ABSTRACT
Amlodipine is a calcium antagonist with a long elimination half-life (35 to 50 h) allowing a once daily dosing in the treatment of hypertension. This randomized, double-blind study was performed to assess the residual antihypertensive effect of amlodipine 5 mg O.D. 3 days after discontinuing therapy in previously well-controlled mild to moderate hypertensive patients. Blood pressure (BP) was evaluated by conventional (OBP) and by ambulatory blood pressure monitoring (ABPM). Amlodipine 5 mg OD administered during a 6-week period, significantly reduced both OBP and ABPM mean values (p < 0.05), whereas no change in heart rate was observed. At the end of the active treatment period, adequately controlled patients were randomized either to amlodipine 5 mg OD (group A) or amlodipine for 12 days followed by a 3-day period on placebo. After this double-blind treatment phase, group P exhibited no significant increase in BP (assessed by OBP or ABPM) when compared to group A. In conclusion, the duration of action of amlodipine extends largely beyond the 24-h span, and when patients omit their treatment for 3 days BP does not significantly increase.
Subject(s)
Amlodipine/pharmacology , Antihypertensive Agents/pharmacology , Calcium Channel Blockers/pharmacology , Adolescent , Adult , Aged , Amlodipine/therapeutic use , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Blood Pressure Determination , Blood Pressure Monitoring, Ambulatory , Calcium Channel Blockers/therapeutic use , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Male , Middle Aged , Prospective Studies , Time FactorsSubject(s)
Anti-Bacterial Agents/adverse effects , Cyclosporine/adverse effects , Immunosuppressive Agents/adverse effects , Kidney Transplantation/physiology , Miocamycin/adverse effects , Postoperative Complications/chemically induced , Adult , Drug Interactions , Female , Humans , Kidney Transplantation/immunology , Pharyngitis/drug therapy , Rhinitis/drug therapyABSTRACT
A 62-year-old man was admitted for acute renal failure due to crescentic rapidly progressive glomerulonephritis. Kidney biopsy showed intense staining for IgA, IgA1 and C3 in a linear pattern along the glomerular basement membrane (GBM). Serologic tests for detecting anti-GBM antibodies were positive for IgA class and IgA1 subclass and negative for IgG and IgA2. Serum IgA anti-GBM antibodies appeared essentially in the polymeric form, an observation in agreement with recent studies demonstrating polymeric IgA response after parenteral immunization. There was no sign of pulmonary involvement. This patient is the first to present with an isolated nephritis due to anti-GBM antibodies restricted to the IgA class (IgA1 subclass). Routine tests for circulating anti-GBM antibodies should also include the IgA class.
Subject(s)
Glomerulonephritis, IGA/immunology , Acute Kidney Injury/immunology , Autoantibodies/blood , Basement Membrane/immunology , Glomerulonephritis, IGA/pathology , Humans , Immunoglobulin A , Kidney Glomerulus/immunology , Male , Middle AgedABSTRACT
A 19 year old girl working as a hairdresser developed a severe anemia due to occult pulmonary hemorrhage followed by anti-GBM glomerulonephritis with normal renal function. Withdrawal of the suspected toxic factor, products used for permanent waving, was followed by both clinical remission and disappearance of linear deposits of immunoglobin from the renal glomeruli. Anti-GBM antibodies were only detected in the serum after clinical healing. In a case of mild Goodpasture, careful search for a toxin and its withdrawal may be the first therapeutic step.