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1.
Article Dans Anglais | IMSEAR | ID: sea-43211

Résumé

BACKGROUND: Anemia is one of most common complications in end stage renal disease (ESRD) patients. Erythropoietin has been recommended for treatment of anemia in these patients. OBJECTIVES: To evaluate the clinical efficacy, safety and usefulness of newly imported erythropoietin, called Espogen, usage in ESRD undergoing hemodialysis. MATERIAL AND METHOD: An open, non-comparative, prospective study of administered Espogen was conducted in 30 ESRD patients undergoing hemodialysis for a 12 week period. Eligible criteria included hemoglobin of less than 8 g%, hematocrit of less than 25% for at least three consecutive months with a serum ferritin of more than 100 ng%. Initial dose of drug was 150 units/kg/week subcutaneously, two or three times a week and dosage was adjusted to maintain the Hb at 10-12g%. RESULTS: In 28 patients, hemoglobin and hematocrit were increased significantly from 7.1 +/- 1.14 g/dl and 22.1 +/- 3.24% at baseline to 10.1 +/- 1.49 g/dl and 31.7 +/- 4.01% at the end of the study period respectively (p < 0.05). Mean weekly of Espogen dosage was 8390 +/- 2452.7 IU/week, which was 152.1 IU/kg/week. Some patients could reduce the dose at week 10. Reticulocyte increased significantly from 0.69 +/- 0.58% at baseline to highest value, 1.41 +/- 0.74 at 2 week and 1.30 +/- 0.66 at the end of the present study. Serum vitamin B12, serum folate, and red blood cell folate were not significantly changed. However serum ferritin decreased significantly from 840.6 +/- 948.95 to 582.7 +/- 990.70 ng/ml (p < 0.05). General condition including SF-36 score and tiredness were improved. There were no significant adverse events except mean arterial blood pressure of pre dialysis value which was statistically significant increased at the end of the present study (from 101.0 +/- 17.65 at week 0 and 110.4 +/- 16.8 mmHg at week 12, p = 0.0223). CONCLUSION: This clinical study showed that Espogen has proven effective and safe for treatment of anemia in hemodialysis patients. No serious adverse events occurred during the study period.


Sujets)
Anémie/traitement médicamenteux , Pression sanguine , Époétine alfa/pharmacologie , Femelle , Ferritines/sang , Antianémiques/pharmacologie , Humains , Défaillance rénale chronique/complications , Mâle , Adulte d'âge moyen , Études prospectives , Dialyse rénale , Résultat thérapeutique
2.
Article Dans Anglais | IMSEAR | ID: sea-38846

Résumé

OBJECTIVE: Treatment of primary nephrotic syndrome (NS) with steroid and cyclophosphamide may be unsuccessful and have much toxicity. Therefore, the authors evaluated the outcome of mycophenolate mofetil (MMF) treatment in these patients. MATERIAL AND METHOD: Fourteen primary NS patients who had failure to steroid and/or cyclophosphamide therapy were treated by MMF for at least 3 months as alternative treatment. Median +/- SD (range) of urine protein to creatinine index (UPCI), serum albumin, serum creatinine, serum cholesterol and dose of prednisolone at the start, 1mo, 3 mo, 6mo, and 12 mo after MMF therapy were compared. RESULTS: In the study group, the mean of UPCI decreased significantly from 2.79 +/- 8.1 to 1.81 +/- 1.54 (p = 0.02) at 12 months after the MMF therapy with no significant change in the mean serum creatinine from 1.14 +/- 0.45 to 1.27 +/- 0.67 mg/dL. The mean serum albumin increased significantly from 2.87 +/- 0.56 to 3.46 +/- 0.76 g/dL (p = 0.05) and the mean of prednisolone dosage decreased significantly from 34.64 +/- 19.16 to 11.11 +/- 8.58 mg/day (p = 0.004). For patients with IgM Nephropathy (IgMN), one of three steroid dependent patients presented with improved renal function. One of two patients with focal segmental glomerulosclerosis (FSGS) had a complete remission and one of two patients with IgA nephropathy (IgAN) had improved renal function with partial remission. CONCLUSION: MMF therapy in NS patients with primary glomerular disease was well tolerated and safe. These efficacies can improve NS, stabilize renal function, and achieve steroid withdrawal.


Sujets)
Adulte , Cyclophosphamide/effets indésirables , Femelle , Études de suivi , Glomérulonéphrite/traitement médicamenteux , Humains , Immunosuppresseurs/effets indésirables , Glomérule rénal , Mâle , Acide mycophénolique/analogues et dérivés , Syndrome néphrotique/traitement médicamenteux , Études rétrospectives , Stéroïdes/effets indésirables , Syndrome de sevrage/étiologie
3.
Article Dans Anglais | IMSEAR | ID: sea-43088

Résumé

Carbamylated hemoglobin (CarbHb) levels expressed as valipe hydantoin (VH) were measured by high performance liquid chromatography (HPLC) in patients with acute renal failure (ARF, n=35) and chronic renal failure (CRF, n=39). CarbHb levels in CRF patients were approximately 2.5 times of those in ARF ones (121.2 +/- 8 vs 54.8 +/- 6 microgVH/gHb, p<0.01). CarbHb levels of 80 microgVH/gHb provided the best statistical values (sensitivity of 89% and specificity of 82%). CarbHb/BUN and Carb/Cr ratios were also effective determinants in differentiation between ARF and CRF. CarbHb/BUN ratio of 1.5 and CarbHb/Cr ratio of 20 were the best statistical cut off points. As such, measurement of CarbHb levels could be a reliable non-invasive method in identifying ARF from CRF patients.


Sujets)
Adulte , Sujet âgé , Azote uréique sanguin , Chromatographie en phase liquide à haute performance , Femelle , Hémoglobine A/analogues et dérivés , Humains , Atteinte rénale aigüe/sang , Défaillance rénale chronique/sang , Mâle , Adulte d'âge moyen , Études prospectives , Courbe ROC , Valine/analyse
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