Naoki Kashihara

Our Goal

 Every aspiring doctor hopes to become an ideal doctor and an excellent physician.
 We ask ourselves each day: What are the requirements for an ideal doctor? Here are our thoughts. Whether a person is an ideal doctor should be evaluated by patients and their families. In a perfect world, an ideal doctor would ensure recuperation from illness, healing of injury, and recovery of health. Unfortunately, it is not uncommon that these goals cannot be fully met. Are health care providers destined to feel a sense of failure and defeat? We know this is not so. What do the patients themselves desire, or their families who love them? We strive to understand their hopes and meet their expectations.We will keep improving our ability to achieve these aims.

 We will face up to illness and struggle against it, while maintaining a strong sense of empathy. What if we were patients? What kind of care would we wish to receive? With these questions in mind, we will treat patients as partners and strive to provide the highest level of care as they fight against illness and live each valuable day.


 The clinical perspective on the causes of kidney diseases is drastically changing. In the past, the most undesirable result was progression to renal insufficiency. Recently, however, it has been clarified that mild albuminuria/proteinuria or renal dysfunction is more strongly related to the development of diseases that decreases QOL, such as stroke, ischemic heart disease, and cardiovascular disease like heart failure and dementia in a relatively short period, rather than as a risk of renal insufficiency in the long term.

 What is a possible reason for this? The causes of renal disorder themselves have changed in a short time period. The main cause of end-stage renal failure was chronic glomerulonephritis in the past. During the past 30 years, the incidence of diabetes mellitus has suddenly increased. Reflecting this increase, the main cause of renal insufficiency has been diabetes since 1998. Nephrosclerosis caused by arteriosclerosis is also increasing as a cause of renal failure.

 This, however, was only the tip of the iceberg. A condition appeared that leads to a large proportion of affected patients developing cardiovascular disease without easily causing renal insufficiency. This is the entity known today as chronic kidney disease (CKD). The development of CKD is related to impaired glucose intolerance/diabetes, obesity, metabolic syndrome, hypertension, smoking and aging.

To gain insight into the origin of disorders with a “wide perspective”

 A rise in the number of patients with CKD is related to lifestyle changes and aging of the Japanese population.
Generally, the cause of “chronic disease” is perceived to be overeating and lack of exercise; that is to say it depends on his/her responsibility. Isn’t it a rather superficial understanding of the problem? Vital organs such as the heart, pancreas and kidneys are formed in the mother’s womb to prepare the fetus for adaptation to the outside world. Middle-aged adults in our society were poorly nourished as babies during and after the war years, and they grew up in a society that became affluent unexpectedly. Consequently, they are now threatened by “chronic disease”. Doesn’t this accurately describe the situation affecting middle-aged people of our time? I cannot help feeling the irrationality in the fact that their dedicated efforts resulted in an affluent society, the benefits of which we are enjoying now.

 We sincerely wish to challenge and overcome this irrationality. We hope to shed light on not only present-day phenomenon but also the origins of disease that are related to the past lifestyle of Japanese people. We are keen to be physician–scientists who possess such skills.

 We hope young people will gather and share these ambitions with us.