Endocrinological pathology of congestive kidney and its resolution

2021 Fiscal Year Final Research Report

• Project/Area Number: 18K08209
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 53040:Nephrology-related
• Research Institution: Nagoya City University (2019-2021); Osaka University (2018)
• Principal Investigator: HAMANO TAKAYUKI 名古屋市立大学, 医薬学総合研究院(医学), 教授 (50403077)
• Project Period (FY): 2018-04-01 – 2022-03-31
• Keywords: 腎うっ血

Outline of Final Research Achievements

Not only in congestive heart failure with congestive kidney (CK), but also in nephrotic syndrome with CK, we found elevated serum ADH levels together with high osmolarity of the urine. As compared to nephrotic syndrome without CK, the urine Na/K of the patients with nephrotic syndrome accompanied by CK (defined as >19% reduction in total kidney volume after the therapy) was significantly higher and SUSPPAP was lower. This finding suggests that sodium retention of nephrotic syndrome with CK is partly mediated by RAAS activation. We reported a case with a severe nephrotic syndrome which was resolved completely by massive fluid removal by diuretics and ARB. This case relapsed after high salt intake. Given that enhanced RAAS activation increase the expression of SGLT2 on proximal tubules leading to sodium retention further, administration of SGLT2 might be promising also in nephrotic syndrome with CK.

Free Research Field

腎臓内科

Academic Significance and Societal Importance of the Research Achievements

心不全においても、ネフローゼにおいてもうっ血腎は意外にも非常に多く、利尿薬をはじめとする適切な治療で早期に改善するものである。ネフローゼであれば、いつも腎生検を施行して腎炎のタイプを同定してから免疫抑制薬で治療すると思われがちだが、実はうっ血腎を伴う重篤なネフローゼではRAAS系阻害薬と利尿薬のみで寛解に至ることは膜性腎症をはじめ稀ではない。まずは腎容積を計測してうっ血腎の有無を評価して、うっ血腎が存在する場合はそういった治療をしてネフローゼが寛解するかどうかを評価してから、腎生検の実施を判断するという選択肢を提示できた点が本研究の意義と考える。