RESUMEN
BACKGROUND AND AIM: Knowledge on the risk of gastrointestinal (GI) bleeding in hemodialysis patients is limited. We evaluated the risk of GI bleeding in hemodialysis patients compared with non-hemodialysis patients. METHODS: We performed a retrospective cohort study from 1996 to 2017 at the Graduate School of Medicine, University of Tokyo, and Horinouchi Hospital. We analyzed patients on hemodialysis for chronic renal failure and controls not on hemodialysis. The primary endpoint was GI bleeding. A survival analysis was performed to estimate the cumulative incidence and hazard ratio of GI bleeding. RESULTS: A total of 14 451 patients were analyzed (417 hemodialysis and 14 034 non-hemodialysis patients). In total, 524 GI bleeding events occurred. Upper and lower GI bleeding occurred in 432 and 92 patients in the hemodialysis and non-hemodialysis groups, respectively. The most frequent source of upper and lower GI bleeding was gastric ulcer and colonic diverticular bleeding, respectively. The cumulative incidence of GI bleeding was 4.44% at 1 year, 7.15% at 3 years, and 10.40% at 5 years in hemodialysis patients; the respective rates were 2.35%, 2.98%, and 3.79% in non-hemodialysis patients during a mean follow-up period of 3.5 years. Hemodialysis was significantly associated with an increased risk of GI bleeding after adjustment (hazard ratio 1.67, P = 0.01, 95% confidence interval 1.13-2.50). CONCLUSIONS: Hemodialysis patients had a GI bleeding rate of 10% over 5 years, and hemodialysis was a risk factor for GI bleeding.
Asunto(s)
Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Diálisis Renal/efectos adversos , Anciano , Anciano de 80 o más Años , Divertículo del Colon/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Riesgo , Factores de Riesgo , Úlcera Gástrica/complicaciones , Factores de TiempoRESUMEN
A 74-year-old man was admitted to our hospital complaining of severe neck pain and general fatigue. He had been undergoing treatment for post-operative neck pain at the out-patient clinic of our hospital, but was now complaining of pain more intense than usual. Chest X-rays revealed diffuse ground glass shadows in bilateral lung fields, and computed tomography revealed diffuse intestinal shadows. A drug lymphocyte stimulation test (DLST) was also performed at that time. Steroid pulse therapy improved the clinical symptoms, hypoxemia and chest X-ray findings. DLST performed again with Yokukansan and Hachimijiogan 133 days after the initial diagnosis of pneumonitis showed Yokukansan was positive. This result showed Yukukansan may be a causative drug for allergic drug-induced pneumonitis. Any drugs including kanpo may be possible to induce allergic pneumonitis.
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Alveolitis Alérgica Extrínseca/etiología , Medicamentos Herbarios Chinos/efectos adversos , Anciano , Alveolitis Alérgica Extrínseca/diagnóstico , Alveolitis Alérgica Extrínseca/tratamiento farmacológico , Humanos , Activación de Linfocitos , Masculino , Metilprednisolona/administración & dosificación , Quimioterapia por Pulso , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Although hypertension is commonly found in patients with autosomal dominant polycystic kidney disease (ADPKD), there is no consensus about which antihypertensive agents are most appropriate. The effects of calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB) on blood pressure and renoprotection were compared in hypertensive patients with ADPKD. METHODS: We randomly assigned 49 participants to CCB amlodipine-based (2.5-10 mg/day) or ARB candesartan-based (2-8 mg/day) regimens. Twenty-five patients (13 males and 12 females) received amlodipine, and 24 patients (13 males and 11 females) received candesartan. This was followed up for 36 months. RESULTS: Baseline characteristics were similar, and blood pressure was well controlled in both groups throughout the study period. Six out of 25 (24.0%) amlodipine and 1 out of 24 (4.2%) candesartan patients were terminated from the protocol due to a twofold increase in serum creatinine and/or decrease in creatinine clearance (Ccr) to half of the baseline. The renal event-free survival rate was significant (p < 0.05, Breslow-Gehan-Wilcoxon test). Serum creatinine was higher in the amlodipine group than in the candesartan group at 24 and 36 months (p < 0.05). The decrease in Ccr at 36 months was larger in the amlodipine group than in the candesartan group (DeltaCcr: -20.9 +/- 13.1 vs. -4.8 +/- 13.8 ml/min, p < 0.01). Urinary protein excretion was significantly lower in the candesartan group than in the amlodipine group at 36 months. Urinary albumin excretion was significantly lower in the candesartan group than in the amlodipine group at 12, 24 and 36 months. CONCLUSIONS: The renoprotective effect of candesartan is considered more favorable than amlodipine in the treatment of ADPKD. This is independent of the antihypertensive effect per se.
Asunto(s)
Amlodipino/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Bencimidazoles/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Riñón Poliquístico Autosómico Dominante/tratamiento farmacológico , Tetrazoles/uso terapéutico , Adulto , Anciano , Albuminuria/metabolismo , Amlodipino/farmacología , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Bencimidazoles/farmacología , Compuestos de Bifenilo , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/farmacología , Creatinina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteinuria/metabolismo , Tetrazoles/farmacologíaRESUMEN
Primary amyloid light chain (AL) amyloidosis is the most common and most aggressive form of systemic amyloidosis. In AL amyloidosis, the products of free light chains (FLCs) of monoclonal amyloidogenic plasma cells deposit in the heart, kidneys, liver, gastrointestinal tract, autonomic nerve systems, and soft tissues, consequently leading to progressive disability and organ failure. Tissue biopsy (mainly bone marrow and subcutaneous fat aspirate) staining with Congo red to demonstrate amyloid deposits is required for diagnosis. Autologous stem cell transplant is the preferred treatment method; however, only 25% of patients are eligible. Non-transplant candidates can be offered melphalan-dexamethasone or clinical trials of new agents (thalidomide, lenalidomide, and bortezomib), which have been shown to improve survival. N-terminal pro-brain natriuretic peptide (>1800 ng/l), cardiac troponin T (>0.025 ng/ml), and dFLC (>180 mg/l) are known poor prognostic factors. Late diagnosis remains a major obstacle for initiating effective therapy while organ dysfunction is still recoverable.