To evaluate the significance of the renal resistive index (RI) as a noninvasive marker of renal histological damage and a prognostic indicator, we examined RI by Doppler ultrasonography in 202 chronic kidney disease (CKD) patients who underwent renal biopsy. RI increased as the CKD stage progressed and correlated with age, systolic blood pressure, estimated glomerular filtration rate (eGFR), and renal histological changes, including glomerulosclerosis, arteriolosclerosis, and tubulointerstitial damage. Prognostic evaluation with a median follow-up period of 38.5 months revealed that patients with RI ≥ 0.7 (high RI group, n = 39) had significantly poorer renal survival than those with RI < 0.65 (normal RI group, n = 120) and 0.65 ≤ RI < 0.7 (high-normal RI group, n = 43). The patients in the high-normal RI group showed good response to steroids. However, in the high RI group, steroid therapy did not significantly improve renal survival. Of the clinical indices studied, RI ≥ 0.7, hypertension, proteinuria, and low eGFR at diagnosis were independent risk factors for worsening renal dysfunction. In conclusion, RI in CKD patients was considered as a marker of renal function, histological damage, and renal prognosis, and a possible determinant of indication for steroids.

Urinary podocyte excretion reflects ongoing glomerular injury in various kidney diseases, and podocyte loss correlated with glomerulosclerosis and impaired selectivity of proteinuria.

No abstract

The patient was a 70-year-old male who started to receive hemodialysis due to diabetic nephropathy in 1992. He developed hematochezia from 1995. Though he had undergone both upper and lower gastroenteral endoscopy repeatedly, the bleeding point was not determined. Scintigram performed to detect gastrointestinal hemorrhage demonstrated an accumulation of activity on the right side of the common iliac artery.Because his blood type was AB and D negative, he was difficult to match for blood transfusion. He was referred to our hospital in June 2006 for more extensive examination and treatment. He underwent double-balloon endoscopy which showed red spots at the middle portion of the jejunum. We treated this lesion using Argon plasma coagulation(APC)and clipping. Thereafter, the same type of lesions appeared four times in different portions of the intestine. However, we successfully treated these by the same method. The prevalence of gastrointestinal bleeding is reportedly higher among ESRD patients than the general population. However, we often could not determine the exact bleeding point and often found it difficult to achieve hemostasis especially for small intestinal lesions. We consider the double-balloon endoscopy technique useful for diagnosis of either jejunal or ileal lesions and that the technique in itself offers a strategy for treating such patients.

Key words：enteral feeding product, hemodialysis, alkalosis, alkalemia, hyperkalemia 〈Abstract〉 In July 2007, a 72-year-old man with a 4-year history of renal insufficiency started hemodialysis due to postinfectious glomerulonephritis. The patient underwent surgery for rupture of chronic aortic dissection in early August and hemodialysis was continued. Due to prolonged postoperative consciousness disturbance, enteral feeding was started and PEG was inserted in late November. To prevent repeated aspiration, the enteral products were changed from Renalen®and Q. P K-4S®to Medief®Pushcare, a gel-type formula. However, the patient ／ ／ subsequently developed severe metabolic alkalosis and hyperkalemia(pH 7.60, HCO3 − 36.8 mEq／L, K 6.5 mEq／ L). Discontinuation of this product and feeding with Terumeal®PG soft rapidly improved both metabolic alkalosis and hyperkalemia. We speculated that the higher concentration of sodium compared to chloride in Medief®