[Itraconazole-induced hypokalemia in a patient with pulmonary aspergilloma].

An 80-year-old man was admitted to the hospital with a diagnosis of pulmonary aspergilloma. A new azole antifungal agent, D 0870, was administered to the patient for 7 days orally, and itraconazole (400 mg/day) was started on March 5, 1997. After 1 month of chemotherapy, facial and pretibial edema were observed and the patient's serum potassium concentration decreased to 2.5 mEq/l. A chest radiograph disclosed cardiomegaly with cardiac effusion and right pleural effusion on admission. The serum potassium concentration rose after the cessation of itraconazole therapy. The serum ITCZ concentration remained high for 2 weeks after admission. Although reports of hypopotassemia induced by ITCZ are rare, we concluded that blood concentrations should be monitored more carefully when treating pulmonary aspergilloma patients with high-dose regimens of ITCZ.

Liddle's syndrome in an elderly woman.

A 78-year-old woman with hypertension was hospitalized with acute bronchitis. However, she was also found to have hypernatremia, hypokalemia, and metabolic alkalosis. Detailed examination showed a low plasma renin activity and plasma aldosterone concentration. A provisional diagnosis of Liddle's syndrome was established and the patient was successfully treated with triamterene. Although Liddle's syndrome is generally considered an inherited hypertensive disease found in young people, a review of the literature indicated that muscle weakness is an important clinical finding in elderly patients with this disease. Liddle's syndrome should be considered in the differential diagnosis of hypertension even in elderly individuals.

A case of nephrotic syndrome associated with ischemic colitis exhibiting thickening of the colon wall.

The patient was a 54-year-old male with proteinuria, which was first noted in 1984. Recently, the patient experienced aggravation of the proteinuria, which resulted in nephrotic syndrome. Renal biopsy revealed findings compatible with membranous nephropathy. While being treated with prednisolone (30 mg/day), the patient experienced intense abdominal pain of sudden onset, diarrhea, and melena. A tumor was demonstrated by abdominal ultrasonography and CT scan. A diagnosis of ischemic colitis was made by colonoscopy. FDP and fibrinogen levels were elevated, and abnormalities of the coagulation and fibrinolytic factors were found at the onset of the symptoms.

Charge distribution of plasma IgG and IgG immune complexes in IgA nephropathy.

IgA nephropathy is characterized by a predominant deposition of IgA in the glomerular mesangium. However, in many cases, deposition of IgG also occurs and the concentration of circulating IgG immune complexes is higher than that in controls. To examine further the possible role of the charge of immunoglobulins in the pathogenesis of IgA nephropathy, we used isoelectric focusing (IEF) and densitometry to investigate the charge distribution of plasma IgG and IgG immune complexes in patients with this disease. Blood samples were taken from patients and healthy adults, and plasma and samples treated with 7.0% polyethylene glycol (PEG) were used. All samples were focused with a Multiphor II flatbet electrofocusing unit apparatus on an agarose gel, then immunofixed with polyclonal goat anti-human IgG, and stained with Coomassie blue R 250. The stained gels were analyzed by densitometry. 1. In plasma, the areas of PI 10-8.9 and PI 10-8.6 in IgA nephropathy were higher in the patients than in the controls. 2. In the 7.0% PEG precipitation, the area PI 8.1-6.1 was higher in the patients than in the controls. These findings suggest that a change in charge distribution of IgG and IgG immune complexes may contribute to the pathogenesis of IgA nephropathy.