論文 - 橋口　明典

【CKDの臨床検査と腎病理診断】 CKDの病理

橋口, 明典

臨床検査 （医学書院）  60 （ 6 ） 642 - 648 2016年06月

共著,  ISSN  0485-1420

　概要を見る

＜Point＞慢性腎臓病(CKD)患者の生検の意義は,疾患の層別化にある.CKD患者の生検の多くは慢性・硬化性病変を伴っているが,これらは非特異的な所見である.硬化性病変が進行した症例では,しばしば病因の特定が困難であるが,これを可能な限り同定するために,標本作製にも慎重さと工夫が求められる.(著者抄録)

たこつぼ型心筋症を合併した顕微鏡的多発血管炎の一例

坂巻 裕介, 橋口 明典, 香野 日高, 林 晃一, 中川 健

日本透析医学会雑誌 （(一社)日本透析医学会）  49 （ Suppl.1 ） 584 - 584 2016年05月

共著, 査読有り,  ISSN  1340-3451

Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy.

Katafuchi R, Kawamura T, Joh K, Hashiguchi A, Hisano S, Shimizu A, Miyazaki Y, Nagata M, Matsuo S, IgA nephropathy Study Group in Japan

Clinical and experimental nephrology （Springer Tokyo）  20 （ 2 ） 244 - 52 2016年04月

共著,  ISSN  1437-7799

　概要を見る

BACKGROUND: The IgA nephropathy (IgAN) Study Group in Japan conducted a multicenter, randomized, controlled trial of tonsillectomy with steroid pulse therapy (TSP) versus steroid pulse monotherapy in patients with IgAN (UMIN Clinical Trial Registry Number; C000000384). The effects of therapies in relation to pathological severity were analyzed in this study. METHODS: The patients with IgAN, urinary protein 1.0-3.5 g/day, serum creatinine of 1.5 mg/dl or less were randomly assigned to receiving TSP (Group A) or steroid pulses alone (Group B). The primary endpoint was the disappearance of proteinuria and/or hematuria. Twenty-six biopsies in Group A and 33 in Group B were available. The histological grades (HG) according to the percentage of glomeruli with crescent or sclerosis and the Oxford classification were analyzed. RESULTS: The patients in Group A had a 4.32- to 12.1-fold greater benefit of disappearance of proteinuria and 3.61- to 8.17-fold greater benefit of clinical remission (disappearance of proteinuria and hematuria) than those in Group B in patients with HG2-3, acute lesions (cellular or fibrocellular crescent) affecting more than 5 % of glomeruli, chronic lesions (fibrous crescents or sclerosis) affecting more than 20 % and S1. In contrast, odds ratios for disappearance of proteinuria or clinical remission in Group A to Group B were not significant in patients with HG 1, acute lesion in 5 % or less of glomeruli, chronic lesion in 20 % or less and S0. The disappearance of hematuria showed no relation to pathological severity. CONCLUSION: TSP might be better employed according to the pathological severity.

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Automatic quantification of morphological features for hepatic trabeculae analysis in stained liver specimens

Ishikawa, M., Murakami, Y., Ahi, S. T., Yamaguchi, M., Kobayashi, N., Kiyuna, T., Yamashita, Y., Saito, A., Abe, T., Hashiguchi, A. and Sakamoto, M.

J Med Imaging (Bellingham) （SPIE）  3 （ 2 ） 027502 2016年04月

共著,  ISSN  2329-4302

　概要を見る

This paper proposes a digital image analysis method to support quantitative pathology by automatically segmenting the hepatocyte structure and quantifying its morphological features. To structurally analyze histopathological hepatic images, we isolate the trabeculae by extracting the sinusoids, fat droplets, and stromata. We then measure the morphological features of the extracted trabeculae, divide the image into cords, and calculate the feature values of the local cords. We propose a method of calculating the nuclear-cytoplasmic ratio, nuclear density, and number of layers using the local cords. Furthermore, we evaluate the effectiveness of the proposed method using surgical specimens. The proposed method was found to be an effective method for the quantification of the Edmondson grade.

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血栓性微小血管症と抗リン脂質抗体症候群を合併したループス腎炎の1例

坂巻, 裕介, 小西, 孝之助, 橋口, 明典, 冨田, 茂樹, 久保田, 英司, 伊藤, 裕 and 林, 晃一

日本腎臓学会誌 58 （ 1 ） 45 - 54 2016年01月

共著,  ISSN  0385-2385

　概要を見る

症例は48歳、女性。21歳時に、顔面、四肢の紅斑および発熱を認め、全身性エリテマトーデス(systemic lupus erythematosus:SLE)と診断され、副腎皮質ステロイド(プレドニゾロン)が開始された。当院入院の13日前にかかりつけ医を受診し、SLEの再燃が疑われて当科紹介となった。当院入院時の血液検査では、汎血球減少症、低補体血症、腎機能障害、ループス抗凝固因子の陽性、検尿では血尿と高度の蛋白尿が認められた。ループス腎炎の活動性評価目的で腎生検を施行後、プレドニゾロンによる免疫抑制療法に加え、抗血小板療法、抗凝固療法を開始した。第22病日には、破砕赤血球の出現を伴う溶血性貧血、血小板減少、腎機能障害の進行が認められた。新鮮凍結血漿を置換液とした血漿交換療法を計10回施行し全身状態や血小板減少は改善したが、腎機能の改善はなく、第36病日には血液透析を導入した。腎生検病理所見は、半月体形成と管内増殖を呈する高度の増殖性腎炎に加え、糸球体係蹄腔内には粗大な血栓を認め、細動脈内腔には閉塞性の硝子様沈着が認められた。蛍光抗体法による染色では、係蹄壁に免疫グロブリンと補体の顆粒状沈着を認め、電子顕微鏡では、分節性に上皮下と基底膜内の高電子密度沈着物を認めたものの、明らかな内皮下沈着物はみられなかった。ループス腎炎では、ステロイドを中心とした免疫抑制療法が治療の主体となるが、APSや血栓性微小血管症を合併した場合、免疫抑制療法に加え、抗血小板療法、抗凝固療法、血漿交換療法を含めた集学的治療が必要となる。ループス腎炎の病態は不明な点が多いが、今回われわれは、TMAが腎障害の進行に関与した可能性が示唆されたループス腎炎の1例を経験したので報告する。(著者抄録)

Elastin Fiber Accumulation in Liver Correlates with the Development of Hepatocellular Carcinoma

Yasui, Y., Abe, T., Kurosaki, M., Higuchi, M., Komiyama, Y., Yoshida, T., Hayashi, T., Kuwabara, K., Takaura, K., Nakakuki, N., Takada, H., Tamaki, N., Suzuki, S., Nakanishi, H., Tsuchiya, K., Itakura, J., Takahashi, Y., Hashiguchi, A., Sakamoto, M. and Izumi, N.

PLoS One （PUBLIC LIBRARY SCIENCE）  11 （ 4 ） e0154558 2016年

共著,  ISSN  1932-6203

　概要を見る

BACKGROUND & AIMS: The fibrosis stage, which is evaluated by the distribution pattern of collagen fibers, is a major predictor for the development of hepatocellular carcinoma (HCC) for patients with hepatitis C. Meanwhile, the role of elastin fibers has not yet been elucidated. The present study was conducted to determine the significance of quantifying both collagen and elastin fibers. METHODS: We enrolled 189 consecutive patients with hepatitis C and advanced fibrosis. Using Elastica van Gieson-stained whole-slide images of pretreatment liver biopsies, collagen and elastin fibers were evaluated pixel by pixel (0.46 mum/pixel) using an automated computational method. Consequently, fiber amount and cumulative incidences of HCC within 3 years were analyzed. RESULTS: There was a significant correlation between collagen and elastin fibers, whereas variation in elastin fiber was greater than in collagen fiber. Both collagen fiber (p = 0.008) and elastin fiber (p < 0.001) were significantly correlated with F stage. In total, 30 patients developed HCC during follow-up. Patients who have higher elastin fiber (p = 0.002) in addition to higher collagen fiber (p = 0.05) showed significantly higher incidences of HCC. With regard to elastin fiber, this difference remained significant in F3 patients. Furthermore, for patients with a higher collagen fiber amount, higher elastin was a significant predictor for HCC development (p = 0.02). CONCLUSIONS: Computational analysis is a novel technique for quantification of fibers with the added value of conventional staging. Elastin fiber is a predictor for the development of HCC independently of collagen fiber and F stage.

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[Renal thrombotic microangiopathy and antiphospholipid syndrome nephropathy in a patient with lupus nephritis]

Sakamaki, Y., Konishi, K., Hashiguchi, A., Tomita, S., Kubota, E., Itoh, H. and Hayashi, K.

Nihon Jinzo Gakkai Shi 58 （ 1 ） 45 - 54 2016年

ISSN  0385-2385

　概要を見る

The patient was a 48-year-old Japanese woman diagnosed as having systemic lupus erythematosus at the age of 21 years when she presented with fever and an erythematous skin rash on her face and extremities. Prednisolone was initiated at that time. Thirteen days before admission to our hospital, she was referred to us by her family physician. Upon admission, blood tests showed pancytopenia, hypocomplementemia, and renal dysfunction, as well as the presence of lupus anticoagulant. Urinalysis showed abundant proteinuria and heavy microscopic hematuria. After performing a renal biopsy, we initiated immunosuppressive therapy and an anticoagulant. On the 22nd hospital day, microangiopathic hemolytic anemia appeared with the progression of thrombocytopenia and renal failure, and the patient subsequently underwent ten sessions of plasma exchange. After the commencement of the plasma exchange, her general condition improved. Her renal dysfunction, however, continued to progress, and hemodialysis was started on the 36th hospital day. The light microscopy showed severe endo- and extra-capillary proliferative glomerulonephritis with abundant crescents, and massive thrombi in the capillary lumen of the glomeruli. The arterioles contained occlusive hyaline materials. An immunofluorescence study showed granular staining of immunoglobulins and complements along the glomerular capillary wall. An electron microscopy examination revealed the presence of electron-dense deposits in the subepithelial and intramembranous areas of the glomeruli, but subendothelial deposits were absent. For cases with lupus nephritis (LN), immunosuppressive therapy based on corticosteroid remains the mainstay of treatment. However, immunosuppression alone may be insufficient when antiphospholipid antibody syndrome and thrombotic microangiopathy (TMA) are also present, and other treatment modalities including antiplatelet therapy, anticoagulation, and plasma exchange are likely to be necessary, as illustrated by the present case. Although the mechanism responsible for LN remains uncertain, we report a case of LN suggesting that TMA is associated with renal dysfunction.

Correction: Elastin Fiber Accumulation in Liver Correlates with the Development of Hepatocellular Carcinoma

Yasui, Y., Abe, T., Kurosaki, M., Higuchi, M., Komiyama, Y., Yoshida, T., Hayashi, T., Kuwabara, K., Takaura, K., Nakakuki, N., Takada, H., Tamaki, N., Suzuki, S., Nakanishi, H., Tsuchiya, K., Itakura, J., Takahashi, Y., Hashiguchi, A., Sakamoto, M. and Izumi, N.

PLoS One 11 （ 8 ） e0160133 2016年

ISSN  1932-6203

　概要を見る

[This corrects the article DOI: 10.1371/journal.pone.0154558.].

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Renal thrombotic microangiopathy and antiphospholipid syndrome nephropathy in a patient with lupus nephritis

Yusuke Sakamaki, Konosuke Konishi, Akinori Hashiguchi, Shigeki Tomita, Eiji Kubota, Hiroshi Itoh, Koichi Hayashi

Japanese Journal of Nephrology （Japanese Society of Nephrology）  58 （ 1 ） 45 - 54 2016年

共著,  ISSN  0385-2385

　概要を見る

The patient was a 48-year-old Japanese woman diagnosed as having systemic lupus erythematosus at the age of 21 years when she presented with fever and an erythematous skin rash on her face and extremities. Prednisolonewas initiated at that time. Thirteen days before admission to our hospital, she was referred to us by her family physician. Upon admission, blood tests showed pancytopenia, hypocomplementemia, and renal dysfunction, as well as the presence of lupus anticoagulant. Urinalysis showed abundant proteinuria and heavy microscopic hematuria. After performing a renal biopsy, we initiated immunosuppressive therapy and an anticoagulant. On the 22nd hospital day, microangiopathic hemolytic anemia appeared with the progression of thrombocytopenia and renal failure, and the patient subsequently underwent ten sessions of plasma exchange. After the commencement of the plasma exchange, her general condition improved. Her renal dysfunction, however, continued to progress, and hemodialysis was started on the 36th hospital day. The light microscopy showed severe endo- And extra-capillary proliferative glomerulonephritis with abundant crescents, and massive thrombi in the capillary lumen of the glomeruli. The arterioles contained occlusive hyaline materials. An immunofluorescence study showed granular staining of immunoglobulins and complements along the glomerular capillary wall. An electron microscopy examination revealed the presence of electron-dense deposits in the subepithelial and intramembranous areas of the glomeruli, but subendo- Thelial deposits were absent. For cases with lupus nephritis (LN), immunosuppressive therapy based on corticosteroid remains the mainstay of treatment. However, immunosuppression alone may be insufficient when antiphos- pholipid antibody syndrome and thrombotic microangiopathy (TMA) are also present, and other treatment modalities including antiplatelet therapy, anticoagulation, and plasma exchange are likely to be necessary, as illustrated by the present case. Although the mechanism responsible for LN remains uncertain, we report a case of LN suggesting that TMA is associated with renal dysfunction.

腎生検所見から何を学ぶか(No.57)　全身性浮腫で発症し血小板減少を伴った管内増殖性腎炎の1例

野田, 翔子, 住田, 圭一, 関根, 章成, 上野, 智敏, 今福, 礼, 川田, 真宏, 平松, 里佳子, 早見, 典子, 長谷川, 詠子, 諏訪部, 達也, 星野, 純一, 澤, 直樹, 高市, 憲明, 西田, 彩, 藤井, 晶子, 大橋, 健一, 藤井, 丈士, 乳原, 善文 and 橋口, 明典

腎と透析 79 （ 6 ） 984 - 996 2015年12月

共著,  ISSN  0385-2156

Feature analyses of trabecular pattern of hepatocellular carcinoma using graph structure

Hideki Komagata, Masahiro Ishikawa, Naoki Kobayashi, Kazuma Shinoda, Masahiro Yamaguchi, Tokiya Abe, Akinori Hashiguchi, Michiie Sakamoto

IIEEJ Transactions on Image Electronics and Visual Computing （The Institute of Image Electronics Engineers of Japan）  3 （ 2 ） 80 - 91 2015年12月

共著, 査読有り,  ISSN  2188-191X

A case of severe osteomalacia caused by Tubulointerstitial nephritis with Fanconi syndrome in asymptomotic primary biliary cirrhosis

Yamaguchi, S, Maruyama, T, Wakino, S, Tokuyama, H, Hashiguchi, A, Tada, S, Homma, K, Monkawa, T, Thomas, J, Miyashita, K, Kurihara, I, Yoshida, T, Konishi, K, Hayashi, K, Hayashi, M, Itoh, H

BMC Nephrol 16   187 - 187 2015年11月

共著,  ISSN  1471-2369

　概要を見る

BACKGROUND: Primary biliary cirrhosis (PBC) is an immune-mediated chronic cholestatic liver disease, characterized by increased concentrations of serum IgM and the presence of circulating anti-mitochondrial antibodies. Although bone diseases such as osteoporosis or osteodystrophy are commonly associated with PBC, osteomalacia which is caused by abnormal vitamin D metabolism, mineralization defects, and phosphate deficiency has not been recognized as a complication of PBC. CASE PRESENTATION: We report the case of a 49-year-old Japanese woman who complained of multiple fractures. Hypophosphatemic osteomalacia was diagnosed from a low serum phosphorus level, 1,25-dihydroxyvitamin D3 level, high levels of bone specific alkaline phosphatase and the findings of bone scintigraphy, although a bone biopsy was not performed. Twenty four hour urine demonstrated a low renal fractional tubular reabsorption of phosphate, increased fractional excretion of uric acid and generalized aminoaciduria. An intravenous bicarbonate loading test suggested the presence of proximal renal tubular acidosis (RTA). These biochemical data indicated Fanconi syndrome with proximal RTA. A kidney biopsy demonstrated t

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Visualization of acetaminophen-induced liver injury by time-of-flight secondary ion mass spectrometry

橋口 明典

ANALYTICAL BIOCHEMISTRY （ACADEMIC PRESS INC ELSEVIER SCIENCE）  488   51 - 58 2015年11月

研究論文（学術雑誌）, 共著,  ISSN  0003-2697

　概要を見る

Time-of-flight secondary ion mass spectrometry (MS) provides secondary ion images that reflect distributions of substances with sub-micrometer spatial resolution. To evaluate the use of time-of-flight secondary ion MS to capture subcellular chemical changes in a tissue specimen, we visualized cellular damage showing a three-zone distribution in mouse liver tissue injured by acetaminophen overdose. First, we selected two types of ion peaks related to the hepatocyte nucleus and cytoplasm using control mouse liver. Acetaminophen-overdosed mouse liver was then classified into three areas using the time-of-flight secondary ion MS image of the two types of peaks, which roughly corresponded to established histopathological features. The ion peaks related to the cytoplasm decreased as the injury became more severe, and their origin was assumed to be mostly glycogen based on comparison with periodic acid Schiff staining images and reference compound spectra. This indicated that the time-of-flight secondary ion MS image of the acetaminophen-overdosed mouse liver represented the chemical changes mainly corresponding to glycogen depletion on a subcellular scale. In addition, this technique also provided information on lipid species related to the injury. These results suggest that time-of-flight secondary ion MS has potential utility in histopathological applications. (C) 2015 Elsevier Inc. All rights reserved.

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C型肝炎関連クリオグロブリン血症に伴う糸球体腎炎の一例

伊藤 智章, 脇野 修, 徳山 博文, 橋口 明典, 小西 孝之助, 海老沼 浩利, 林 松彦, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 992 - 992 2015年08月

共著,  ISSN  0385-2385

菲薄基底膜病の母を有し、Alport症候群が疑われた一症例

田島 敬也, 脇野 修, 中谷 英章, 徳山 博文, 橋口 明典, 小西 孝之助, 林 松彦, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 961 - 961 2015年08月

共著,  ISSN  0385-2385

抗甲状腺薬内服中にMPO-ANCAが陽性となった腎症の一例

盛崎 瑞葉, 脇野 修, 徳山 博文, 中谷 英章, 橋口 明典, 小西 孝之助, 林 松彦, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 966 - 966 2015年08月

共著,  ISSN  0385-2385

両側視力障害を主訴に緊急搬送されRPLSを認めた高血圧合併糖尿病性腎症の1症例

篠塚 圭祐, 徳山 博文, 橋口 明典, 小西 孝之助, 脇野 修, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 960 - 960 2015年08月

共著,  ISSN  0385-2385

ポラプレジンクによる薬剤性急性尿細管間質性腎炎の一例

萩原 あいか, 徳山 博文, 脇野 修, 橋口 明典, 小西 孝之助, 林 晃一, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 954 - 954 2015年08月

共著,  ISSN  0385-2385

びまん性大細胞型B細胞性リンパ腫に合併した治療抵抗性IgA腎症の一例

藤井 健太郎, 脇野 修, 徳山 博文, 橋口 明典, 小西 孝之助, 林 松彦, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 1016 - 1016 2015年08月

共著,  ISSN  0385-2385

RPGNを呈したPR3-ANCA陽性膜性腎症の一例

村丘 寛和, 徳山 博文, 橋口 明典, 小西 孝之助, 林 晃一, 脇野 修, 伊藤 裕

日本腎臓学会誌 （(一社)日本腎臓学会）  57 （ 6 ） 966 - 966 2015年08月

共著,  ISSN  0385-2385