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1.
S. Afr. med. j. (Online) ; 109(9): 665-667, 2019. ilus
Article in English | AIM | ID: biblio-1271246

ABSTRACT

Background. Hypertension in pregnancy is a risk factor for end-stage chronic kidney disease (ESKD) and is particularly common in South Africa (SA). There are no data for the risk of developing chronic kidney disease (CKD).Objectives. To conduct a study of all female patients who presented to the renal replacement programme at Groote Schuur Hospital, Cape Town, SA.Methods. This was a retrospective study of female patients with ESKD who were presented to renal replacement meetings between 2007 and 2017. For each patient who was assessed, there was a comprehensive letter detailing patient demographics, as well as psychosocial and medical history, which served as the source data. Patients with a history of hypertension in pregnancy were identified as the case group and those without the condition were the control group. Patient demographics, causes of CKD, kidney function and outcome of the meeting were documented.Results. Of the 415 female patients with ESKD, 70 (16.9%) had a history of hypertension in pregnancy. The ethnic breakdown was as follows: 132 (42.44%) black, 172 (55.3%) mixed ancestry and 7 (2.25%) white. Compared with the control group, the patients were younger, with a median age of 33 v. 41 years (p<0.001), higher serum creatinine 1 045 v. 751 µmol/L (p=0.017) and lower estimated glomerular filtration rate (eGFR) 4.0 v. 5.1 mL/min (p=0.029). Patients were more likely to abuse methamphetamine (5.7 v. 1.7%; p=0.049), and less likely to be diabetic (1.4 v. 20.9%; p<0.001) or HIV-positive (2.9 v. 12.5%; p=0.019). There were no ethnic differences between patients and controls. Underlying causes of renal disease showed significant differences, as patients were more likely to have hypertensive nephropathy (57.1 v. 22.9%; p<0.0001), and less likely to have diabetic kidney disease (1.4 v. 20.4%; p<0.001), HIV-associated nephropathy (HIVAN) (1.4 v. 6.4%) or polycystic kidney disease (1.4 v. 7.0%). There was no difference in acceptance to the dialysis and transplant programme (53 v. 47%).Conclusions. This study suggests an important link between hypertension in pregnancy and ESKD. The patients were significantly younger, presented later and were more likely to have hypertensive nephropathy. Methamphetamine abuse appears to be a risk factor. The study suggests that all women with hypertensive disorders during pregnancy need further evaluation and follow-up postpartum


Subject(s)
Chronic Kidney Disease-Mineral and Bone Disorder , Hypertension, Pregnancy-Induced , South Africa
2.
S. Afr. med. j. (Online) ; 107(10): 887-891, 2017. ilus
Article in English | AIM | ID: biblio-1271143

ABSTRACT

Background. Non-adherence to antihypertensives is a cause of 'pseudo-treatment-resistant' hypertension.Objective. To determine whether monitoring plasma amlodipine concentrations and inhibition of angiotensin-converting enzyme (ACE) can be adjunct adherence tools.Methods. Patients with hypertension who were prescribed enalapril and amlodipine were enrolled. Blood pressures (BPs) were monitored and an adherence questionnaire was completed. Steady-state amlodipine was assayed using liquid chromatography-mass spectrometry and degree of ACE inhibition using the Z-FHL/HHL (z-phenylalanine-histidine-leucine/hippuryl-histidine-leucine) ratio.Results. One hundred patients (mean (standard deviation) age 50.5 (12) years, 46% male) were enrolled. Based on plasma assays, 26/97 patients (26.8%) were unsuppressed by enalapril and 20/100 (20%) were sub-therapeutic for amlodipine. There were significant BP differences based on plasma levels of the medication: 21/20 mmHg lower in the group with suppressed ACE and 26/20 mmHg in the group with steady-state amlodipine concentrations.Conclusions. Monitoring antihypertensive adherence by assaying plasma medication concentrations is a feasible option for evaluating true v. pseudo-resistant hypertension


Subject(s)
Amlodipine , Antihypertensive Agents , Drug Monitoring , Hypertension , Medication Adherence , South Africa
3.
Fisioter. Bras ; 8(5): 313-316, set.-out. 2007.
Article in Portuguese | LILACS | ID: lil-491305

ABSTRACT

Com o objetivo de pesquisar os efeitos histológicos da irradiação laser de baixa intensidade na reparação óssea, selecionamos 10 ratos que foram submetidos à fratura de fêmur com fixação intramedular e distribuídos em dois grupos de igual número (grupos I e II). Os animais do grupo II foram submetidos à terapia laser Arseneto de Gálio (10 J/cm²) iniciada imediatamente após a cirurgia, totalizando nove sessões. Os animais foram sacrificados, para a análise histológica, com administração intraperitoneal de tiopental sódico no décimo, vigésimo e trigésimo dia após a cirurgia. Na avaliação histológica verificamos resultados positivos no grupo tratado.


The aim of the present study was to research the histological effects of low-power laser irradiation (LPLI) on fracture healing in rats. Ten Wistar male rats were subjected a femur bone fracture with internal fixation and divided into two groups of the same number (groups I and II). The group II was treated with laser AsGa (10 J/cm²), the laser therapy started after surgery, and had 9 sessions. The rats were sacrificed, for histological analysis, with thiopental sodium administration in the tenth, twentieth and thirtieth days after surgery. Histological analysis demonstrated positive results in the irradiation group compared with control group.


Subject(s)
Evaluation Study , Fracture Fixation , Histology , Lasers , Low-Level Light Therapy , Osteogenesis
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