Publications by authors named "Keiichi Kinowaki"

A 47-year-old woman with a 12-year history of anemia and high C-reactive protein (CRP) levels was admitted to our hospital with worsening fatigue and night sweats. She had high levels of immunoglobulin G (IgG; 4182 mg/dL), IgA (630.6 mg/dL), and CRP (7.

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We herein report a 69-year-old man with acute kidney injury who required dialysis after receiving a combination of three drug-induced lymphocyte stimulation test-positive drugs. A kidney biopsy showed tubulointerstitial nephritis with severe eosinophilic infiltration and numerous granuloma formations. Acute eosinophilic granulomatous tubulointerstitial nephritis was diagnosed.

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  • A 62-year-old man with diabetes was hospitalized due to symptoms like numbness in his legs and widespread blistering on his skin.
  • Diagnostic tests revealed a condition called mononeuritis multiplex and significant eosinophil presence, leading to the diagnosis of eosinophilic granulomatosis with polyangiitis alongside allergic bullous lesions.
  • Biopsies from his kidneys, muscles, and skin showed evidence of vasculitis and high eosinophilic infiltration, while immunohistological studies indicated cell death involving eosinophils, referred to as eosinophil ETosis.
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Background: MRI is expected to be a valuable tool for evaluating disease activity in immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (IgG4-TIN). However, the correlation between MRI findings and renal histopathological findings remains to be elucidated.

Purpose: This study aimed to clarify the correlation between MRI findings and renal histopathological findings in IgG4-TIN.

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A kidney biopsy was performed in a 64-year-old woman with type 2 diabetes mellitus and less than 1 g of proteinuria who rapidly progressed to end-stage renal failure after approximately 2 years of treatment with two dipeptidyl peptidase 4 (DPP-4) inhibitors for type 2 diabetes mellitus. The biopsy revealed not only a coincidental diagnosis of renal cell carcinoma, which was not evident on pre-biopsy computed tomography, but also severe thrombotic microangiopathy (TMA)-like glomerular endothelial cell damage in the noncancerous areas. These results suggest that DPP4 inhibitors may have been involved in two kidney diseases.

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  • After a relapse two years later, he was switched to baricitinib, achieving remission again before RA recurred and he discovered a tumor in his kidney at age 72.
  • Following surgical removal of the tumor, which was identified as renal cell carcinoma (RCC), the patient reported joint pain relief but ultimately died from systemic metastases about 10 weeks later, with the RA and RCC linked as a paraneoplastic syndrome.
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  • Chemotherapy is essential for treating certain breast cancers, and the balance between its benefits and side effects can be assessed using the Oncotype DX (ODX) test, although it's costly.
  • Researchers aimed to create a nomogram to predict the recurrence score (RS) using clinicopathological variables, which could help identify patients who might not need the ODX test.
  • The study found that factors like progesterone receptor levels and histological grade effectively predicted RS, with their nomogram showing high accuracy and the potential for cost savings in clinical evaluations.
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Introduction: This study aimed to analyze the clinical course of TAFRO syndrome in patients through extended follow-up, focusing on recurrent cases and long-term remission.

Methods: This was a retrospective case series study. We assessed the clinical course of patients diagnosed with TAFRO syndrome between January 2012 and September 2022 at Toranomon Hospital or Toranomon Hospital Kajigaya, excluding those patients who died during the initial hospitalization.

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  • * Four years later, a follow-up biopsy showed worsening kidney conditions and new signs of membranous nephropathy, indicating complications from the ongoing renal issues.
  • * Six years after the initial admissions, he developed bullous pemphigoid linked to DPP4 inhibitors he was taking, leading to their discontinuation and a diagnosis of IgG4-related kidney disease associated with these medications.
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  • A 28-year-old woman with untreated high blood pressure for 5 years was hospitalized due to breathing issues, coughing up blood, and eye problems.
  • Imaging revealed lung plaques and she experienced kidney damage, low platelets, and anemia.
  • After 8 weeks of antihypertensive treatment, her kidney function improved, leading to a diagnosis of malignant nephrosclerosis linked to a hypertensive crisis.
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  • - A 63-year-old man with a history of polycystic kidney disease received a kidney transplant from his wife and later developed kidney issues after receiving COVID-19 vaccines, including proteinuria and hematuria.
  • - A kidney biopsy revealed findings consistent with membranous nephropathy (MN), showing chronic damage and deposits that indicated a newly developed condition after the transplant.
  • - The case suggests a possible link between the COVID-19 vaccination and the onset of MN in kidney transplant patients, highlighting the need for awareness of such potential complications.
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We experienced three cases of a fever and subsequent severe, prolonged gross hematuria after COVID-19 vaccination. A kidney biopsy revealed immunoglobulin A (IgA) nephropathy, and electron microscopy showed two types of podocytopathy (podocyte damage): loss of foot processes from the glomerular basement membrane and foot process effacement. Mesangial interposition was also present in cases 1 and 3 but not in case 2.

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  • - A 53-year-old Japanese man developed gastric Burkitt's monomorphic post-transplant lymphoproliferative disorder (B-PTLD) 28 months after receiving a kidney transplant in Ethiopia, following complaints of gastric discomfort.
  • - Prior to the transplant, his serum tests for Epstein-Barr virus (EBV) were negative, but a biopsy of the tumor revealed positive EBV-encoded small RNAs, indicating the onset of B-PTLD.
  • - The patient underwent intensive treatment with R-CHOP and DA-EPOCH-R chemotherapy, which has been effective so far, with no relapse reported, highlighting a rare case of successful B-PTLD management.
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We present a 51-year-old male patient with a history of Child-Pugh Grade B alcoholic liver cirrhosis (ALC) who developed renal impairment (serum creatinine of 2.00 mg/dL) and nephrotic syndrome (a urinary protein level of 4.35 g/gCr).

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A 48-year-old woman visited our hospital because of bilateral lacrimal gland enlargement. Her serum immunoglobulin G4 (IgG4) level was high, and positron emission tomography-computed tomography showed significant positive findings in the bilateral lacrimal gland. A biopsy revealed a considerable increase in IgG4/CD138, leading to a diagnosis of IgG4-related dacryoadenitis.

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A 37-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital with a liver volume of 8,000 cm. Hepatic arterial embolization was performed using a microcoil but was ineffective. Eight years later, the hepatomegaly progressed to liver failure and death.

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  • A 62-year-old man with type 2 diabetes experienced a significant decline in kidney function and developed widespread skin lesions.
  • Diagnostic tests confirmed he had bullous pemphigoid for his skin condition and tubulointerstitial nephritis for his kidney issues.
  • After stopping the DPP-4 inhibitor medication, his skin lesions improved and kidney decline slowed, highlighting potential side effects of DPP-4 inhibitors on both skin and renal health.
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Recurrence and metastasis are resistant to multimodal treatments, and are the major causes of death in breast cancer. Accumulating evidence suggests that the IL17RB signaling pathway plays a key role in progression and metastasis of breast cancer. Clinical significance of the IL17RB positivity in tumor tissues has been also reported as a poor prognostic factor in breast cancer.

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A 49-year-old Japanese woman was admitted to our hospital with weight loss of 15 kg, nephrotic-range proteinuria (4.5 g/g.Cre), and hematuria over a 6-month period.

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Pancreatic neuroendocrine carcinoma (NEC) and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) are rare pancreatic malignant tumors, and comprehensive gene analyses are scarce. In this study, six NECs and six MiNENs were collected, immunohistochemistry for synaptophysin, chromogranin A, INSM1, Ki-67, and Rb was conducted, and KRAS mutational status was examined. Among these cases, comprehensive gene expression analysis of oncogene pathways using nCounter® were performed with six NECs and four MiNENs, and those data were compared with that of three pancreatic ductal adenocarcinomas (PDACs), with that of three normal pancreatic ducts, and with each other.

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A 35-year-old woman was admitted for the examination of lower leg edema and proteinuria. A kidney biopsy showed membranous nephropathy (MN) with fine granular deposits of IgG along the glomerular capillary and poor spike formation, differing from primary MN in the presence of positive IgG3 and C1q. Lupus nephritis was excluded because serum complement and anti-dsDNA antibody, anti-Smith antibody, and anti-cardiolipin antibody tests were negative.

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Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used to treat type 2 diabetes (T2D). Lowering blood glucose is expected also to reduce the progression of diabetic nephropathy. We experienced a patient with T2D who achieved good glycemic control with a DPP-4 inhibitor but experienced rapid deterioration of renal function.

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A 32-year-old man was admitted for the evaluation of proteinuria (5.69 g/day). A light microscopic examination showed markedly dilated glomerular capillary loops with vacuolated areas in many glomeruli, and vacuolated areas were seen on peritubular capillaries in the tubulointerstitium.

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  • - A 58-year-old woman with rheumatoid arthritis developed Hodgkin lymphoma after being treated with methotrexate, prompting her to start nivolumab, a type of cancer immunotherapy.
  • - Two weeks into nivolumab treatment, she experienced increased joint pain and was hospitalized for worsening symptoms.
  • - A wrist joint biopsy revealed immune-related synovitis with a predominance of T cells (especially CD8 T cells) rather than the B cells typically associated with rheumatoid arthritis.
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