腎臓科英語：必須語彙とフレーズ

"glomerulus"

A tiny tuft of capillaries enclosed within the Bowman's capsule at the start of each nephron, where blood plasma is filtered to form the primary filtrate

"The biopsy revealed thickening of the glomerular basement membrane, consistent with early diabetic nephropathy."

"nephron"

The basic functional and structural unit of the kidney, consisting of the glomerulus, Bowman's capsule, proximal tubule, loop of Henle, distal tubule, and collecting duct

"Each kidney contains approximately one million nephrons, though this number declines gradually with age and disease."

"glomerular filtration rate (GFR)"

The volume of fluid filtered from the renal glomerular capillaries into the Bowman's capsule per unit time, used as the principal measure of kidney function

"The patient's estimated GFR had fallen to 28 mL/min/1.73 m², placing her in stage 4 chronic kidney disease."

"tubular reabsorption"

The process by which the renal tubules reclaim useful substances — including glucose, amino acids, water, and electrolytes — from the filtrate back into the bloodstream

"Defective tubular reabsorption of phosphate in Fanconi syndrome leads to phosphaturia and hypophosphataemia."

"renin–angiotensin–aldosterone system"

A hormonal cascade initiated by renin release from the juxtaglomerular apparatus that regulates blood pressure, sodium balance, and fluid volume by promoting angiotensin II formation and aldosterone secretion

"ACE inhibitors interrupt the renin–angiotensin–aldosterone system, reducing intraglomerular pressure and slowing the progression of diabetic nephropathy."

"loop of Henle"

The hairpin-shaped segment of the nephron tubule that descends into the renal medulla and creates an osmotic gradient essential for the concentration of urine

"Loop diuretics such as furosemide act at the thick ascending limb of the loop of Henle to block sodium–potassium–chloride cotransport."

"collecting duct"

The final tubular segment through which concentrated filtrate passes before entering the renal pelvis, where antidiuretic hormone regulates water permeability to control final urine concentration

"Mutations in aquaporin-2 channels of the collecting duct cause nephrogenic diabetes insipidus, impairing the kidney's ability to concentrate urine."

"renal cortex"

The outer layer of the kidney containing the glomeruli, proximal and distal convoluted tubules, and the initial segments of collecting ducts, where most filtration and reabsorption occurs

"Ultrasound showed reduced renal cortical thickness bilaterally, a finding consistent with chronic parenchymal disease."

"chronic kidney disease (CKD)"

A persistent abnormality of kidney structure or function lasting more than three months, classified into five stages based on eGFR and albuminuria category

"The multidisciplinary team reviewed the patient's progression from CKD stage 3a to stage 4 over the preceding eighteen months."

"albuminuria"

The presence of abnormal amounts of albumin in the urine, categorised as microalbuminuria (30–300 mg/g creatinine) or macroalbuminuria (above 300 mg/g), serving as both a diagnostic marker and risk factor for CKD progression

"Annual screening for albuminuria is recommended in all patients with type 2 diabetes as an early indicator of diabetic kidney disease."

"uraemia"

The clinical syndrome resulting from the accumulation of nitrogenous waste products — including urea and creatinine — in the blood when kidney function is severely impaired

"The patient presented with uraemic encephalopathy, pericarditis, and intractable pruritus, prompting urgent initiation of haemodialysis."

"renal anaemia"

Anaemia arising in CKD primarily due to insufficient erythropoietin production by the diseased kidneys, leading to reduced red blood cell synthesis

"The nephrologist commenced treatment with an erythropoiesis-stimulating agent to correct renal anaemia and improve the patient's fatigue and exercise tolerance."

"renal osteodystrophy"

A spectrum of bone disorders arising in CKD due to disturbances in calcium, phosphate, PTH, and vitamin D metabolism, including osteomalacia, osteitis fibrosa cystica, and adynamic bone disease

"Renal osteodystrophy was suspected after imaging revealed subperiosteal bone resorption and elevated parathyroid hormone levels in the dialysis patient."

"hyperkalaemia"

An abnormally elevated serum potassium concentration, a potentially life-threatening complication of advanced CKD that can cause fatal cardiac arrhythmias

"The patient was admitted with ECG changes indicating severe hyperkalaemia, which was treated with intravenous calcium gluconate and urgent haemodialysis."

"metabolic acidosis"

A reduction in blood pH and bicarbonate concentration caused by impaired acid excretion and bicarbonate regeneration in the diseased kidney, accelerating CKD progression and promoting muscle catabolism

"Oral sodium bicarbonate supplementation was prescribed to correct persistent metabolic acidosis and slow the decline in residual renal function."

"cardiorenal syndrome"

A bidirectional interplay between cardiac and renal dysfunction in which each organ's failure accelerates deterioration in the other, classified into five subtypes based on the primary initiating organ

"Acute decompensated heart failure triggered type 1 cardiorenal syndrome, causing an acute-on-chronic worsening of the patient's already impaired GFR."

"nephrotic syndrome"

A clinical syndrome characterised by heavy proteinuria (above 3.5 g/day), hypoalbuminaemia, peripheral oedema, and hyperlipidaemia, resulting from increased glomerular permeability to protein

"The child presented with pitting oedema, frothy urine, and a serum albumin of 18 g/L, meeting the diagnostic criteria for nephrotic syndrome."

"nephritic syndrome"

A constellation of findings — haematuria with red cell casts, hypertension, oliguria, and mild to moderate proteinuria — caused by inflammatory glomerular damage

"Post-streptococcal glomerulonephritis classically manifests as nephritic syndrome two to three weeks after a throat infection in children."

"focal segmental glomerulosclerosis (FSGS)"

A pattern of glomerular injury characterised by scarring that affects only some glomeruli (focal) and only part of each affected glomerulus (segmental), a leading cause of nephrotic syndrome in adults

"Genetic testing identified a NPHS2 podocin mutation underlying the steroid-resistant FSGS in the young patient, guiding targeted management."

"IgA nephropathy"

The most common primary glomerulonephritis worldwide, characterised by mesangial deposition of IgA immune complexes, typically presenting as macroscopic haematuria during respiratory infections

"The renal biopsy confirmed IgA nephropathy with Oxford MEST-C score features predicting a high risk of progression to end-stage kidney disease."

"membranous nephropathy"

An immune-complex–mediated glomerulonephritis characterised by subepithelial deposits and thickening of the glomerular basement membrane, the most frequent cause of nephrotic syndrome in white adults

"Anti-PLA2R antibody titres were markedly elevated, confirming primary membranous nephropathy and guiding the decision to commence rituximab therapy."

"rapidly progressive glomerulonephritis (RPGN)"

A clinical syndrome defined by a rapid loss of kidney function over days to weeks, with crescents on biopsy, requiring urgent immunosuppressive treatment to prevent irreversible renal failure

"The discovery of crescentic glomerulonephritis on biopsy, combined with positive ANCA serology, prompted immediate high-dose methylprednisolone and cyclophosphamide therapy."

"minimal change disease"

The most common cause of nephrotic syndrome in children, characterised by normal light microscopy findings but diffuse podocyte foot process effacement on electron microscopy, and highly responsive to corticosteroids

"The four-year-old responded dramatically to oral prednisolone within two weeks, achieving complete remission of the minimal change disease nephrotic syndrome."

"lupus nephritis"

Kidney inflammation caused by systemic lupus erythematosus, classified into six histological classes based on the pattern and degree of immune complex deposition in the glomerulus

"Renal biopsy revealed class IV lupus nephritis with diffuse proliferative changes, leading to the addition of mycophenolate mofetil and hydroxychloroquine to the treatment regimen."

"haemodialysis"

A renal replacement therapy in which blood is circulated through an extracorporeal circuit, passed across a semipermeable membrane in a dialyser to remove waste solutes and excess fluid by diffusion and ultrafiltration

"The patient was established on thrice-weekly haemodialysis sessions of four hours duration via a functioning arteriovenous fistula."

"peritoneal dialysis"

A renal replacement therapy that uses the peritoneum as a dialysing membrane, with dialysate instilled into the peritoneal cavity to remove waste products by diffusion and excess fluid by osmosis

"The patient chose continuous ambulatory peritoneal dialysis, allowing her to perform exchanges at home and maintain employment."

"arteriovenous fistula"

A surgically created connection between an artery and a vein, usually at the wrist or forearm, that produces high-flow venous access suitable for repeated haemodialysis needle puncture

"The vascular surgeon created a radiocephalic arteriovenous fistula six months before the anticipated start of haemodialysis to allow adequate maturation."

"ultrafiltration"

The removal of excess plasma water across a semipermeable membrane driven by hydrostatic or osmotic pressure gradients, used in haemodialysis to correct fluid overload

"Isolated ultrafiltration was prescribed to remove three litres of excess fluid accumulated during the intradialytic period without causing hypotensive episodes."

"continuous renal replacement therapy (CRRT)"

A slow, continuous form of extracorporeal renal replacement used in haemodynamically unstable critically ill patients, providing gradual fluid removal and solute clearance over 24 hours

"The intensivist commenced CRRT via a temporary jugular vascular catheter when the patient developed anuric acute kidney injury and was too unstable to tolerate standard intermittent haemodialysis."

"dialysis adequacy"

A measure of how effectively a dialysis session removes urea and other waste products, most commonly expressed as the Kt/V ratio, where K is dialyser clearance, t is treatment time, and V is urea distribution volume

"Monthly assessment of dialysis adequacy revealed a Kt/V of 1.1, below the minimum recommended target of 1.2, prompting an extension of each haemodialysis session."

"intradialytic hypotension"

A fall in systolic blood pressure of 20 mmHg or more during or immediately after a haemodialysis session, the most frequent acute complication of haemodialysis, caused by rapid volume removal and autonomic dysfunction

"Recurrent intradialytic hypotension was managed by reducing the ultrafiltration rate, lowering dialysate temperature, and reviewing the patient's dry weight target."

"peritonitis"

Inflammation of the peritoneal membrane, most commonly caused by bacterial contamination during peritoneal dialysis exchanges, presenting with cloudy dialysate effluent, abdominal pain, and fever

"Empirical intraperitoneal antibiotics covering both Gram-positive and Gram-negative organisms were administered when the effluent cell count confirmed peritoneal dialysis-related peritonitis."

"human leucocyte antigen (HLA) matching"

The process of comparing the HLA antigens of donor and recipient to assess immunological compatibility, with closer matching associated with lower rates of rejection and better long-term graft survival

"The six-antigen HLA-matched living-donor kidney provided the best possible immunological compatibility, predicting excellent long-term graft function."

"calcineurin inhibitor"

A class of immunosuppressant drugs — principally tacrolimus and ciclosporin — that prevent T-cell activation by blocking calcineurin-mediated transcription of interleukin-2, forming the cornerstone of post-transplant maintenance immunosuppression

"Tacrolimus trough levels were monitored daily in the early post-transplant period to optimise immunosuppression and avoid the nephrotoxicity associated with elevated calcineurin inhibitor exposure."

"acute rejection"

An immune-mediated attack on the transplanted kidney occurring days to weeks after transplantation, classified as T-cell–mediated (cellular) or antibody-mediated, typically presenting with rising creatinine and confirmed on biopsy

"The surveillance biopsy at three months revealed subclinical acute T-cell–mediated rejection, prompting a pulse of intravenous methylprednisolone to reverse the inflammatory damage."

"delayed graft function"

The failure of a transplanted kidney to function immediately after transplantation, defined by the need for dialysis in the first week post-transplant, caused by ischaemia–reperfusion injury during organ procurement and preservation

"The deceased-donor kidney from an older donor with prolonged cold ischaemia time developed delayed graft function requiring three sessions of haemodialysis before establishing adequate urine output."

"panel reactive antibody (PRA)"

A measure of the percentage of a random donor panel against which a transplant candidate's serum reacts, reflecting the degree of presensitisation to HLA antigens and the risk of finding a compatible donor

"After multiple blood transfusions, the patient's PRA rose to 85%, significantly lengthening the wait for a compatible deceased-donor kidney."

"chronic allograft nephropathy"

Progressive, irreversible loss of transplant function over months to years driven by a combination of immune-mediated injury, calcineurin inhibitor toxicity, hypertension, and recurrent disease, the leading cause of late graft failure

"The gradual rise in serum creatinine and proteinuria at five years post-transplant, confirmed by interstitial fibrosis and tubular atrophy on biopsy, was consistent with chronic allograft nephropathy."

"living donor"

An individual who donates one kidney to a recipient while alive, either as a genetically related donor or an unrelated altruistic donor, offering superior outcomes compared with deceased-donor transplantation

"A pre-emptive living-donor transplant from the patient's sister avoided the need for dialysis and conferred a significant survival advantage over waiting for a deceased-donor organ."

"BK virus nephropathy"

Kidney injury in transplant recipients caused by reactivation of the BK polyomavirus in the setting of immunosuppression, potentially leading to irreversible graft loss if not detected and managed early

"A rising BK viraemia on monthly surveillance triggered a pre-emptive reduction in immunosuppression to prevent the development of BK virus nephropathy."

"acute kidney injury (AKI)"

An abrupt deterioration of kidney function defined by the KDIGO criteria as a rise in serum creatinine of 0.3 mg/dL or more within 48 hours, or a 50% rise within seven days, or a urine output below 0.5 mL/kg/h for six or more hours

"Post-operative AKI was identified when the serum creatinine rose from baseline within 24 hours after major cardiac surgery, requiring urgent nephrology review."

"prerenal azotaemia"

Elevation of blood urea and creatinine resulting from reduced renal perfusion rather than intrinsic kidney damage, caused by volume depletion, heart failure, or hepatorenal syndrome, and reversible with restoration of renal blood flow

"Aggressive intravenous fluid resuscitation promptly corrected the prerenal azotaemia caused by profuse diarrhoea and dehydration in the elderly patient."

"acute tubular necrosis (ATN)"

The most common cause of intrinsic acute kidney injury, characterised by injury and death of tubular epithelial cells due to ischaemia or nephrotoxic agents such as aminoglycosides, contrast media, or myoglobin

"Granular muddy-brown casts in the urinary sediment confirmed the diagnosis of acute tubular necrosis following prolonged hypotension during septic shock."

"contrast-induced nephropathy"

Acute kidney injury occurring within 48 to 72 hours of intravascular administration of iodinated contrast media, particularly in patients with pre-existing CKD, diabetes, or volume depletion

"To reduce the risk of contrast-induced nephropathy, the radiologist ordered pre-hydration with intravenous sodium bicarbonate and used the minimum necessary volume of iso-osmolar contrast."

"fluid overload"

An excess accumulation of extracellular fluid causing oedema, pulmonary congestion, and haemodynamic compromise, commonly occurring in AKI and advanced CKD due to impaired renal fluid excretion

"The patient developed respiratory distress secondary to fluid overload, necessitating urgent diuretic therapy and preparation for haemodialysis."

"hyponatraemia"

A serum sodium concentration below 135 mmol/L, the most common electrolyte disorder in hospitalised patients, classified by serum osmolality and volume status into hypo-osmolar, iso-osmolar, and hyper-osmolar subtypes

"Severe hyponatraemia at 118 mmol/L with neurological symptoms was treated with cautious hypertonic saline infusion, targeting a correction rate no faster than 10 mmol/L per 24 hours to prevent osmotic demyelination."

"rhabdomyolysis"

The breakdown of skeletal muscle fibres releasing myoglobin and other intracellular contents into the circulation, which can precipitate AKI by direct tubular toxicity, tubular obstruction, and renal vasoconstriction

"A markedly elevated creatine kinase of 85,000 U/L confirmed rhabdomyolysis in the athlete who had collapsed during a marathon, prompting vigorous intravenous fluid administration to prevent AKI."

"renal replacement therapy (RRT)"

Any therapeutic modality that replaces the excretory functions of the kidneys, encompassing haemodialysis, peritoneal dialysis, and kidney transplantation, initiated when kidney function is insufficient to sustain life

"The multidisciplinary team discussed modality choice with the patient at the predialysis clinic, explaining the relative merits of each form of renal replacement therapy."