Search PubMed⌕ Search

Biomedical subjects

M Godin

Publications and source records attributed to M Godin.

At least 73 records · Page 4Linked to original sources
PubMed1991

Acute renal thrombosis induced by angiotensin-converting enzyme inhibitors in patients with renovascular hypertension.

Acute reversible renal failure is a widely recognized potential complication of angiotensin-converting enzyme inhibitor (ACEI) administration in renovascular hypertension, particularly in bilateral artery stenosis or stenosis involving a solitary kidney. We report herein 2 cases of a rare but severe complication, i.e., acute renal artery thrombosis. Whereas marked hypotension does not seem to be necessary to trigger acute renal failure following ACE inhibition, by contrast, the fall in blood pressure could play an important role in our patients. Since single-dose ACEI has been advocated in order to improve the predictive value of renal scintigraphy or plasma renin activity measurements in the diagnosis of renovascular hypertension, the potential risk of this approach should be stressed.

Acute Disease↗
PubMed1991

[Indications for angiographic study of renal arteries in elderly hypertensive subjects].

During a 30 months period, 70 patients (60-84 years old) underwent a renal artery angiographic investigation, either by combined intravenous angiography and pyelography, either by intravenous or intra-arterial digital angiography. Thirty-nine were males, 31 were females. All patients were hypertensive. Thirty-three had a normal renal function and 37 had a renal insufficiency arbitrarily definite as creatinine clearance lower than 60 ml/min (m = 33 +/- 15 ml/min). Eight aortic anevrysms were discovered. Thirteen patients (18.6%) had atherosclerotic renovascular disease. Criteria which led to undertake these investigations and results are listed in the following table. [table; see text] Transluminal percutaneous angioplasty and surgical treatment were performed 7 and 3 times respectively. In one case, nephrectomy was done. In all these patients but one, improvement of hypertension and/or renal function occurred. In patients with renal impairment, difference in size between the two kidneys detected by echography or plain abdominal X-rays were noted in 8 among the 9 patients with renovascular disease; six among them had proteinuria less than 0.5 g/day. In conclusion, in hypertensive patients older than 60, criteria for detection of renovascular disease are the same as in younger patients. When renal function is decreased, difference in size between the two kidneys requires an angiographic evaluation. Proteinuria does not exclude renovascular pathology.

Age Factors↗
PubMed1990

Renal granulomatous sarcoidosis: report of six cases.

Six cases of chronic renal failure related to granulomatous renal sarcoidosis are reported and compared with data in the literature. The particular features of sarcoidosis granulomatous interstitial nephritis should be emphasised because presentation may be misleading. Renal failure usually presents with a rapidly progressive course, either isolated or associated with mild proteinuria and sterile leukocyturia, while extrarenal localisations may be absent. Diagnosis should be suspected on the basis of elevated or paradoxically normal serum calcium concentrations, due to increased plasma concentrations of calcitriol, while immunoreactive circulating parathormone concentrations are depressed. Calcitriol as well as angiotensin-converting enzyme could represent unregulated secretion products from granulomatous tissue and their plasma concentrations may roughly reflect activity of the disease. Early corticosteroid treatment dramatically improves renal function but long-term renal prognosis may be oblitered due to progressive chronic renal failure related to fibrosis scarring.

Adrenal Cortex Hormones↗
PubMed1990

Disposition of fleroxacin, a new trifluoroquinolone, and its metabolites. Pharmacokinetics in renal failure and influence of haemodialysis.

The pharmacokinetics of fleroxacin and its metabolites following a single oral dose of fleroxacin 400mg were examined in 6 healthy subjects and 24 patients with various degrees of renal insufficiency. Plasma and urine samples, collected at various times after administration, were assayed by high performance liquid chromatography (HPLC). In healthy subjects, Cmax was 6.8 +/- 0.7 mg/L; tmax = about 1h, t1/2 = 14 +/- 2h, total clearance = 4.86 +/- 0.72 L/h and the percentage of unchanged fleroxacin excreted in urine in 48 hours was 48 +/- 4% (HPLC). Plasma concentrations of metabolites were very low and accounted for no more than 5% of the levels of unchanged fleroxacin. In uraemic patients Cmax did not change, whatever the degree of renal failure; tmax was increased in patients with a glomerular filtration rate below 0.6 L/h, and Vd/f was independent of the severity of renal failure. These data suggest that bioavailability of the drug is unchanged. In uraemic patients t1/2 was prolonged and AUC multiplied by a factor of 2 to 3. A linear relationship was found between total and renal clearances of fleroxacin and creatinine clearance. Accumulation of N-demethyl-fleroxacin and N-oxide-fleroxacin was very high in uraemic patients, due to slow formation of these metabolites and decreased urinary elimination. Dialysance of fleroxacin and of its metabolites was approximately 3.6 to 4.8 L/h. These findings suggest that fleroxacin dosage may need to be reduced in patients with severe renal disease; in haemodialysed patients, treated every 2 days, a single dose of fleroxacin 400mg is recommended at the end of each dialysis session.

Adult↗
PubMed1990

[Hypertension in the aged person. Numerous questions, few responses].

Blood pressure levels increase with age. So, the prevalence of both isolated systolic (systolic pressure greater than 160 mmHg and diastolic less than 90 mmHg) and diastolic hypertension (diastolic pressure greater than 95 mmHg) in the elderly is high. Due to high variability of blood pressure and to overestimation of real blood pressure when arterial walls are sclerosed, the true prevalence of hypertension is probably overestimated. Nevertheless, like in younger persons, hypertension in elderly is a major risk factor of cardiovascular morbidity and mortality. Results of clinical trials designed in the last 30 years have clearly proved benefit of antihypertensive therapy. However, a lot of questions remain: Is treating hypertension justified in the very old? Has isolated systolic hypertension to be treated? Which antihypertensive drugs may be used? Is screening for atherosclerotic renovascular disease useful? Which investigations have to be performed for diagnosing atheromatous renal failure?

Aged↗
PubMed1990

Atrial natriuretic peptide in the renal response to an acute protein load.

A high protein meal acutely stimulates the glomerular filtration rate. In order to assess the possible role of atrial natriuretic peptide (ANP) as a mediator of this renal response, the ANP plasma concentrations were measured with a sensitive radioimmunoassay method before and after a large protein load (1.5 g/kg body weight given as a meat meal). Creatinine clearance increased significantly while fractional excretion of sodium remained constant. ANP plasma concentrations did not change after the protein load and the intra-individual variations of creatinine clearance were not correlated with the intra-individual changes in ANP plasma concentrations. It was concluded that ANP was probably not involved in the renal haemodynamic changes observed after a large protein load.

Adult↗
PubMed1989

Pharmacokinetics of cilazapril in patients with renal failure.

1. The pharmacokinetics of a single 1 mg dose of cilazapril were determined in six subjects with normal renal function and in 19 uraemic patients with various degrees of renal impairment. 2. Significant decreases in systolic and diastolic blood pressure were noted in all groups of subjects between 2 and 8 h after administration of 1 mg cilazapril. 3. There was a significant correlation between ACE inhibition at 24 h and creatinine clearance (CrCL). 4. For cilazapril, Cmax and tmax were independent of creatinine clearance. AUC(24) was inversely related to CrCL and apparent plasma clearance (CL/F) was directly related to CrCL. 5. For cilazaprilat, Cmax and tmax were related to creatinine clearance. AUC(24) was inversely related to CrCl and apparent plasma clearance (CL/F) was directly related to CrCL. 6. Dialysis clearance was approximately 2 l h-1 for cilazapril and for cilazaprilat. 7. The effects of renal impairment on cilazapril and cilazaprilat kinetics were similar to those observed for other inhibitors of angiotensin-converting enzyme such as captopril, enalapril and lisinopril. 8. It may be necessary to modify doses of cilazapril for the treatment of essential hypertension in uraemic patients. When creatinine clearance was below 15 ml min-1 cilazaprilat concentrations were increased, half-lives were prolonged and ACE inhibition remained above 90% for at least 24 h. A reduced dosage is indicated for these patients. 9. In patients requiring haemodialysis, maintenance doses of 0.5 mg given after each haemodialysis session are sufficient.

Adult↗
PubMed1989

[Drug-induced nephropathies].

The list of nephrotoxic drugs is long. The kidney is particularly susceptible to the nephrotoxic action of drugs, because of its functional properties, including: a) the high volume of renal blood flow, which brings large amounts of toxin; b) the large area in contact with the drug, either in the glomerulus or the tubule epithelium, which enables toxin interaction or uptake; c) the kidney's ability to transfer active substances, which provides specific transfer mechanisms that mediate cellular uptake; d) drug breakdown, which may occur in renal tubules and lead to the formation of toxic metabolites from non-toxic parent substances; e) the kidney's concentrating mechanisms, which can increase urinary and interstitial concentrations of non-absorbed products; f) the high metabolic rate of tubule cells required for normal function, which is subject to perturbation. Indeed, nephrotoxins affect every aspect of renal pathology, from acute renal failure due to functional alterations to that resulting from tubule cell necrosis. These anomalies may occur suddenly or after a long period of exposure to the toxic agent. They may be localized in the cortex or the medulla and affect all parts of the nephron: the glomeruli, the tubules, the interstitium or the vessels. How then is the topic of a brief expose to be chosen? It was made based upon the results of a questionnaire addressed to French nephrologists.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

[Pharmacokinetics of cyclosporin A in patients with nephrotic syndrome].

The pharmacokinetics of Cy A have been studied in patients with N.S.. Eight patients (7 M, 1 F) received a single 12.5 mg/kg oral dose and a single 4 mg/kg intravenous dose. Plasma was separated from red blood cells at 22 degrees C, at least 2 hr after drawing. Cy A plasma levels were determined by reverse HPLC. The comparison of our pharmacokinetic parameters for the oral route with those from reference patients showed significant differences for T1/2 Ka and Tmax which were decreased in N.S. For the I.V. route we found a decrease in total plasma clearance (CLTP). Absolute bioavailability (18%) was also diminished. Moreover total cholesterol and B apolipoprotein were increased in our nephrotic population. Cy A is highly bound to lipoprotein and we found a significant negative correlation between CLTP of Cy A and either B apolipoprotein or total cholesterol. We conclude that the increase of lipoprotein in N.S. is probably responsible of the modifications in pharmacokinetics of Cy A. Nevertheless Cy A dosage can be not modified in N.S. when oral route is used and divided by a factor two for the I.V. route.

Adult↗
PubMed1988

Comparative pharmacokinetics of tromethamine fosfomycin and calcium fosfomycin in young and elderly adults.

The pharmacokinetics of two oral forms of fosfomycin, tromethamine (trometamol) salt and calcium salt, were studied in five young (age, 29 +/- 3 [standard deviation] years) and eight elderly (age, 72 +/- 6 years) adults. The subjects received a single 40-mg/kg (body weight) (approximately equal to 3-g) calcium fosfomycin dose and a 25-mg/kg (approximately equal to 2-g) tromethamine fosfomycin dose in fosfomycin acid form. Blood and urine samples were collected for 24 h. Antibiotic concentrations in serum and urine were measured by microbiological assay. In all subjects, the peak levels of the calcium salt in serum were two- to fourfold lower than those of the tromethamine salt (6 to 7 and 18 to 22 micrograms/ml, respectively), indicating poor intestinal absorption of the calcium form. The elimination half-life of the two oral forms was about 5 h in young adults, and the half-life was only moderately longer in elderly subjects, with large individual variations: 8.28 +/- 5.51 h for tromethamine fosfomycin and 11.80 +/- 6.86 h for calcium fosfomycin. In elderly subjects, absorption of the tromethamine salt form was not modified, but the time to peak level was delayed for the calcium salt (2.58 +/- 0.54 h versus 1.41 +/- 0.67 h in young adults). Pharmacokinetic elimination of the two forms of fosfomycin was only moderately affected in elderly subjects; we observed lower urinary elimination, about 58 versus 28% of the dose in 24-h urines for the tromethamine salt and decreased renal clearance of both forms. However, the dosages of tromethamine and calcium fosfomycin need not be adjusted for elderly subjects who have endogenous creatinine clearances above 50 ml/min per 1.73 m2.

Adult↗
PubMed1988

Is apalcillin nephrotoxic?

Apalcillin is a new semisynthetic penicillin used as a sodium salt. More than 4,000 patients have been treated with this antibiotic, but increased serum creatinine levels were noted in 18 cases. In 5 of these cases, apalcillin was possibly responsible, and in 13 it was doubtful. We decided to study renal function of normal volunteers treated with 4 g of apalcillin. Three periods were studied: a pretreatment control period of 80 min followed by a treatment period of 60 min and a posttreatment period of 40 min. Inulin and p-aminohippurate (PAH) infusion were continued during all three periods. At the beginning of the treatment period, 2 g of apalcillin was injected as a bolus, followed by infusion of 2 g of apalcillin over 1 h. Urinary volume was measured every 20 min. Creatinine, insulin, and PAH clearances and urinary excretion of sodium, potassium, calcium, and magnesium were calculated for each period. Urinary beta-2-microglobulin excretion was also assessed. Analysis of variance was done. We observed no variation in clearances of creatinine or inulin or in urinary electrolyte output. PAH clearance was significantly decreased during apalcillin infusion. Apalcillin appeared to compete with PAH for proximal tubular secretion but induced no further renal dysfunction.

Ampicillin↗