[Isotopic renogram after captopril administration: clinical experience in the assessment of the hypertensive patient]. / Renograma isotópico después de la administración de captopril: experiencia clínica en la valoración del paciente hipertenso.

BACKGROUND: Isotopic renogram allows renal function to be estimated in both kidneys independently. The glomerular filtrate in ischemic kidneys is largely dependent on the tone of the efferent glomerular arteriolae and therefore on the concentration of circulating angiotensin II. METHODS: In 42 patients with severe high blood pressure in whom renal angiographic study was carried out for suspicion of vasculo-renal hypertension, an isotopic renogram using 99m Tc-DTPA as a tracer was performed in basal conditions and following the administration of 50 mg of oral captopril. RESULTS: In 21 patients both the angiographic examination and the post-captopril renogram were normal. In 16 patients in whom uni or bilateral stenosis higher than 50% of the lumen of renal artery was observed on angiographic examination, the post-captopril renogram showed changes. In 5 patients the angiography was normal while the renogram showed evaluable changes. No false negatives were observed in the post-captopril renogram, however the basal renogram was not demonstrative in 6 patients with stenosis of the renal artery. Sensitivity of the test was thus 100% and specificity 80%. The positive predictive value was 76% and the negative predictive value 100%. CONCLUSIONS: The post-captopril renogram may be a useful test in the functional study of renal behaviour in patients with vasculo-renal hypertension.

"Results of large surface hemodialysis (LSH): a shorter and cheaper treatment".

A surface area of 5 m2, a QB of 500 ml/min and a QD of 1000 ml/min reduces the time of hemodialysis to just 6 hours per week. All the patients had been in a conventional dialysis program for at least 2 years. These patients have now been in LSH for a period of between 2 and 3 years. Most patients have no appreciable residual function, they follow a free diet, living a normal life, and weigh between 51 and 88 Kg, ranging in ages from between 26 and 69 years. We use this technique with 3 schedules: Schedule I) 2 hours/3 days/week; Schedule II) 3 hours/2 days/week; Schedule III) 6 hours/1 day/week. In the 3 schedules the clinical and biochemical results have been the same as with conventional dialysis. With this technique the patients have greater freedom and comfort because they avoid 312 hours per year connected to the artificial kidney. The patients in Schedule II also avoid 52 dialysis sessions and 104 trips to the dialysis center per year. And the patients in Schedule III also avoid 104 dialysis sessions and 208 trips to the center per year. Furthermore, the cost savings in Schedule II is $2,500 per year/patient and in Schedule III $8,500 per patient/year.