Renal Hemodynamic Changes after β-Blocker-Diuretic Combination Therapy in Azotemic Hypertensive Patients

The effects of β-blocker therapy with either nadolol or propranolol were compared during therapy with hydrochlorothiazide (HCTZ) 50 mg b.i.d. on glomerular filtration rate (GFR), effective renal plasma flow (ERPF), effective renal blood flow (ERBF), blood pressure, and heart rate in 22 patients with essential hypertension and mild to moderate renal insufficiency. The clearances of inulin and para-aminohippurate (PAH) were used to estimate renal hemodynamic measurements. These parameters were determined after 2 weeks of HCTZ plus placebo and at 1, 3, and 6 months after the addition of β-blocker to HCTZ. Significant reductions in blood pressure and heart rate were seen, but no significant reduction of renal hemodynamics were seen with either β-blocker-HCTZ combination. Since 50% of the patients in each drug group were either Black or White, hemodynamic data were also analyzed by race. One month after β-blocker addition there was a slight reduction of GFR in both Whites (47 ± 6 vs. 40 ± 5 ml/min, p > .05) and Blacks (44 ± 5 vs. 40 ± 6 ml/min, p < .05). By month 6, GFR in Whites rose to 57 ± 9 ml/min, whereas in Blacks it fell significantly to 36 ± 6 ml/min (p < .01). Similarly, at month 1, ERBF declined by 12% and 13% in Whites and Blacks, respectively. However, at month 6, ERBF rose by 28% in Whites and remained 11% lower in Blacks, p< .05. In summary, in the group as a whole neither β-blocker significantly altered renal hemodynamics when added to HCTZ therapy. However, after six months of combined therapy, Whites had elevations whereas Blacks had reductions of GFR and ERBF. These results suggest that the addition of β-blocker to diuretic therapy may be detrimental to certain hypertensive patients with limited renal reserve accelerating their need for a renal replacement therapy.

Effects of ketorolac tromethamine on erythropoietin levels in Sprague Dawley rats

Ketorolac tromethamine (KT) is a potent analgesic, most often used in its injectable form postoperatively. Similar to other nonsteroidal antiinflammatory drugs (NSAIDs), it inhibits prostaglandin (PG) synthesis. Prostaglandins have been shown to be involved in the regulation of renal function as well as erythropoietin (Ep) production. The intent of this study was to determine the effect of KT on plasma Ep levels in Sprague Dawley (SD) rats. Twenty rats received either 15 mg/kg/d or the KT vehicle IM for 5d. Blood samples (1 ml) were collected via tail vein each day of treatment. Plasma Ep levels were significantly higher in the KT rats than normal controls with the greatest difference occurring on d4 of treatment (70.1 ± 10.8 vs 30.9 ± 10.84 mU/ml, p < 0.01). This change in Ep corresponded with a significant reduction in hematocrit (KT, 29.5 ± 2.2 vs C, 40.8 ± 2.2%, p< 0.01). Presence of fecal blood was noted in the KT treated rats. A similar second experiment was designed to determine if blood loss was the cause of altered Ep production. In this experiment controls (HC) were bled via tail vein, to match the hematocrits of KT treated animals. Repeated administration of KT led to a steady reduction in hematocrit. When compared, hematocrit matched animals showed no difference in plasma Ep levels on all days of treatment (KT, 48.0 ± 4.9 vs HC, 44.6 ± 3.1 mU/ml, N.S.). In conclusion, repeated administration of KT showed no impairment of Ep production and release in response to reduced hematocrit, suggesting that in this instance, prostaglandin inhibition plays a minimal role in Ep production or release.

[Late vesico-vaginal fistula after colporrhaphy for urinary incontinence]

We present a case of a 65 year-old woman with a late vesicovaginal fistula after colporrhaphy. Too late proper diagnosis of that complication caused perivesical tissue inflammation and led to damage to the urinary bladder, occlusion of the urethra as well as created a massive inflammatory tumor in the minor pelvis, which suggested a cancerous process. Bilateral hydronephrosis forced us to make bilateral nephrostomy. After intensive antiinflammatory therapy, anterior exenteration and Bricker's operation were performed with a finally good effect.

Hyponatremia in spinal cord injury

Hypoosmolar hyponatremia (serum Na+ less than 130 mmol/L) has proven a common and incompletely explained phenomenon in the spinal cord injured patient. When present, it has generally been preceded by excessive fluid intake and environmental/dietary factors which reversibly restrict free water excretion. We have attempted to more fully characterize the determinants of SCI-associated hyponatremia by retrospectively analyzing its features and treatment response in a series of 14 hyponatremic SCI patients. In most instances, hyponatremia could be attributed to uncontrolled fluid intake in the presence of an acute or semiacute illness and thus stimuli for non-osmotic releases of arginine vasopressin. Treatment measures generally included administration of 3% saline, with all patients recovering uneventfully from their episode of hyponatremia.

Diuretics versus calcium-channel blockers in systemic hypertension: a preliminary multicenter experience with hydrochlorothiazide and sustained-release diltiazem

The safety and efficacy of sustained-release diltiazem 120 to 180 mg, 2 times a day, were compared with hydrochlorothiazide 25 to 50 mg, 2 times a day, and the combination of diltiazem and hydrochlorothiazide in 56 patients with mild to moderate hypertension (supine diastolic blood pressure between 95 and 114 mm Hg) using a placebo-controlled, parallel-design protocol. Data from an additional 21 patients were evaluated for safety only. The data reported herein represent the preliminary experience from a larger 200-patient multicenter study. All patients received placebo for 4 weeks, followed by either hydrochlorothiazide or diltiazem titrated to achieve a diastolic blood pressure reduction of greater than or equal to 10 mm Hg to reach a goal supine diastolic blood pressure of less than 90 mm Hg. Patients not achieving the treatment goal received hydrochlorothiazide plus diltiazem. At week 14, on maintenance monotherapy, diltiazem and hydrochlorothiazide produced comparable reductions in blood pressure from placebo baseline (160.3 +/- 24.3/101.7 +/- 5.5 to 145.2 +/- 24.1/89.8 +/- 7.4 mm Hg with diltiazem, 156.0 +/- 15.6/103.7 +/- 4.7 to 134.1 +/- 12.5/89.2 +/- 9.5 mm Hg with hydrochlorothiazide, p less than 0.001 for both). Diltiazem and hydrochlorothiazide achieved goal blood pressure in 42% and 45% of patients, respectively. The effects in responders were sustained for 6 months. In patients who did not achieve the treatment goal, 63% responded to diltiazem plus hydrochlorothiazide.No clinically significant postural hypotension was observed on any regimen. Heart rate was slightly lower with diltiazem than with hydrochlorothiazide. Adverse effects were minimal with diltiazem, hydrochlorothiazide and diltiazem plus hydrochlorothiazide but more hypokalemia occurred with hydrochlorothiazide.(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary Prostaglandin E2 Excretion after the Resumption of Renal Function Post Renal Transplantation

Previous studies have demonstrated that the renal prostaglandin system participate in the recovery from ischemic events, in diuresis and in natriuresis. This study was undertaken to probe renal prostaglandin E2 synthesis during the first and second weeks after renal transplantation

Urinary prostaglandin E2 excretion was greatly elevated immediately after transplantation, compared to the second week, and differences in urine PGE2 concentration were also significant. This suggests that enhanced prostaglandin synthesis accompanies the resumption of renal function after transplantation.