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急性胆管炎に抗菌薬をどう選択する? (日経BP)

こんにちは、AST専従薬剤師として抗菌薬適正使用に携わっている柏原です。今回は、急性胆管炎に対する薬物治療の考え方や、実際のASTの関わりについて紹介したいと思...

  1. 最前線で新型コロナ対応に当たったキーパー...
  2. 薬局の待合にデジタルサイネージを設置! ...
  3. 夜間頻尿でベオーバが追加処方された患者 ...
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Podocyte hypertrophic stress and detachment precedes hyperglycemia or albuminuria in a rat model of obesity and type2 diabetes-associated nephropathy.

著者 Minakawa A , Fukuda A , Sato Y , Kikuchi M , Kitamura K , Wiggins RC , Fujimoto S
Sci Rep.2019 Dec 06 ; 9(1):18485.
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Type2 diabetes-associated nephropathy is the commonest cause of renal failure. Mechanisms responsible are controversial. Leptin-deficient hyperphagic Zucker (fa/fa) rats were modeled to test the hypothesis that glomerular enlargement drives podocyte hypertrophic stress leading to accelerated podocyte detachment, podocyte depletion, albuminuria and progression. By 6weeks, prior to development of either hyperglycemia or albuminuria, fa/fa rats were hyperinsulinemic with high urinary IGF1/2 excretion, gaining weight rapidly, and had 1.6-fold greater glomerular volume than controls (P < 0.01). At this time the podocyte number per glomerulus was not yet reduced although podocytes were already hypertrophically stressed as shown by high podocyte phosphor-ribosomal S6 (a marker of mTORC1 activation), high urinary pellet podocin:nephrin mRNA ratio and accelerated podocyte detachment (high urinary pellet podocin:aquaporin2 mRNA ratio). Subsequently, fa/fa rats became both hyperglycemic and albuminuric. 24 hr urine albumin excretion correlated highly with decreasing podocyte density (R = 0.86), as a consequence of both increasing glomerular volume (R = 0.70) and decreasing podocyte number (R = 0.63). Glomerular podocyte loss rate was quantitatively related to podocyte detachment rate measured by urine pellet mRNAs. Glomerulosclerosis occurred when podocyte density reached <50/10um. Reducing food intake by 40% to slow growth reduced podocyte hypertrophic stress and "froze" all elements of the progression process in place, but had small effect on hyperglycemia. Glomerular enlargement caused by high growth factor milieu starting in pre-diabetic kidneys appears to be a primary driver of albuminuria in fa/fa rats and thereby an under-recognized target for progression prevention. Progression risk could be identified prior to onset of hyperglycemia or albuminuria, and monitored non-invasively by urinary pellet podocyte mRNA markers.
PMID: 31811176 [PubMed - in process]
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