing steadily around the world, however few studies have discussed the risk factors for progression in patients with early-stage CKD. Therefore, we designed a retrospective cohort study of patients with early-stage CKD to identify the risk factors influencing the annualized slope of the estimated glomerular filtration rate (eGFR). ⋯ Proteinuria, smoking habit, hypertension and low HDL were clearly related to accelerated disease progression in patients with early-stage CKD. Therefore, aggressive treatment of these risk factors is essential in the early stages of CKD.
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Amyopathic dermatomyositis (ADM) is a clinical subtype of dermatomyositis, characterized by the absence of motor weakness and the presence of normal muscle enzyme levels. ADM is sometimes accompanied by interstitial pneumonia that shows a rapid progressive course associated with a poor prognosis. We describe a 70-year-old man who presented rapidly progressive interstitial pneumonia associated with clinically ADM (C-ADM); he was successfully treated with polymyxin B-immobilized fiber column (PMX) hemoperfusion.
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Reduced glomerular filtration rate (GFR) is a risk factor of cardiovascular diseases. Accurate assessment of GFR together with early and appropriate treatment of chronic kidney disease (CKD) is important. Although the Japanese Society of Nephrology has recently announced two equations (equation 0.741 and equation 194) to estimate GFR for Japanese, the clinically significant estimated GFR (eGFR) in Japanese has not been identified. We examined the clinical significance of eGFR with regard hyperkalemia. ⋯ From the viewpoint of the increase in incidence of hyperkalemia, using an eGFR below 50 mL/min/1.73 m2 as the cutoff has clinical significance when equation 0.741 is used and a cutoff at 60 mL/min/1.73 m2 is appropriate when equation 194 is used.
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Case Reports
A fulminant case of renal vein thrombosis in a patient with autoimmune disorder and membranous nephropathy.
A previously healthy middle-aged woman noted a rapid onset of flank pain with gross hematuria. Enhanced CT scan showed thrombosis of the inferior vena cava and right renal vein. Laboratory findings revealed nephrotic proteinuria, Sjogren's syndrome (SjS), and Graves' disease (GD). ⋯ Renal specimens showed venous infarction with diffuse hemorrhagic and severe congestive renal necrosis, and membranous nephropathy (MN). The present case was diagnosed as acute renal necrosis due to catastrophic thrombosis in a patient with SjS, GD, and MN. It was thought that sudden development of thrombosis may have been caused by the status of the autoimmune disorders, and the associated MN.