RESUMO
Using the cardio-ankle vascular index (CAVI) as an indicator, we assessed improvement of arterial stiffness in 95 outpatients with hypertension complicated by type 2 diabetes mellitus who were treated orally for >or= 12 months with telmisartan 40 mg/day, losartan 50 mg/day or candesartan 8 mg/day. At 1 year, in the telmisartan and losartan groups CAVI did not change whereas in the candesartan group CAVI showed a statistically significant decrease of 2.70%. Although telmisartan is believed to enhance the activity of peroxisome proliferator-activated receptor (PPAR-gamma) in vitro, it did not ameliorate arterial stiffness in our patients. Candesartan, however, improved arterial stiffness independently of blood pressure lowering and without PPAR-gamma agonist action, possibly by direct action resulting from its potent affinity and binding capacity for the angiotensin II type 1 receptor. We conclude that candesartan is a potentially useful therapy against arterial stiffness in hypertensive patients with type 2 diabetes mellitus.
Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II , Anti-Hipertensivos , Benzimidazóis , Benzoatos , Diabetes Mellitus Tipo 2/patologia , Hipertensão , Losartan , Tetrazóis , Resistência Vascular/efeitos dos fármacos , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Animais , Tornozelo , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Benzimidazóis/farmacologia , Benzimidazóis/uso terapêutico , Benzoatos/farmacologia , Benzoatos/uso terapêutico , Compostos de Bifenilo , Pressão Sanguínea/fisiologia , Comorbidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Coração , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Losartan/farmacologia , Losartan/uso terapêutico , Masculino , Pessoa de Meia-Idade , PPAR gama/agonistas , Telmisartan , Tetrazóis/farmacologia , Tetrazóis/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the usefulness of renal biopsy in the overall management of patients with diabetes mellitus (DM), we examined the relationship between the clinical parameters and histopathological findings of renal biopsy samples. METHODS: Renal biopsy specimens were obtained from 109 type 2 diabetic patients with proteinuria. Samples were divided into the following two groups: Diabetic Nephropathy (DN) group (n=80) had typical diabetic lesions without other renal diseases, complication group (n=29) had diabetic lesions with other renal diseases. Furthermore, DN group was subdivided into two subgroups: slow progressive group (SP group, n=32), the level of serum creatinine (s-Cr) was normal at the time of renal biopsy and three years after renal biopsy, and fast progressive group (FP group, n=14), the level of s-Cr was normal at the time of renal biopsy but more than doubled three years after renal biopsy. RESULTS: The level of total protein was significantly lower and HbA1c significantly higher in the DN group than in the Complication group. However, other clinical parameters were not significantly different between the two groups. Urinary protein, systolic and diastolic blood pressure in FP group were significantly higher than in SP group. The percentage of sclerotic glomeruli, the severity of mesangial expansion, tubular injury and cell infiltration were significantly greater in FP than in SP group. CONCLUSIONS: Our results indicated that a complete evaluation of renal pathology in DM could not be made by clinical parameters only, and that the progression of DN could be accurately predicted by histopathological evaluation. Therefore, this study emphasizes the importance of renal biopsy in the overall management of patients with DM and/or DN.
Assuntos
Nefropatias Diabéticas/patologia , Rim/patologia , Adulto , Biópsia , Progressão da Doença , Feminino , Mesângio Glomerular/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
We experienced a case of lupus nephritis with antiphospholipid antibody syndrome. A renal biopsy specimen from this patient showed various renal histological changes, but the results of urinalysis were almost normal. The patient was a 56-year-old woman diagnosed as having systemic lupus erythematosus with antiphospholipid antibody syndrome in 1983. In 1998, she had diarrhea and blood gas analysis showed metabolic acidosis. Therefore, she was admitted to our hospital and underwent renal function examination. The glomerular filtration rate was reduced(GFR: 40/ml/min), but urinalysis was almost normal. To examine her renal dysfunction, we performed open renal biopsy. Her renal tissues showed global glomerular sclerosis, mesangial cell proliferation and infiltration of cells in the tubulointerstitial area(WHO II). Furthermore, some arterioles showed organized thrombus formation and recanalization due to the antiphospholipid antibody syndrome. Renal biopsy of patients with lupus nephritis is useful not only for precise diagnosis, but also for the selection of appropriate treatment.
Assuntos
Síndrome Antifosfolipídica/patologia , Rim/patologia , Nefrite Lúpica/patologia , Urinálise , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/urina , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Nefrite Lúpica/complicações , Nefrite Lúpica/urina , Pessoa de Meia-IdadeRESUMO
We experienced two cases of limb edema of unknown pathogenesis. No evidence was found concerning involvement of the kidneys, heart of other visceral organs. Case 1 was 22-year-old woman. Her white blood cell count increased to 13,100/microliter with 65.0% eosinophils. Case 2 was a 27-year-old woman. Her white blood cell count increased to 23,300/microliter with 67.0% eosinophils. In these cases, extensive diagnostic evaluations revealed no evidence of atopy, neoplasms, collagen-vascular disease, or parasitic infestation. We diagnosed these cases as episodic angioedema with eosinophilia. In both cases, the angioedema improved gradually in parallel with a decrease in the white blood cell count. This disorder is very rare, but it is very important to consider it in differential diagnosis especially for nephrologists.
Assuntos
Angioedema/complicações , Eosinofilia/complicações , Adulto , Feminino , HumanosRESUMO
Development of drugs requires electrophysiological studies of small animals like mice, rats or guinea pigs. Electrocardiography (ECG) of hirsute animals is time-consuming. We have developed a micro magnetometer array with a 9-channel superconducting quantum interference device (SQUID) with a 2.5-mm diameter pickup-coil for noncontacting measurement of magnetocardiograms (MCGs) in small animals. The micro-MCG successfully recorded the PQRST complex in mice, rats and guinea pigs. A regional myocardial injury was made in rat hearts with a cryoinjury probe, and the characteristic pattern of the injury was recorded in the MCG. An anterior myocardial injury created a QS pattern in the MCG, and a posterior myocardial injury created a QR pattern in the MCG. Quinidine-induced QT prolongation was successfully detected by micro-MCG in mice and rats. Simultaneous recording of ECG and MCG was conducted after intraperitoneal administration of quinidine (60 mg/kg) in guinea pigs. QT interval corrected for heart rate (QTc) in both ECG and MCG correlated well. The newly developed micro-MCG may facilitate electrophysiological studies of small animals, and may enable high-throughput screening of drug-induced QT abnormality.