Renal amiloid'li hastalarda etyoloji, klinik bulgular ve tedaviye yanıt

TEZ1419Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 1993.Kaynakça (s. 49-55) var.55 s. : rnk. res. ; 30 cm.

A comparison of the effectiveness of sublingual losartan, sublingual captopril and sublingual nifedipine in hypertensive urgency

The use of sublingual captopril and nifedipine has been indicated in hypertensive emergencies and in patients with essential hypertension, with the assumption that by this route, there would be a faster absorption and thus a more rapid effect on blood pressure (BP) than by the oral route. A comparative study of the effects of Losartan, angiotensin II receptor antagonist, captopril and nifedipine on blood pressure was carried out in patients with hypertensive urgency. Sixty patients with hypertensive urgency were subdivided into 3 groups of 20 patients each. The first group received sublingual captopril (25 mg), the second group received sublingual nifedipine (10 mg) and the third group received sublingual losartan (50 mg). In the captopril, nifedipine and losartan groups, the mean systolic pressures at the onset of hypertensive urgency were 188.00±23, 190.00±35 and 190.50±21 mmHg respectively. At 90 minutes, in the captopril, nifedipine and losartan groups, the mean systolic blood pressures were 138.50±18, 144.50±25 and 146.25±21 mmHg respectively. In the captopril, nifedipine and losartan groups, the mean diastolic blood pressures at the onset of hypertensive urgency were 116.00±15, 121.50±22 and 109.25±14 mmHg respectively. In the captopril, nifedipine and losartan groups, at 90 minutes, mean diastolic blood pressures were 84.75±10, 95.25±19 and 88.50±12 mmHg respectively. A significant (<0.05) hypotensive effect of sublingual captopril, nifedipine and losartan therapy occurred at 90 minutes. The results of the study indicate that sublingual losartan is an effective drug in patients with hypertensive urgencyThe use of sublingual captopril and nifedipine has been indicated in hypertensive emergencies and in patients with essential hypertension, with the assumption that by this route, there would be a faster absorption and thus a more rapid effect on blood pressure (BP) than by the oral route. A comparative study of the effects of Losartan, angiotensin II receptor antagonist, captopril and nifedipine on blood pressure was carried out in patients with hypertensive urgency. Sixty patients with hypertensive urgency were subdivided into 3 groups of 20 patients each. The first group received sublingual captopril (25 mg), the second group received sublingual nifedipine (10 mg) and the third group received sublingual losartan (50 mg). In the captopril, nifedipine and losartan groups, the mean systolic pressures at the onset of hypertensive urgency were 188.00±23, 190.00±35 and 190.50±21 mmHg respectively. At 90 minutes, in the captopril, nifedipine and losartan groups, the mean systolic blood pressures were 138.50±18, 144.50±25 and 146.25±21 mmHg respectively. In the captopril, nifedipine and losartan groups, the mean diastolic blood pressures at the onset of hypertensive urgency were 116.00±15, 121.50±22 and 109.25±14 mmHg respectively. In the captopril, nifedipine and losartan groups, at 90 minutes, mean diastolic blood pressures were 84.75±10, 95.25±19 and 88.50±12 mmHg respectively. A significant (<0.05) hypotensive effect of sublingual captopril, nifedipine and losartan therapy occurred at 90 minutes. The results of the study indicate that sublingual losartan is an effective drug in patients with hypertensive urgenc

Two different results in captopril renography of the same patient

Renovasküler hipertansiyon tanısında genellikle kaptoprilli radyonüklid renografiden yararlanılmaktadır. Biz burada aynı çekim tekniği uygulandığında farklı zamanlarda farklı renogram eğrisi elde ettiğimiz olguyu sunduk.Radionüclide renography with captopril intervention is generally used in diagnosis of renovascular hypertension. Here, we report a case with different renograms at different times using with the same technique

The Effects of Pentoxifylline on Peritoneal Functions and Cytokine Levels in Patients Followed with Continuous Ambulatory Peritoneal Dialysis

AMAÇ: Sürekli ayaktan periton diyalizi; son dönem böbrek yetersizliğinde sıklıkla kullanılan renal replasman tedavi seçeneğidir. Bu çalışmada; sürekli ayaktan periton diyalizi hastalarında pentoksifilinin periton geçirgenliğine ve sitokinlere etkisini değerlendirmeyi amaçladık. GEREÇ ve YÖNTEMLER: Çukurova Üniversitesi Nefroloji Bilim Dalında takip edilmekte olan 21 periton diyaliz hastası çalışmaya alındı.Hastaların standart tedavilerine ilaveten pentoksifilin 3 hafta süre ile 2x400 mg /gün verildi. Hastaların; yaş, cinsiyet, kronik böbrek yetmezliğinin etiyolojisi, periton diyalizinin süresi, fizik muayene bulguları, idrar miktarı, vücut ağırlığı, kullandığı ilaçlar kaydedildi. Pentoksifilin öncesi ve sonrasında periton dengelenme (eşitlenme) testi yapıldı, Kt/Vüre, ve kreatinin klirensi hesaplandı. Transport tipi, ultrafiltrasyon miktarı, idrar volümü ve peritoneal sıvı ile sodyum atılımı miktarı belirlendi. BULGULAR: Başlangıca göre pentoksifilin kullanımı sonrasında serum ve periton sıvısında BUN, kreatinin, sodyum, total protein, albümin, IL-1, IL-6, IL-10, TNF-alfa, sistatin C ve beta-2 mikroglobulin düzeylerinde, Kt/Vüre, kreatinin klirensinde istatistiksel olarak anlamlı farklılık saptanmadı. Hastalar diyabetik ve non-diyabetik olarak gruplandırıldığında da ölçülen belirteçlerde farklılık saptanmadı. Peritoneal sodyum ile Kt/Vüre, ultrafiltrasyon ve idrar volümü + ultrafiltrasyon toplamı arasında ilişki saptanmadı. Pentoksifilin öncesi ve sonrası serum albümin düzeyi ile serum IL-10 arasında negatif korelasyon mevcuttu, istatistiksel olarak anlamlıydı(p:0,049). SONUÇ: Pentoksifilinin periton membranı geçirgenliğinde etkili olmadığı saptandı. Pentoksifilin kullanım süresinin kısa olması ve/veya hasta sayısının nispeten az olması çalışmamızın sonuçlarını olumsuz etkilemiş olabilir.OBJECTIVE: Continuous Ambulatory Peritoneal Dialysis is more frequently used as renal replacement therapy for end stage renal failure patients. The aim of this study was to evaluate the effects of pentoxifylline on cytokines and permeability of peritoneum in continuous ambulatory peritoneal dialysis patients. MATERIAL and METHODS: 21 patients with peritoneal dialysis followed at Çukurova University Department of Nephrology were included. Pentoxifylline was given 2x400 mg daily for three weeks in addition to the standard therapy. All of the patient characteristics such as age, sex, accompanied disease, duration of peritoneal dialysis, edema, body weight, drugs were recorded. Peritoneal equilibration test was done before and after pentoxifylline therapy. Kt/Vurea and creatinine clearance were calculated. Peritoneal transport type, ultrafiltrate and urine volumes and peritoneal sodium excretion were determined. RESULTS: There was no difference for the Kt/Vurea, creatinine clearence, the serum and peritoneal dialysate levels of BUN, creatinine, sodium, albumin, IL-1, IL-6, IL-10, TNF-alpha, beta-2 microglobulin between baseline and after the pentoxifylline therapy. Additionally, there was no difference for measured parameters in diabetic and nondiabetic groups. Relationships between peritoneal sodium excretion and Kt/Vurea, ultrafiltration and sum of urine volume+ultrafiltrate were not found. There was a statistically significant negative correlation between serum albumin and serum IL-10 levels at baseline and after pentoxifylline therapy (p; 0,049). CONCLUSION: Pentoxifylline was not found to be effective in peritoneal permeability. This may be related to the short duration of pentoxifylline therapy and/or the relatively small number of the patients

The effects of pentoxifylline on peritoneal functions and cytokine levels in patients followed with continuous ambulatory peritoneal dialysis

AMAÇ: Sürekli ayaktan periton diyalizi; son dönem böbrek yetersizliğinde sıklıkla kullanılan renal replasman tedavi seçeneğidir. Bu çalışmada; sürekli ayaktan periton diyalizi hastalarında pentoksifilinin periton geçirgenliğine ve sitokinlere etkisini değerlendirmeyi amaçladık. GEREÇ ve YÖNTEMLER: Çukurova Üniversitesi Nefroloji Bilim Dalında takip edilmekte olan 21 periton diyaliz hastası çalışmaya alındı.Hastaların standart tedavilerine ilaveten pentoksifilin 3 hafta süre ile 2x400 mg /gün verildi. Hastaların; yaş, cinsiyet, kronik böbrek yetmezliğinin etiyolojisi, periton diyalizinin süresi, fizik muayene bulguları, idrar miktarı, vücut ağırlığı, kullandığı ilaçlar kaydedildi. Pentoksifilin öncesi ve sonrasında periton dengelenme (eşitlenme) testi yapıldı, Kt/Vüre, ve kreatinin klirensi hesaplandı. Transport tipi, ultrafiltrasyon miktarı, idrar volümü ve peritoneal sıvı ile sodyum atılımı miktarı belirlendi. BULGULAR: Başlangıca göre pentoksifilin kullanımı sonrasında serum ve periton sıvısında BUN, kreatinin, sodyum, total protein, albümin, IL-1, IL-6, IL-10, TNF-alfa, sistatin C ve beta-2 mikroglobulin düzeylerinde, Kt/Vüre, kreatinin klirensinde istatistiksel olarak anlamlı farklılık saptanmadı. Hastalar diyabetik ve non-diyabetik olarak gruplandırıldığında da ölçülen belirteçlerde farklılık saptanmadı. Peritoneal sodyum ile Kt/Vüre, ultrafiltrasyon ve idrar volümü + ultrafiltrasyon toplamı arasında ilişki saptanmadı. Pentoksifilin öncesi ve sonrası serum albümin düzeyi ile serum IL-10 arasında negatif korelasyon mevcuttu, istatistiksel olarak anlamlıydı(p:0,049). SONUÇ: Pentoksifilinin periton membranı geçirgenliğinde etkili olmadığı saptandı. Pentoksifilin kullanım süresinin kısa olması ve/veya hasta sayısının nispeten az olması çalışmamızın sonuçlarını olumsuz etkilemiş olabilir.OBJECTIVE: Continuous Ambulatory Peritoneal Dialysis is more frequently used as renal replacement therapy for end stage renal failure patients. The aim of this study was to evaluate the effects of pentoxifylline on cytokines and permeability of peritoneum in continuous ambulatory peritoneal dialysis patients. MATERIAL and METHODS: 21 patients with peritoneal dialysis followed at Çukurova University Department of Nephrology were included. Pentoxifylline was given 2x400 mg daily for three weeks in addition to the standard therapy. All of the patient characteristics such as age, sex, accompanied disease, duration of peritoneal dialysis, edema, body weight, drugs were recorded. Peritoneal equilibration test was done before and after pentoxifylline therapy. Kt/Vurea and creatinine clearance were calculated. Peritoneal transport type, ultrafiltrate and urine volumes and peritoneal sodium excretion were determined. RESULTS: There was no difference for the Kt/Vurea, creatinine clearence, the serum and peritoneal dialysate levels of BUN, creatinine, sodium, albumin, IL-1, IL-6, IL-10, TNF-alpha, beta-2 microglobulin between baseline and after the pentoxifylline therapy. Additionally, there was no difference for measured parameters in diabetic and nondiabetic groups. Relationships between peritoneal sodium excretion and Kt/Vurea, ultrafiltration and sum of urine volume+ultrafiltrate were not found. There was a statistically significant negative correlation between serum albumin and serum IL-10 levels at baseline and after pentoxifylline therapy (p; 0,049). CONCLUSION: Pentoxifylline was not found to be effective in peritoneal permeability. This may be related to the short duration of pentoxifylline therapy and/or the relatively small number of the patients

Sublingual valsartan in hypertensive urgency

The objective of this study was to assess the effect of sublingual valsartan in a group of patients with hypertensive urgency. Forty-one patients with hypertensive urgency and systolic blood pressure >200 mmHg, diastolic blood pressure >100 mmHg were studied in an emergency room. Supine blood pressure readings were taken and the patients were given 80 mg of valsartan sublingually. Blood pressure and heart rate were recorded at 15 min intervals over a 90 min period. Systolic blood pressure decreased from 211.22±14.65 mmHg to 158.17±15.48 mmHg, diastolic blood pressure dropped from 120.12±13.44 mmHg to 93.05±6.01 mmHg. The differences were statistically significant. The heart rate decreased from 87.90±13.47 beats per minute to 82.59±10.84 beats per minute. The results of our study indicate that sublingual valsartan is an effective drug in patients with hypertensive urgency and it is easy to use sublingually because it is in a capsule form and it is side-effect free. Further work is required to assess the effect of sublingual valsartan in patients with hypertensive urgency.The objective of this study was to assess the effect of sublingual valsartan in a group of patients with hypertensive urgency. Forty-one patients with hypertensive urgency and systolic blood pressure >200 mmHg, diastolic blood pressure >100 mmHg were studied in an emergency room. Supine blood pressure readings were taken and the patients were given 80 mg of valsartan sublingually. Blood pressure and heart rate were recorded at 15 min intervals over a 90 min period. Systolic blood pressure decreased from 211.22±14.65 mmHg to 158.17±15.48 mmHg, diastolic blood pressure dropped from 120.12±13.44 mmHg to 93.05±6.01 mmHg. The differences were statistically significant. The heart rate decreased from 87.90±13.47 beats per minute to 82.59±10.84 beats per minute. The results of our study indicate that sublingual valsartan is an effective drug in patients with hypertensive urgency and it is easy to use sublingually because it is in a capsule form and it is side-effect free. Further work is required to assess the effect of sublingual valsartan in patients with hypertensive urgency

The effect of dietary calcium intake on plasma renin activity and parathormon in deoxycorticosteron salt hypertension

The effects of diets containing 2% and 4% calcium (Ca) on deoxycorticosteron (DOC) salt hypertension were studied in 29 male rats weighting 210-260 g. Rats were categorized into four groups: Group I: control rats (6), group II: DOC hypertensive group (n=8), group III: DOC-low Ca diet (2% CaCl 2 ) (8) and group IV: DOC-high Ca diet (4% CaCl2 ) (n=7). During the six weeks follow up period, indirect systolic blood pressure (SBP) was highest in group II while it was found to be less increased in group III and IV. Weight increase was lowest in group IV (<0.005 versus 3 other groups). There was no relationship between blood pressure (BP) and plasma renin activity (PRA), parathormon (PTH), ngiotensin II (AII), serum Ca, serum phosphorus, urine Ca and final body weight. Serum Ca level was lower in group II as compared to group III (<0.006). PTH was lower in group III and IV than other groups but the differences were statistically nonsignificant. PRA was found supressed in group IV and group II compared to control and group III (Control vs group II p=0.014, control vs group IV p=0.006, group III vs group IV p=0.01). However, the decrease in PRA was more important in group IV than group III. Left heart weight was greater in group IV than group II (p = 0.033) while right heart weight was not different among the groups. Kidney weight showed an increase in group II and group III, when compared with controls (p=0.009, p=0.045 respectively). As a result, at uninephrectomized DOC-salt treated hypertension model in rats, the increase in BP was less prominent in Ca supplemented diet and this effect continued during the study period. In this hypertension model with suppressed PRA, we can state that a decrease in PTH which suggests the suppression of parathyroid gland, may affect BP.The effects of diets containing 2% and 4% calcium (Ca) on deoxycorticosteron (DOC) salt hypertension were studied in 29 male rats weighting 210-260 g. Rats were categorized into four groups: Group I: control rats (6), group II: DOC hypertensive group (n=8), group III: DOC-low Ca diet (2% CaCl 2 ) (8) and group IV: DOC-high Ca diet (4% CaCl2 ) (n=7). During the six weeks follow up period, indirect systolic blood pressure (SBP) was highest in group II while it was found to be less increased in group III and IV. Weight increase was lowest in group IV (<0.005 versus 3 other groups). There was no relationship between blood pressure (BP) and plasma renin activity (PRA), parathormon (PTH), ngiotensin II (AII), serum Ca, serum phosphorus, urine Ca and final body weight. Serum Ca level was lower in group II as compared to group III (<0.006). PTH was lower in group III and IV than other groups but the differences were statistically nonsignificant. PRA was found supressed in group IV and group II compared to control and group III (Control vs group II p=0.014, control vs group IV p=0.006, group III vs group IV p=0.01). However, the decrease in PRA was more important in group IV than group III. Left heart weight was greater in group IV than group II (p = 0.033) while right heart weight was not different among the groups. Kidney weight showed an increase in group II and group III, when compared with controls (p=0.009, p=0.045 respectively). As a result, at uninephrectomized DOC-salt treated hypertension model in rats, the increase in BP was less prominent in Ca supplemented diet and this effect continued during the study period. In this hypertension model with suppressed PRA, we can state that a decrease in PTH which suggests the suppression of parathyroid gland, may affect BP