Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy for Treatment of Calcium Channel Blockers, Angiotensin II Receptor Blockers, and Metformin Overdose

An overdose of antihypertensive agents, such calcium channel blockers (CCBs) and angiotensin II receptor blocker (ARBs), and the antihyperglycemic agent, metformin, leads to hypotension and lactic acidosis, respectively. A 40-year-old hypertensive and diabetic man with hyperlipidemia and a weight of 110 kg presented to the emergency room with vomiting, dizziness, and hypotension following an attempted drug overdose suicide with combined CCBs, ARBs, 3-hydroxy-3-methylglutaryl-coemzyme A reductase inhibitors, and metformins. A conventional medical treatment initially administered proved ineffective. The treatment was then changed to simultaneous extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), which was effective. This shows that simultaneous ECMO and CRRT can be an effective treatment protocol in cases of ineffective conventional medical therapy for hypotension and lactic acidosis due to an overdose of antihypertensive agents and metformin, respectively.

The effects and mechanisms of benazepril and losartan on glomerular podocyte autophagy in aged spontaneously hypertensive rats / 中华老年医学杂志

Objective To examine the effects of benazepril and losartan on glomerular podocyte autophagy in aged spontaneously hypertensive rats (SHRs) and investigate the underlying mechanisms of renal-protective effects of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB).Methods Wistar-Kyoto rats (WKYs) were used as the normal control (NORM) group (2 ml physiological saline per day).SHRs were randomly divided into 4 groups:the CTRL group (2 ml physiological saline per day),the ACEI group (10 mg · kg-1 · d-1),the ARB group (30 mg· kg-1 ·d-1) and the combined group (10 mg· kg-1 · d-1 benazepril and 30 mg· kg-1 · d-1),with six 18-month-old make rats in each group.The experiments were conducted during a 4-month period.Blood pressure was monitored regularly.At the end of the experiments,we measured the levels of urine protein,urine creatinine,serum creatinine (SCR),blood urea nitrogen (BUN),and serum and renal cortex angiotensin Ⅱ (AngⅡ).Ultrastructural changes in the kidney were examined under light and transmission electron microscopy.The expressions of nephrin,LC3BⅡ,Atg5 and p62 in the glomerulus were analyzed by Western blot analysis.Results After treatment,the blood pressure and the urine albumin/creatinine ratio of the four SHR groups were still significantly higher than those of the NORM group,but the blood pressure and the urine albumin/creatinine ratio of the ARB group and the combined group were significantly lower than those of the CTRL group (all P＜ 0.05);There were no significant differences in SCR and BUN levels among these five groups (P＞ 0.05);The level of serum AngⅡ of the combined group was significantly higher than that of the CTRL group [CTRL (0.08±0.00) μg/L,Combined (0.12±0.01) μg/L,P＜0.05];The levels of cortex AngⅡ of the four SHR groups were significantly lower than those of the NORM group,while the level of cortex AngⅡ of the ARB group was significantly higher than that of the CTRL group (all P＜0.05);Renal ultrastructural examination revealed shrunken glomeruli,fused or effaced epithelial cell foot processes,and focal atrophy of renal tubules in the four SHR groups.These pathological changes were more serious in the CTRL group but less so in the combined group.There were significantly more autophagosomes in the NORM group and the combined group than in the CTRL group (P＜0.05).Compared with the NORM group,the expressions of nephrin,LC3BⅡ,Atg5 and p62 in the CTRL group were suppressed significantly (P ＜ 0.05).The expressions of nephrin,LC3BⅡ and Atg5 in the ACEI group and the expressions of nephrin,LC3BⅡ,Atg5 and p62 in the ARB group and the combined group were higher than in the CTRL group (P＜0.05).Conclusions ACEI/ARB can decrease the autophagic activity of glomerular podocytes.The renal-protective effects of ACEI/ARB may be mediated by glomerular podocyte autophagy,which is induced by AngⅡ.

Clinical Study of the Protective Effect of ACEI and ARB on Patients with Diabetic Nephropathy / 中国慢性病预防与控制

Objective To investigate the protective effect of angiotensin converting enzyme inhibitor(ACEI) and angiotensin receptor antagonist(ARB) on renal function of type 2 diabetic nephropathy patients.Methods 60 patients with type 2 diabetic nephropathy and mild or midrange damages of renal function were observed.The patients all accepted routine diabetic therapy and were randomly divided into three groups,ACEI group,ARB group and combination group with ACEI and ARB.The blood pressure,blood creatinine and urine protein of 24 hours were measured before therapy and 8 weeks after therapy.Results The excretive amounts of urine protein decreased in all groups.The excretive levels of urine protein in combination group significantly decreased than in ACEI group and ARB group(P

Effects of valsartan and benazepril on glomerulosclerosis in rats with 5/6 nephrectomy / 中国临床药理学与治疗学

AIM: To observe and compare the improvement of glomerul- osclerosis in rats with 5/6 nephrectomy by valsartan and benazepril. METHODS: Thirty Sprague-Dawley male rats were selected and performed five-sixths nephrectomy to produce chronic renal failure model. Two weeks after the surgery, the rats were randomly divided into model group, valsartan group and benazepril group, and established a shame group serving as normal control. The weight, blood pressure, blood uria nitrogen (BUN) and serum creatinine were measured on the sixth week after operation, then the rats were killed to take the kidneys for pathological histological observation. Immunohistochemistry was used to examine the expression of TGF-? 1 protein and fibronectin (FN) and collagen IV in glomeruli. RESULTS: As compared with model group, systolic pressure decreased (P

Relationship between the angiotensin receptor/antagonist and renal diseases / 中国临床药理学与治疗学

The renin-angiotensin system plays an important role in the pathogenesis and chronic progress of renal diseases. The increased plasma level of angiotensin can induce the changes of haemodynamics and diverse cytokines secreted by the kidney, and the change promotes the renal injury. How to block renin-angiotensin system has been a focus of nephrology. Recently, with the emerging of angiotensin receptor antagonist, the relationship between the angiotensin receptor antagonist and renal diseases has being realized.