著者

富田 益臣 大塚 泰史 飯田 里菜子 小林 政司 栗山 哲 細谷 龍男

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.47, no.5, pp.531-535, 2005-07-25 (Released:2010-05-18)

参考文献数

11

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An 85-year-old woman with Parkinson's disease was admitted to our hospital to conduct a further work-up for progressive gait disturbance. She had been on medications for the disease for more than a decade prior to admission. In order to improve her condition, she was newly administered pramipexole, a dopamine agonist, from day 3 in addition to the preceding anti-Parkinson's therapy. However, on day 10, her consciousness level was rapidly deteriorated into delirium (JCS II-10), which was not accompanied by neurological signs and symptoms. Laboratory tests showed severe hyponatoremia with relatively increased urinary sodium excretion, and severe low serum osmolarity with an increased urinary osmolarity. Brain CT and brain MRI showed no specific abnormalities except for those related to aging. Blood concentration of ADH measured at the onset was substantially higher (39.5pg/ml) than normal (0.3-3.5pg/ml under normal osmolarity). Diseases causing hyponatremia, such as liver cirrhosis, congestive heart failure, hypotonic dehydration, and malignancy-associated inappropriate ADH secretion (SIADH), were all excluded. Under the suspicion of SIADH due to pramipexole, the drug was discontinued and as a result, her consciousness level improved rapidly together with a prompt reduction in ADH level (9.2pg/ml).To the best of our knowledge, the present case is the first that demonstrates pramipexole-induced SIADH. Since pramipexole is classified as a dopaminergic receptor agonist, this case may provide new insight into a link between ADH and the dopaminergic receptor in the central nervous system.

著者

栗山 哲 友成 治夫 大塚 泰史 大城戸 一郎 細谷 龍男

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.45, no.4, pp.367-371, 2003-05-25 (Released:2011-03-01)

参考文献数

19

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Combination therapy with angiotensin receptor antagonist (ARB) plus angiotensin converting enzyme inhibitor (ACE-I) (ARB/ACE-I) was efficacious in reducing proteinuria in patients with progressive renal disease. However, this therapy may be associated with the worsening of anemia and hyperkalemia. The present study addressed whether or not triple therapy with low dose ARB, low-dose diuretic (D) and calcium channel blocker(CCB) (ARB/D/CCB) is as effective as therapy with low-dose ARB/ACE-I in retarding the progression of overt diabetic nephropathy. In the triple therapy, the patients were initially subjected to monotherapy with CCB for 24 weeks. Low-dose ARB and low-dose D were added to the treatment for an additional 24-week period. In parallel, patients undergoing double therapy were initially treated with low-dose ACE-I alone for 24 weeks, and then low-dose ARB was added for an additional 24-week period. The results were as follows: 1) In the triple therapy, blood pressure was reduced by 9 mmHg in systole and 5 mmHg in diastole (not significant) compared to monotherapy with CCB. There was a significant decline in proteinuria (3.3±1.2 g/day in the CCB-treated period vs. 2.1± 1.0 g/day in the ARB/D/CCB-treated period, n=12, p=0.0143) . Furthermore, a significant improvement in the slope of reciprocal serum creatinine concentration (1/Cr) was found in response to triple therapy (l /Cr : -0.0118±0.0009 in the CCB-treated vs. -0.0035±0.0028 (1/mg/dl/month) in the ARB/D/CCB-treated period, n =12, p <0.001) . There was neither a worsening of anemia nor an increase in the serum potassium (K) concentration. 2) In the double therapy, blood pressure was reduced by 12 mmHg in systole(p=0.0079, n=11) and 6 mmHg in diastole(n=11, p=0.0037) compared to the monotherapy with ACE -I . A significant improvement in the slope of 1/Cr was found in the double therapy (1/Cr : -0.00952±0.0052 in the ACE- I treated period vs. -0.0029±.0028(1/mg/dl/month) in the ARB/ACE-I, n=1 I, p<0.001). In addition, there was a substantial reduction in hematocrit and increase in serum K concentration. The present result suggests that triple therapy consisting of ARB/D/CCB is as efficacious as double therapy with ARB/ACE-I in protecting the kidney from the progression in patients with diabetic overt nephropathy. The former may be expected to have less adverse effects.