[Examination of activated charcoal preparations in chronic kidney disease: comparing Kremezin (K) and Merckmezin (M)].

BACKGROUND: Two activated charcoal preparations, Kremezin (K) and Merckmezin (M), are both available in Japan and derived from similar materials. However, their microstructures are distincty different, and possibly reflect differences in their properties of absorbance. To evaluate the difference between K and M, we investigated the effects of K and M on the clinical parameters related to uremia in pre-dialysis patients. METHODS: A prospective, randomized, open-label, two-arm, parallel-group comparative clinical trial was planned, as follows. After the 4-week observation period, twenty-two patients who were enrolled in this study were randomly distributed into two groups, K or M, for 8 weeks. RESULTS: There were no significant differences between the K and M groups in the characteristics of the patients. The rate of change of serum indoxyl sulfate was significantly reduced in the K group compared with the M group (p=0.002). Creatinine clearance was preserved in the K group, but decreased in the M group (p=0.045). CONCLUSIONS: K had more favorable effects in adsorbing uremic toxins and preserving renal function in the uremic patients than M.

[Kidney disease improvement plan avoids dialysis for life].

Initially, chronic kidney disease (CKD) cases with no progression or remission are reported, those are experienced in our hospital and have a possibility relates to prevent dialysis through life. Considering the roadmap for treatment of CKD, misgivings of "clinical practice guidebook for diagnosis and treatment of CKD" are firstly noticed. In this guidebook, 24 hour urine collection method is almost ignored. We usually get very important various informations from this method. Moreover, it is necessary for practitioner and nephrologist to look education plan over again. For the spread of the CKD treatment, consultant and management fee is necessary, because the treatment takes a lot of time and is very complicated.

Pseudoaldosteronism caused by combined administration of cilostazol and glycyrrhizin.

We report a case of obvious pseudoaldosteronism which occurred after the additional administration of cilostazol against arteriosclerosis obliterans (ASO) for bilateral legs in a 65 year-old man patient who had safely received glycyrrhizin for the previous ten years. Serum potassium level of the patient had been kept above 4 mEq/L until initiating cilostazol in November, 2006, then gradually decreased to 2.5 mEq/L for the following seven months. Both plasma renin activity and aldosterone were suppressed under co-administration of the angiotensin converting enzyme inhibitor, imidapril and the angiotensin II receptor blocker, olmesartan, both of which had been prescribed for longer than a year. Urinary potassium excretion was accelerated even in the critical level of hypokalemia. Because other drugs and supplements had not been changed at least for a year, pseudoaldosteronism caused by the combination of glycyrrhizin and another triggering factor, possibly cilostazol was highly suspected. By discontinuation of glycyrrhizin, potassium supplement, and the additional administration of the aldosterone blocker, spironolactone, the serum potassium level returned to the normal level two weeks later, even though cilostazol had been continued to avoid progression in his ASO. This is the first report of a case exhibiting pseudoaldosteronism induced by the interaction of glycyrrhizin with cilostazol, not by glycyrrhizin alone.