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Different modes of renal proximal tubule regeneration in health and disease

World Journal of Nephrology 2012年第4期1卷 92-99页

作者： yoshihide fujigaki First Department of Medicine Hamamatsu University School of Medicine Hamamatsu JapanAuthor contributions： fujigaki Y solely contributed to this paper.Supported by A Grant-In-Aid for Scientific Research First Department of Medicine Hamamatsu University School of Medicine

Tissues are equipped with reasonable strategies for re-pair and regeneration and the renal proximal tubule （PT）is no exception. New information has become availableon the mode of PT regeneration in mammals. Unlikethe intestinal epithelium with a high rate of turnovermaintained by the stem cell system, the kidney has lowturnover under normal physiological conditions. The PTseems to be maintained physiologically by hyperplasia,a regenerating system with self-renewal of mature tu-bular cells. This mode of regeneration is advantageousfor effective replenishment of randomly isolated andeliminated tubular cells by self-renewal of adjacentcells. On the other hand, it has been suggested thatdedifferentiation of mature tubular cells plays a role inregeneration after acute kidney injury. Recent studiesemploying genetic labeling and DNA-labeling tech-niques have confrmed that the proliferation of preex-isting injured mature tubular cells contributes mainlyto PT regeneration in ischemic reperfusion injury. Thismode of regeneration is beneficial with regard to therapid reparation of focally injured tubules often inducedby ischemic reperfusion injury. What happens, howeverwhen the PT is homogeneously injured with almost noremaining surviving cells？ Is the PT equipped with another backup regeneration system, e.g., the stem cell system？ Is it possible that certain types of renal injuries evoke a stem cell response whereas others do not？ This review focuses on all three possible modes of tis-sue regeneration （compensatory hyperplasia, dediffer-entiation and stem cell system） in mammals and their involvement in PT regeneration in health and disease.

关键词： Proximal tubule Regeneration Compensa-tory hyperplasia Dedifferentiation Stem cell Progeni-tor cell

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Case of human immunodeficiency virus infection presenting as a tip variant of focal segmental glomerulosclerosis: A case report and review of the literature

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World Journal of Nephrology 2018年第4期7卷 90-95页

作者： Daiki Goto Naro Ohashi Asumi Takeda yoshihide fujigaki Akira Shimizu Hideo Yasuda Kazuhisa Ohishi Internal Medicine 1 Hamamatsu University School of Medicine Division of Nephrology Hamamatsu Medical Center Department of Internal Medicine Teikyo University School of Medicine Department of Pathology Nihon University School of Medicine

The incidence of the collapsing variant of focal segmental glomerulosclerosis(FSGS) as a human immunodeficiency virus(HIV)-associated nephropathy has reduced since the introduction of antiretroviral therapy(ART). However, the incidence of other variants of FSGS, except for the collapsing variant, is increasing, and its therapeutic strategies remain uncertain. A 60-year-old HIV infected man in remission with ART was admitted for progressive renal insufficiency and nephrotic-ranged proteinuria. Renal biopsy revealed a tip variant of FSGS and his clinical manifestations resolved with corticosteroid therapy. HIV infected patients might develop non-collapsing FSGS, including tip variant of FSGS and corticosteroid therapy might be effective for them. A renal biopsy might be essential to determine the renal histology and to decide on corticosteroid therapy.

关键词： Focal segmental glomerulosclerosis Tip variant Antiretroviral therapy Corticosteroid therapy Human immunodeficiency virus

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Calcitriol-induced hypercalcemia in a patient with granulomatous mycosis fungoides and end-stage renal disease

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World Journal of Nephrology 2013年第2期2卷 44-48页

作者： Takamasa Iwakura Naro Ohashi Naoko Tsuji Yoshitaka Naito Shinsuke Isobe Masafumi Ono Tomoyuki Fujikura Takayuki Tsuji Yukitoshi Sakao Hideo Yasuda Akihiko Kato Toshiharu Fujiyama Yoshiki Tokura yoshihide fujigaki First Department of Medicine Hamamatsu University School of Medicine Higashi-ku Hamamatsu 431-3192 Japan Blood Purification Unit Hamamatsu University School of Medicine Higashi-ku Hamamatsu 431-3192 Japan Department of Dermatology Hamamatsu University School of Medicine Higashi-ku Hamamatsu 431-3192 Japan

An 86-year-old man, diagnosed as having mycosis fungoides in May 2008 and treated with repeated radiation therapy, was admitted to our hospital for initiation of hemodialysis due to end-stage renal disease(ESRD) in April 2012. On admission, his corrected serum calcium level was 9.3 mg/d L, and his intact parathyroid hormone level was 121.9 pg/mL(normal range 13.9-78.5pg/mL), indicating secondary hyperparathyroidism due to ESRD. After starting hemodialysis, urinary volume diminished rapidly. The serum calcium level increased(12.7 mg/dL), and the intact parathyroid hormone level was suppressed(< 5 pg/m L), while the 1,25-dihy-droxyvitamin D3(calcitriol) level increased(114 pg/mL, normal range: 20.0-60.0 pg/m L) in June 2012. The possibilities of sarcoidosis and tuberculosis were ruled out. Skin biopsies from tumorous lesions revealed a diagnosis of granulomatous mycosis fungoides. The serum soluble interleukin-2 receptor levels and the degrees of skin lesions went in parallel with the increased serum calcium and calcitriol levels. Therefore, the patient was diagnosed as having calcitriol-induced hypercalcemia possibly associated with granulomatous mycosis fungoides. Granulomatous mycosis fungoides is rare, and its association with calcitriol-induced hypercalcemia has not been reported. Careful attention to calcium metabolism is needed in patients with granulomatous mycosis fungoides, especially in patients with ESRD.

关键词： Calcitriol-induced hypercalcemia Granulomatous mycosis

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