Clinical lessons from an elderly man with amiodarone-induced interstitial lung disease

An 82-year-old man was in relatively good health despite a background of hypertension, chronic kidney disease stage 4 (estimated glomerular filtration rate 15 – 30 ml/min) and extensive vascular disease requiring carotid endartectomy, coronary artery bypass grafting, repair of an abdominal aortic aneurysm, and stenting of both renal arteries. In May 2005 he developed rapid atrial flutter after an episode of acute coronary syndrome. He was successfully cardioverted to sinus rhythm. After a loading dose of amiodarone he continued on 200 mg daily, and remained in sinus rhythm

Community acquired bacteraemia : a prospective survey of 239 cases

The incidence and epidemiology of bacteraemia has been widely reported in the United States and Europe but little data is available from Southern Africa. In addition, most studies have concentrated on the overall incidence of bacteraemia, on individual organisms, or clinical situations, and it is difficult to interpret the data from these studies with regard to community acquired bacteraemia. From a retrospective survey of summaries from a single medical ward at Groote Schuur Hospital it was estimated that bacteraemia accounted for about 4% of the total admissions. It was therefore thought useful to provide clinicians particularly at Groote Schuur Hospital with information about community acquired bacteraemia to improve overall patient management. With this in mind it was decided to undertake a comprehensive prospective study of community acquired bacteraemia at Groote Schuur Hospital

Investigation of the ethnic differences and genetics of salt sensivity and salt-sensitive hypertension in South Africa

Includes abstract. Includes bibliographical references

Update on the role of candesartan in the optimal management of hypertension and cardiovascular risk reduction

Hypertension is the most prevalent cardiovascular disease of adults and is a major risk factor for cardiovascular (CV) and cerebrovascular morbidity and mortality worldwide. Treatment of hypertension leads to reduction of CV morbidity and mortality through blood pressure reduction. The role of renin–angiotensin–aldosterone system (RAAS) in the pathophysiology of hypertension is mainly through generation of potent vasoconstrictor angiotensin II, stimulation of aldosterone secretion, and increase in sympathetic activation. Angiotensin II receptor blockers such as candesartan, a long-acting agent, alter this system by blocking the activation of angiotensin I receptors. Several important clinical trials have tested the efficacy of candesartan with placebo, antihypertensive agents, or other agents that block the RAAS for the control of hypertension and reduction of key CV risk factors such as microalbuminuria, heart failure, retinopathy, and carotid intima medial thickness. Candesartan has been shown to be a well-tolerated and effective antihypertensive agent with positive metabolic characteristics and additional benefits on CV and cerebrovascular outcomes. The aim of this review is to discuss the pharmacology, efficacy, and safety of candesartan, with an overview of key hypertension and CV studies involving candesartan

Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

BACKGROUND: Methamphetamine abuse has risen dramatically in South Africa. The chronic effects of abuse on the kidneys and blood pressure have not been documented. This study reviewed patients referred for evaluation of kidney disease and/or hypertension, who had been abusing methamphetamines. METHODS: The records of patients referred to the renal unit between 2005 and 2013 who had been using methamphetamines were retrospectively reviewed. Patient demographics, biophysical parameters, blood pressure, renal function, renal ultrasound and biopsy findings, complications of chronic kidney disease and comorbidities were recorded. RESULTS: Forty-seven patients were included in the study. Their mean age was 29 years. Hypertension was present in 42 (89.4%) of patients, with malignant hypertension in 21 (44.7%). Forty-five (95.7%) had chronic kidney disease (CKD), and 26 (55.3%) had end-stage renal disease. Renal biopsies were performed in 24 patients. Twelve (50.0%) of the biopsies showed hypertensive changes and 14 (58.3%) mesangiocapillary glomerulonephritis type 1, with deposition of IgM and C3 complement. CONCLUSION: Methamphetamine use is associated with severe hypertension, mesangiocapillary glomerulonephritis and CKD