Three-month experience with tacrolimus once-daily regimen in stable renal allografts.

INTRODUCTION: MR-4, the new oral formulation of tacrolimus that allows once-daily dosing, may improve patient compliance. The purpose of this study was to evaluate the safety and efficacy parameters among a group of stable renal allografts after conversion to MR-4. METHODS: We enrolled 82 stable kidney recipients, who had received their grafts 43.9 +/- 38.3 months prior. They were of mean age 56 +/- 12 years and included 70.7% men. Sixty-six patients were converted on a milligram-for-milligram basis from their total daily dose; the remaining patients were converted at the physician's discretion. Three patients were excluded: 1 because of the development of abdominal pain, and 2 because of dosing errors. Tacrolimus trough levels and renal function tests were evaluated at entry and on days 7, 30, and 90. RESULTS: Only 5 (7.6%) converted patients required a later dose adjustment. In the group of 61 patients who did not require this adjustment, the mean tacrolimus trough levels decreased during the first week (6.8 +/- 1.7 to 5.8 +/- 2.0; P < .000). Thirty-eight patients completed 3 months of follow-up. Their tacrolimus trough levels, serum creatinine levels, and proteinuria remained stable. The number of capsules per patient needed after the conversion to MR-4 was lower (3.9 +/- 1.6 versus 2.9 +/- 1.0; P < .000). There were no cases of acute rejection episodes. CONCLUSION: Based on a milligram-for-milligram conversion, only 7.6% of our patients required a dose adjustment. With this conversion, an initial decrease in tacrolimus trough levels was documented at day 7, which remained stable to the end of the study. The patients needed a lower number of capsules. These results supported the safety of MR-4.

Síndrome del ácido transretinoico y necrosis cortical renal / All-trans retinoic acid sindrome and renal cortical necrosis

Se describe el caso de una paciente con leucemia aguda promielocítica (LAP) que desarrolló síndrome del ácido transretinoico (SAR). ElSAR se presenta en enfermos con LAP tratados con ácido transretinoico (ATRA). Tiene incidencia de 5 a 27% con mortalidad de hasta 29%. Clínicamente se manifiesta con fiebre, hipotensión, insuficiencia respiratoria, renal y hepática, infiltrados pulmonares, derrame pleural y pericárdico, y edema generalizado. Es secundario al efecto del ATRA sobre la diferenciación de los promielocitos, lo que desencadena respuesta inflamatoria sistémica, daño endotelial con síndrome de fuga capilar y obstrucción de la microcirculación e infiltración tisular. El tratamiento consiste en la suspensión del ATRA, esteroides y medidas de soporte

We described a patient with acute promyelocytic leucemia (APL) who developed all-trans retinoic acid syndrome (ATRAS). ATRAS presents inpatients with APL treated with all-trans retinoic acid (ATRA). It has an incidence from 5-27% with mortality of 29%. ATRAS clinical manifestations are fever, hypotension, respiratory, renal and hepatic insufficiency, lung infiltrates, pleural and pericardic efussion, and generalized edema. It is secondary to ATRA effect on promyelocyte differentiation, which causes systemic inflammatory response syndrome, endothelium damage with increase in capillary permeability, microcirculation obstruction, and tissue infiltration. Treatment is based on ATRA suspension, steroids and support measures

[All-trans retinoic acid syndrome [corrected] and renal cortical necrosis]. / Síndrome del ácido transretinoico y necrosis cortical renal.

We described a patient with acute promyelocytic leukemia (APL) who developed all-trans retinoic acid syndrome (ATRAS). ATRAS presents in patients with APL treated with all-trans retinoic acid (ATRA). It has an incidence from 5-27% with mortality of 29%. ATRAS clinical manifestations are fever, hypotension, respiratory, renal and hepatic insufficiency, lung infiltrates, pleural and pericardic effusion, and generalized edema. It is secondary to ATRA effect on promyelocyte differentiation, which causes systemic inflammatory response syndrome, endothelium damage with increase in capillary permeability, microcirculation obstruction, and tissue infiltration. Treatment is based on ATRA suspension, steroids and support measures.

Hipertensión arterial y menopausia reciente: estudio comparativo de dos fármacos hipotensores

Objetivo. Analizar durante doce semanas la eficacia antihipertensiva, tolerancia clínica y perfil metabólico del amlodipino y el carvedilol en mujeres hipertensas con menopausia de comienzo reciente. Diseño. Estudio prospectivo y aleatorio. Material y métodos. Cuarenta mujeres (edad media: 51,1 ñ 0,89 años; tiempo de menopausia: 1,6ñ0,53 años; meses desde el diagnóstico de la hipertensión arterial [HTA]: 20,70ñ9,31). Se excluye menopausia quirúrgica. Treinta y dos (80 por ciento) HTA grado I y 8 (20 por ciento) grado II de la Organización Mundial de la Salud (OMS). Previamente y durante dos semanas se suspendió el tratamiento previo: 16 (40 por ciento) no tratadas, 14 (35 por ciento) tratadas no controladas y 10 (25 por ciento) tenían intolerancia. Se establecieron dos grupos de tratamiento a los que las pacientes se asignaron de manera aleatoria: 20 pasaron a recibir 5 mg de amlodipino y las otras 25 mg de carvedilol, todas en dosis única por las mañanas. Al inicio y final del estudio se determinaron las cifras de presión arterial sistólica (PAS), presión arterial diastólica (PAD), frecuencia cardíaca, índice de masa corporal de Quetelet y analítica sanguínea: colesterol total y HDL, triglicéridos, glucosa, ácido úrico, creatinina, sodio y potasio. Consideramos que existía control de la presión arterial con cifras de PAS < 130 mmHg y de PAD < 85 mmHg. Se recogieron los efectos que cada paciente atribuía a la medicación del estudio. La significación estadística se estableció para una p < 0,05.Resultados. Se analizan los resultados de 37 pacientes; tres del grupo amlodipino se excluyeron por edemas en miembros inferiores. En ambos grupos se produjo un descenso (p < 0,001) de las cifras de PAS y de PAD, existiendo únicamente control de la PAD. La frecuencia cardíaca disminuyó (p < 0,01) en el grupo del carvedilol. No existieron diferencias significativas en el resto de los parámetros analizados. Efectos secundarios: 2 (10 por ciento) en el grupo del carvedilol y 5 (25 por ciento) en el de amlodipino. Conclusión. Ambos fármacos mostraron eficacia antihipertensiva y perfil metabólico neutro en el tratamiento de la HTA en la mujer postmenopáusica, con mejor tolerancia clínica del carvedilol (AU)

[Biochemical plasma changes in essential hypertension patients treated for a year]. / Cambios bioquímicos plasmáticos en pacientes hipertensos esenciales tratados durante un año.

The possibility that certain antihypertensive drugs produce metabolic alterations in patients with hypertension treated during one year, has been prospectively assessed in 40 patients with essential hypertension with matched age and blood pressure readings. Four groups (Gr) of 10 patients each were studied. Group 1 received 100 mg/day of atenolol (AT), group 2 received 5 mg of amiloride and 50 mg of hydrochlorothiazide (4 tablets per week), group 3 received 40 mg/day of nifedipine retard (NF) and group 4 received 50 mg/day of captopril (CP). The parameters studied prior and after one month of treatment were the following: urea, creatinine, uric acid, Na+, K+, Ca+, total cholesterol, HDL-cholesterol, triglycerides, glycemia, blood pressure (BP), pulse rate (PR) and body weight. Both group 1 and 2 showed significantly increased total cholesterol (p less than 0.001 and p less than 0.01 respectively) as well as decreased HDL levels. In addition, group 2 had significantly increased levels of uric acid, glycemia and triglycerides (p less than 0.01). In the latter groups no significant changes were found within body weight, lipid levels, glycemia, uric acid ruling-out weight gain as a possible cause for these adverse metabolic effects. Pulse rate decreased in group 1. Group 3 pulse rate significantly increased (p less than 0.001) However, no other changes were significant. No significant biochemical or pulse rate readings were found in group 4. BP was best controlled in groups 1, 3 and 4.