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Background. Diabetic patients with moderate to advanced renal failure have severe hypertension and often require multiple antihypertensive agents to control it. Nevertheless, no standardized therapy has been established. This study was designed to examine the safety and efficacy of the biliary-excreted angiotensin converting enzyme inhibitor temocapril in those patients whose blood pressure was not adequately decreased by calcium channel blocker monotherapy. Methods. Twenty-seven patients who did not reach the therapeutic goal of blood pressure (140/90 mm Hg) with amlodipine monotherapy were assigned to receive temocapril (2 mg) and amlodipine (5 mg) for 3 months. Blood samples for hematological and biochemical examinations were taken every month during treatment. Twenty-four-hour urine was collected to measure urinary protein excretion. Trough plasma concentrations and pharmacokinetics were measured during temocapril treatment. Results. Blood pressure was significantly decreased ( P < 0.05) from 158 ± 14/91 ± 9 to 148 ± 15/83 ± 8 mm Hg by the addition of temocapril. The peak serum concentration (Cmax) was 86.3 ± 22.7 μg/l at 3.9 ± 1.6 h (Tmax) after administration. Mean area under curve for 0 to 24 h (AUC0–24 h) was 1179 ± 273 μg/l · h. Trough levels showed a steady state. After temocapril therapy, the slope of the reciprocal of creatinine decreased compared with that before the addition of temocapril. Urinary protein excretion significantly decreased from 3100 ± 1100 to 2300 ± 1100 mg/day. There was no significant change in hematological and biochemical data. Conclusions. The present findings suggest that temocapril can be safely used in patients with advanced diabetic nephropathy, and in combination with dihydropyridine calcium channel blockers it decreases blood pressure and effectively retards the aggravation of renal insufficiency for 3 months in those patients. [ABSTRACT FROM AUTHOR]

A 31-year-old woman was diagnosed as having Bartter's syndrome in 1978, although suspicions remained that she had been taking diuretics surreptitiously. Careful observation and repeated urinary drug analyses revealed no clue that she had been taking diuretics, until 20 years later, when the urine samples at last disclosed traces of furosemide. At this time she showed proteinuria, of 2 g/day, and hypercholesteremia. The glomerular filtration rate had decreased to 66 ml/min per 1.73 m2. The 24-h urinary concentrations of β2-microglobulin, N-acetyl-β- d-glucosaminidase (NAG) activity, and other urinary enzymes that are indicators of damage in proximal tubular cells, were increased, showing proximal tubular damage. The function of the loop of Henle was evaluated by a hypotonic saline loading test. The fractional distal chloride reabsorption, an index of the solute conservation rate in the loop of Henle, was 65.4%, which was lower than the normal value (88.9 ± 6.2%). The maximal urinary concentrating ability was 357 mOsm/kg·H2O, and a short ammonium chloride loading test showed impairment in the acidification of the urine. The third renal biopsy specimens showed some obsolescent glomeruli, marked juxtaglomerular cell hyperplasia, intraluminal calcification, interstitial infiltration of lymphocytes with fibrosis, and thickening of arteriolar walls with narrow lumens. Patients often attempt to hide their use of diuretics from medical staff, leading to them to make a misdiagnosis of Bartter's syndrome. Although the patient described here has not experienced life-threatening adverse effects from furosemide abuse, some findings appear to be irreversible, suggesting the deterioration of renal function. Patients should realize that longstanding abuse of diuretics causes not only metabolic abnormalities but also the risk of renal damage. [ABSTRACT FROM AUTHOR]

A case is presented in which suprarenal neurilemoma was associated with paroxysmal attacks of hypertension, headache and sweating with elevated plasma and urinary catecholamines. Pheochromocytoma was excluded using an overnight clonidine suppression test. Ultrasonography, computed tomography and magnetic resonance imaging, which showed cystic mass with a pedicle continuing to the widened intervertebral foramen, were helpful for the preoperative diagnosis of retroperitoneal neurilemoma. The excised tumor was revealed to be benign neurilemoma and contain detectable levels of adrenaline, noradrenaline and dopamine. The relationships between tumor catecholamines and clinical manifestations will be discussed. [ABSTRACT FROM AUTHOR]