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論文(リポジトリ)
Trautmann, Agnes ; Vivarelli, Marina ; Samuel, Susan ; Gipson, Debbie ; Sinha, Aditi ; Schaefer, Franz ; Hui, Ng Kar ; Boyer, Olivia ; Saleem, Moin A ; Feltran, Luciana ; Müller-Deile, Janina ; Becker, Jan Ulrich ; Cano, Francisco ; Xu, Hong ; Lim, Yam Ngo ; Smoyer, William ; Anochie, Ifeoma ; Nakanishi, Koichi ; Hodson, Elisabeth ; Haffner, Dieter ; International Pediatric Nephrology Association
出版情報: Pediatric Nephrology.  35  pp.1529-1561,  2020-05-07.  Springer
URL: http://hdl.handle.net/20.500.12000/46947
概要: Idiopathic nephrotic syndrome newly affects 1–3 per 100,000 children per year. Approximately 85% of cases show complete remission of proteinuria following glucocorticoid treatment. Patients who do not achieve complete remission within 4–6 weeks of glucocorticoid treatment have steroid-resistant nephrotic syndrome (SRNS). In 10–30% of steroid-resistant patients, mutations in podocyte-associated genes can be detected, whereas an undefined circulating factor of immune origin is assumed in the remaining ones. Diagnosis and management of SRNS is a great challenge due to its heterogeneous etiology, frequent lack of remission by further immunosuppressive treatment, and severe complications including the development of end-stage kidney disease and recurrence after renal transplantation. A team of experts including pediatric nephrologists and renal geneticists from the International Pediatric Nephrology Association (IPNA), a renal pathologist, and an adult nephrologist have now developed comprehensive clinical practice recommendations on the diagnosis and management of SRNS in children. The team performed a systematic literature review on 9 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, formulated recommendations and formally graded them at a consensus meeting, with input from patient representatives and a dietician acting as external advisors and a voting panel of pediatric nephrologists. Research recommendations are also given.
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井上, 卓 ; 新里, 譲 ; Inoue, Taku ; Shinzato,Yuzuru
出版情報: 琉球医学会誌 = Ryukyu Medical Journal.  27  pp.123-129,  2008.  琉球医学会 — Ryukyu Medical Association
URL: http://hdl.handle.net/20.500.12000/0002015585
概要: Background: Elevated heart rate is closely associated with cardiovascular morbidity, mortality and all-cause mortality. Elevated heart rate is also associated with cardiovascular risk factors. The aim of the present study was to evaluate whether elevated heart rate is associated with cardiovascular morbidity independent of cardiovascular risk factors. Methods & Results: We examined the association between heart rate and cardiovascular morbidity of ambulatory patients. Of 102 patients, 3 were excluded because of low ejection fraction. Among the remaining 99 subjects (54 men, 45 women, $66 pm 12$ years of age), 34 (20 men, 14 women, $ 71\pm 8$ years of age) had a history of cardiovascular disease. The subjects with cardiovascular disease were significantly older, and had lower systolic blood pressure and lower total cholesterol levels than those without cardiovascular disease. Multivanable logistic regression analysis adjusted for age, sex, and antihypertensive agents revealed that a 20 beats/min heart rate increase was associated with an approximately 4-fold increase in the risk for cardiovascular disease (OR 3.597, 95% CI 1.456 - 8.888, p=0.0055). Metabolic syndrome (OR 1.276, 95% CI 0.434 - 3.752, p=NS) and chronic kidney disease (OR 0.736, 95% CI 0.238 - 2.279, p=NS) were not associated with cardiovascular disease. After excluding the patients prescribed such heart rate-lowering drugs as $ \beta $ -antagonist or diltiazem, heart rate increase was still the only factor associated with the risk for cardiovascular disease ( OR3.692, 95% CI 1.123 - 12.137, p=0.0351). Conclusions: Elevated heart rate is closely associated with cardiovascular morbidity independent of other cardiovascular risk factors such as metabolic syndrome or chronic kidney disease.
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