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The growth of the dietary supplement in Japanese market suggests that the patient's need for assistance with self-care will also continue to grow. Patients' burgeoning acceptance and use of alternative therapies is another indication that patients seeking more from the health care system. The questionnaire showed that the most of them are expecting the pharmacists to provide their knowledge of dietary supplements. However, only limited amount of information is available. We founded the group Alterna in 2003, that compose the pharmacists working in community pharmacies accompanied with those in pharmaceutical universities. We have published the journal named "Alterna" that includes the information of dietary supplements, and it attained Vol. 9 in 2008. In the past studies, we evaluated the content and solubility of coenzyme Q10 dietary supplements in Japanese markets, some of which showed poor solubility. In others, we had taken up the information about vitamin and minerals, tea catechins, DHA and EPA, cooking oils to reduce body fat, collagen, etc. Findings in these studies present the opportunities for the pharmacists to provide the significant positive impact on health care outcomes and costs to patients.

We experienced a case of A-59-year-old woman having autosomal dominant polycystic kidney disease with renal insufficiency associated with pelvic insufficiency fracture. On admission the pelvic bone compressed by the enlarged kidney and liver due to polycystic disease was demonstrated on the pelvic CT. Her bone mineral density was not significantly decreased contrary to our expectation. The prominent bone absorption in the endosteal and exosteal surface of the cortical bone was demonstrated in the bone specimen form iliac bone although the state of the cancellous bone and bone formation rate was normal. We performed the transcatheter embolization (TAE) to the kidney and liver to diminish their sizes. The fracture was rapidly improved and she could walk 6 months later after the TAE. In this case, we considered that the longstanding compression to the pelvic bone by the enlarged liver and kidney made the cortical and the binding of muscle/tendon and cortical bone fragile and it led to the pelvic insufficiency fracture.

Hyperparathyroidism, renal osteodystrophy and ectopic calcification, caused by hypocalcemia and hyperphosphatemia, are important complication in renal dysfunction, especially in end stage renal disease. Because it is the reason for reducing the survival rate and quality of life in these patients, it is important to control them from early stage in renal dysfunction. K/DOQI (kidney disease outcomes quality initiative) guideline shows us the recommended practical level and its account. It may be helpful for our daily clinical work.

Intact-PTH began to increase early at 1.0

Na/H antiporter located in the plasma membrane is mandatory to maintain cell pH. Two isoforms with different sensitivities to amiloride have been identified. They seem to be products from different mRNAs. The amiloride-sensitive form exists in the non-epithelial cells and the basal membrane of the epithelial cells. The amiloride-resistant form is confined in the apical membrane of the epithelial cells and is important for the vectorial transport of HCO3-. The amiloride-sensitive form has been cloned and sequenced. It is a glycoprotein composed of 815 amino acids. Functional analysis of Na/H antiporter by expressing mutant Na/H antiporter cDNA is in progress.

Pharmacokinetics of cefoperazone (CPZ) was examined in 5 patients with end-stage renal failure on maintenance intermittent peritoneal dialysis. Blood levels of CPZ given as a 1 g intravenous bolus injection were not different whether a patient was on or off peritoneal dialysis. Peritoneal clearance of CPZ was 1.6-1.9 ml/min. Blood CPZ levels reached the therapeutic level within 30-120 minutes after an intraperitoneal administration of 1 g CPZ, and remained at the level at least for 3-5 hours. Side effects of CPZ were not observed in any patient. These data indicate that the peritoneal dialysis does not affect blood CPZ levels given intravenously and that effective blood levels of CPZ can be maintained for several hours after an intraperitoneal injection of the drug. Thus, CPZ is considered useful in renal failure patients on peritoneal dialysis.