Risk of CVD and mortality due to CKD needs to be stratified according to the underlying renal diseases.

Insufficient control of serum calcium and phosphate levels in patients undergoing hemodialysis is associated with increased mortality. As commonly used calcium-containing phosphate binders can cause arterial calcification, newly developed calcium-free phosphate binders, such as sevelamer hydrochloride (SH) and lanthanum carbonate (LC), have received much attention. We assessed the efficacy and safety of SH and LC treatment in Japanese patients undergoing hemodialysis in a prospective randomized open blinded endpoint (PROBE) crossover study. Forty-two patients were randomized to receive SH or LC for 13 weeks, with the dosages adjusted every 2 weeks, followed by treatment with the other drug for another 13 weeks. The average daily doses of SH and LC were 2971 ± 1464 mg and 945 ± 449 mg, respectively. The mean dosage ratio of SH to LC was 3.05, which was maintained throughout the treatment period. SH and LC were similarly effective at controlling serum calcium and phosphate levels in the majority of patients (78-93%). A few serious adverse events (AEs) involving the biliary system occurred during the LC treatment period, but they were not considered to be treatment-induced. Although the incidence of constipation, the most common treatment-related AE, was higher during the SH period (27% vs. 5%; P < 0.05), no difference was observed in total treatment-related AEs. This study demonstrates that SH and LC are comparable treatments for controlling serum phosphate and calcium levels, and that both compounds are safe and well-tolerated in Japanese patients undergoing hemodialysis.

Background The prevalence of acute renal infarction (ARI) in Japan remains unclear. We describe the clinical features and renal prognosis of ARI in Japanese patients. Methods This single-center, retrospective, observational study included 33 patients with newly diagnosed ARI (2009)(2010)(2011)(2012)(2013). Their clinical features and long-term renal outcomes were evaluated. Results The prevalence of ARI among emergency room patients was 0.013 %. The incidence of ARI among in-patients was 0.003 % (mean age 71.9 ± 13.4 years; men 63 %). Enhanced computed tomography or renal isotope scans were obtained to diagnose ARI. ARI involved the left kidney in 70 %, right kidney in 18 %, and both kidneys in 12 % of patients. Four cases had splenic infarction, and 70 % of patients had atrial fibrillation. We noted abdominal or flank pain in 66 %, fever ([37.6°C) in 36 %, and nausea/ vomiting in 6 % of patients. The white blood cell count, and levels of lactate dehydrogenase and C-reactive protein peaked at 2-4 days after onset. Acute kidney injury due to ARI occurred in 76 % of patients. The estimated glomerular filtration rate decreased to *70 % and recovered to *80 % of the original value after 1 year. The mortality rates were 9 and 15 % at 1 month and 1 year, respectively. Conclusions We determined the prevalence of ARI among emergency room patients, its incidence among inpatients, and short-term and long-term mortality. The majority of ARI cases were of cardiac origin, and the others were due to trauma or systemic thrombotic disease. Clinicians should recognize ARI as a fatal arterial thrombotic disease.

Our findings showed that not only delayed distal latency but also decreased amplitude may predict the need for respiratory assistance during the subsequent disease course.

Auditory brainstem response (ABR) was used to assess possible brainstem damage in 76 neonates with asphyxia and intracranial haemorrhage (ICH). Fifty-eight neonates had ICH, 52 had neonatal asphyxia and 34 of these patients had both. Eighty-nine percent of the patients with neonatal asphyxia showed some abnormal patterns in response, the major one being an increase in the threshold of wave V. In the ICH group, abnormal patterns were observed in 62.5%, among whom the prolongation of the I-V interpeak latency (IPL) and of wave V latency was seen more frequently than the increase of threshold of wave V. In the case of neonatal asphyxia associated with ICH, both the prolongation of the latency and the increase of threshold were observed equally. These abnormalities of ABR were associated with worsening clinical condition and conversely normalized gradually following the improvement of the underlying disease. Especially the I-V IPL, wave V latency and the threshold of wave V could serve as indicators of the treatment.