著者

Kazutaka Aonuma Tsuyoshi Shiga Hirotsugu Atarashi Kosuke Doki Hirotoshi Echizen Nobuhisa Hagiwara Junichi Hasegawa Hideharu Hayashi Kenzo Hirao Fukiko Ichida Takanori Ikeda Yorinobu Maeda Naoki Matsumoto Toshiyuki Sakaeda Wataru Shimizu Mitsuru Sugawara Kyoichi Totsuka Yoshimasa Tsuchishita Kazuyuki Ueno Eiichi Watanabe Masayuki Hashiguchi Sumio Hirata Hidefumi Kasai Yoshiaki Matsumoto Akihiko Nogami Yukio Sekiguchi Tokuko Shinohara Atsushi Sugiyama Naokata Sumitomo Atsushi Suzuki Naohiko Takahashi Eiji Yukawa Masato Homma Minoru Horie Hiroshi Inoue Hiroshi Ito Takanori Miura Tohru Ohe Kimikazu Shinozaki Kazuhiko Tanaka on behalf of the Japanese Circulation Society and the Japanese Society of Therapeutic Drug Monitoring Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.81, no.4, pp.581-612, 2017-03-24 (Released:2017-03-24)

参考文献数

185

被引用文献数

33

著者

Sumio HIRATA Mami MATOBA Satoshi IZUMI Taku FURUKUBO Miyuki OTA Minori FUJITA Senji OKUNO Tomoyuki YAMAKAWA

出版者

日本臨床薬理学会

雑誌

臨床薬理 (ISSN:03881601)

巻号頁・発行日

vol.34, no.3, pp.87-90, 2003-05-31 (Released:2010-06-28)

参考文献数

15

被引用文献数

4 7

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We present a 68-year-old male case, hemodialysis patient (body weight 56.8 kg) with Clostridium difficile (C. difficile) induced pseudomembranous colitis. The colitis was treated with orally administered vancomycin (VCM), 2.0 g/day, for 14 days leading to high serum levels. At this time, the VCM treatment was discontinued following negative stool cultures for C. difficile, and the serum VCM concentration was 58.7 μg/ml, the highest level in oral VCM case reports up to the present. Mean bioavailability was estimated as 16.8% during the VCM administration period in this patient, and it was assumed that the intestinal absorption of VCM was increased with severe colitis. As the serum VCM levels continued to decrease gradually, the symptoms of colitis improved. Nevertheless, the patient's colitis relapsed after oral levofloxacin treatment for bronchitis and high fever, although the serum VCM levels were still far greater than the minimum inhibitory concentration of C. difficile infection.This finding suggests that VCM concentrations may remain insufficient in the colon despite the high serum levels. The high and persistent serum VCM concentrations in this patient may be due to the follow-ing: 1. increased absorption of VCM with severe colitis, 2. decreased excretion with renal impairment leading to VCM serum accumulation, and 3. too high a VCM dosage. We conclude that patients with both renal failure and severe intestinal disease may absorb and accumulate significant amounts of orally administered VCM. Therefore, a high dose oral VCM should be avoided in hemodialysis patients with severe pseudomembranous colitis.

著者

Sakura Nakatani Keisuke Maeda Junji Akagi Misato Ichigi Marina Murakami Yoshihiko Harada Sara Utsumi Masaki Fukunaga Yuki Narita Yuki Kondo Yoichi Ishitsuka Tetsumi Irie Daisuke Kadowaki Sumio Hirata

出版者

The Pharmaceutical Society of Japan

雑誌

Biological and Pharmaceutical Bulletin (ISSN:09186158)

巻号頁・発行日

vol.42, no.8, pp.1350-1357, 2019-08-01 (Released:2019-08-01)

参考文献数

30

被引用文献数

1 7

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Creatinine (Cr) levels are strongly affected by muscle mass, and the estimated glomerular filtration rate (eGFR), a measure based on serum creatinine (SCr), is often overestimated in patients with sarcopenia. To evaluate the coefficient of determination (R2) between eGFR and the actual measured value, we performed a linear regression analysis of a modified GFR (mGFR: measured Cr clearance × 0.715) and various renal function estimates adjusted for muscle mass in 19 patients with sarcopenia. The eGFR values based on SCr (eGFRcr) were higher than those based on mGFR, although a high R2 (0.704; p < 0.001) was found between these values. There was no deviation between eGFR based on serum cystatin C (eGFRcys) and mGFR, although the R2 value 0.691 was equivalent to that of eGFRcr. In the equation used to calculate eGFRcr not adjusted for body surface area (mL/min), muscle mass parameters obtained from bioelectrical impedance analysis were used instead of actual body weight to recalculate the eGFRcr. The R2 between this eGFRcr and mGFR did not improve, although there was less deviation. However, assuming that all patients were female by using female coefficients for all patients, the R2 between eGFRcr-fcc (eGFRcr with female coefficient correction) and mGFR improved and was the highest (0.808) on substitution of appendicular skeletal muscle mass. The correlation between eGFRcr-fcc and mGFR improved over eGFRcys when muscle mass was substituted for body weight in the equation used to estimate eGFR in patients with sarcopenia and sex differences were removed.