著者

藤見 惺

出版者

社団法人 日本透析医学会

雑誌

日本透析療法学会雑誌 (ISSN:09115889)

巻号頁・発行日

vol.25, no.3, pp.205-210, 1992-03-28 (Released:2010-03-16)

参考文献数

7

著者

井関 邦敏 藤見 惺 川崎 晃一 尾前 照雄

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.21, no.2, pp.157-163, 1979 (Released:2010-07-05)

参考文献数

14

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A case of pseudo Bartter syndrome in furosemide abuse was described. The case was 24 year-old female, a nurse, who was admitted because of persistent hypokalemia on, she noted pretibial edema for which furosemide was prescribed by a local doctor. Since then, she had taken about 80 mg of furosemide daily until, when transient cardiac and respiratory arrest developed and serum potassium was found to be 2.0 mEq per liter. The patient was advised to discontinue furosemide. Serum potassium, however, remained inn hypokalemic range in spite of potassium supplementation. At admission she appeared healthy and denied using furosemide, diuretics and laxatives. Serum potassium was 2.4, sodium 143, chloride 90 mEq per liter. Arterial blood pH was 7.477 and plasma bicarbonate 31.3 mEq per liter. Diagnosis of pseudo Bartter syndrome was suspected because of 1) persistent hypokalemia with increases in potassium clearance, plasma renin activity, plasma aldosterone concentration 2) low response of blood pressure to angiotensin II 3) minimal to moderate hyperplasia of J-G apparatus 4) no improvement of clinical condition with indomethacin. After discharge, the patient had been well with persistent hypokalemia until, when she became unconscious abruptly followed by generalized convulsion. Serum potassium was 1.5 mEq per liter. Incidentally it was discovered that she had obtained a lot of furosemide from pharmacy without doctor's prescription. At first she insisted not to take furosemide but finally admitted taking furosemide 280 mg daily. It was quite surprising that she had been taking furosemide continuously even though having episodes of cardiac and respiratory arrest, generalized convulsion which, she should know, might be deeply related to f urosemide usage. It is strongly suggested that furosemide abuse would be one another etiologic condition for pseudo Bartter syndrome and furosemide should not be prescribed without careful supervision.

著者

大地 信彰 稲永 隆 平方 秀樹 名西 史夫 小野山 薫 藤島 正敏 王 幸則 三井島 千秋 藤見 惺

出版者

社団法人 日本透析医学会

雑誌

日本透析療法学会雑誌 (ISSN:09115889)

巻号頁・発行日

vol.19, no.11, pp.1069-1074, 1986-11-28 (Released:2010-03-16)

参考文献数

26

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蛋白同化ステロイド剤の1つであるmepitiostaneを貧血治療薬として, 33例の安定透析例を対象に使用した. 本剤投与前6ヵ月間におけるHt値の自然変動を各症例毎に調べ, その平均値および標準偏差値SDを求めた. 本剤投与前のHt値より, 投与後4 S D以上Htの上昇を認めた症例を有効群, それ以外を無効群とし, 各群間におけるBUN, 血清鉄等各パラメーターの経時的推移を比較検討した. さらに, 透析患者にみられる続発性副甲状腺機能亢進症が, その造血効果に及ぼす影響について検討を加えた. mepitiostaneは10mgないし20mgを朝, 夕の分服とし, 4ヵ月間連日経口投与した.結果: 1. 有効群ではHt値は投与1ヵ月後より有意に上昇し, 平均で4.6%増加した. 同時に血清Creat値の上昇, BUN値の低下等蛋白同化作用に基づくと考えられる変化がより強くみられた. 2. 有効群では貧血改善に伴い血清鉄が有意に低下した. これは鉄利用亢進に基づく変化と考えられ, 鉄剤の併用で本剤の貧血改善効果がより増大する可能性が示唆された. 3. 透析患者にみられる続発性副甲状腺機能亢進症が, 本剤の造血効果を抑制している可能性が示唆された.