CORRECTION OF POSTTRANSPLANT ERYTHROCYTOSIS WITH ENALAPRIL
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Erythrocytosis (i.e., elevation in red cell mass) frequently develops after renal transplantation and is associated with increased risk of thromboembolic incidents and hypertension. Because it has been reported that enalapril may induce anemia in renal allograft recipients, we have undertaken a prospective study to estimate the efficacy and safety of enalapril therapy for erythrocytosis and to establish the mechanism by which enalapril reduces red cell mass. Seventeen (12 male and 5 female) long-term renal allograft recipients with increased hematocrit value (> 55% for male and > 50% for female) and elevated red cell mass as determined with 51Cr-labeled autologous erythrocytes were treated with enalapril. After 3 months of therapy, enalapril was withdrawn and patients were observed in order to differentiate spontaneous remission of erythrocytosis from effects of enalapril therapy. After 3 months of the treatment, mean hematocrit decreased from 51.1% (range 47–56%) to 42.9% (range 37–51%; P<0.01). Red cell mass significantly decreased during this period (from 46.7 ml/kg, range 32.5–60.7 ml/kg, to 32.9 ml/kg, range 20.1–60.1 ml/kg; P<0.01). Serum erythropoietin levels also changed from 12.2 mlU/ml (range 1.0–33.0 mlU/ml) at baseline to 5.4 mlU/ml (range 0.7–24.2 mlU/ml; P<0.05). During the following 3 months without enalapril treatment, an increase in hematocrit was noted, reaching 51.7% (range 46–58%; P<0.05). No serious side effects of enalapril were observed during the study, but there was a need to reduce other hypotensive drugs in some patients. Serum creatinine did not change significantly during enalapril therapy (1.49 mg/dl, range 0.9–2.3 mg/dl, and 1.55 mg/dl, range 1.0–2.3 mg/dl; before and after 3 months of therapy, respectively). Our study proves that enalapril can be safely and effectively used to treat posttransplant erythrocytosis. The effect of enalapril on red cell mass results from reducing erythropoietin production.Hypoxia
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This prospective study was carried out to estimate the efficacy and safety of Enalapril therapy in post-transplant erythrocytosis. Thirteen long-term renal allograft recipients (11 males and two females) with increased hematocrit values (>51%) and elevated red cell mass were treated with Enalapril for 12 weeks; their age ranged from 18 to 54 years. At the end of the study period the mean hematocrit values decreased from 53.9% to 46.7%, red cell mass significantly decreased from 50.8 ml/kg to 40.5 ml/kg. During the following six months without Enalapril treatment, an increase in hematocrit was observed reaching a mean of 47.5%. In conclusion, enalapril can be safely and efficiently used to treat post-transplant erythrocytosis.
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Goal: to examine the level of erythropoietin among patients with diabetes mellitus type 1 (DM 1) and different types of anemia and stages of diabetic nephropathy. Materials and methods: erythropoietin level analysis were conducted among 121 patients with DM 1 with and without anemia. Results: patients suffering from DM type 1 with anemia for less than 5 years have higher erythropoietin rates, than those who have DM for 5-15 years and longer time. Patients who suffer from DM for more than 15 years have the same erythropoietin rates regardless of the fact if they also have anemia or not. DM patients with anemia experience the decrease of erythropoietin level as far as Chronic Kidney Disease (CKD) is progressing. This decrease becomes statistically significant among patients with CKD of the 3, 4, and 5 stages (in comparison with patients without diabetic nephropathy (p=0,00)). Patients with Anemia Chronic Disease (ACD) and CKD have the same erythropoietin rates as patients without anemia (p=0,93 and p=0,40). Conclusion: The longer patients suffer from DM 1 and the CKD progress, the more the level of erythropoietin is going down. At duration DM 1 more than 15 years level of erythropoietin at patients DM with anemia corresponds to level of erythropoietin at patients without anemia. Patients with ACD don't have correlation of level of hemoglobin with erythropoietin. Where there is ACD, no hemoglobin-related increase in erythropoietin level is observed (which can be the reason of its appearance and advance). Patients with iron deficiency anemia, have elevating the level of erythropoietin despite an appreciable lesion of function of kidneys.
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Serum MK‐422 and plasma angiotensin converting enzyme activity were measured during the introduction of enalapril therapy in eight patients with heart failure. In a second study of 16 patients, we recorded exercise tolerance, clinical status and haemodynamics before and after 12 weeks of placebo or enalapril treatment. Increasing doses of enalapril gave step‐wise increments in serum MK‐422. Plasma converting enzyme activity remained low for at least 24 h after each dose of enalapril (5, 10 and 20 mg). Compared to placebo patients (n = 8), those receiving enalapril (n = 8) tended to improve their exercise performance and clinical status, and showed a fall in right heart pressures after 12 weeks of treatment.
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Background: Reticulocyte production index (IPR) is used to determine the classification of functional anemia. More specific laboratory parameters are used in managing patient. There were some inappropriate of IPR correlation with the diagnosis of anemia in clinical practice. Objectives: The study was designed to know normal hematocrit in Sardjito General Hospital, to determine IPR in various anemia and to compare with standard IPR and final diagnosis in anemia. Methods: Observational study was done in patients with anemia who whole blood examination in uderwent Clinical Pathology Laboratory on January 2001 until May 2002. Reticulocyte and hematocrit examination were performed before treatment. Patients were followed until. The diagnosis of anemia was established based on the clinical manifestations and laboratory results. Normal mean calculated hematocrit was based on age and sex. IPR was calculated based on standard hematocrit (45%) and mean normal hema-tocrit. Results: The normal mean hematocrit in male, female, children and infant were 43%, 39%, 40% and 48%, respectively. There was significant difference between the 2 formulas. The concordance of IPR determination in hipoproliferative anemia and maturation defects were 100%, in hemolytic/hemorrhagic anemia and maturation defect was 23,5%. The IPR of hypoproliferative anemia and maturation defect anemia differed significantly with haemolytic/ hemorrhagic anemia. IPR determination using factual hematpcrit show a better correlation with classification of functional than using standard hematocrit of 45%. Conclusion: IPR determination based on normal calculated hematocrit mean gave more benefit in increasing the correlation with classification of functional anemia. IPR value showed inappropriate result in hemolytic/hemorhagic anemia probably due to comorbidities. Key words : IPR - functional clasification anemial - anemia - normal calculated hematocrit
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End-stage renal disease (ESRD) typically is associated with severe anemia. The major contributor to the anemia appears to be the absolute or relative deficiency of erythropoietin (EPO) production by the kidney. A series of clinical trials have been conducted in the United States using recombinant human EPO (rh EPO) to treat anemic patients with ESRD. The encouraging results of the Phase I-II clinical trials have been confirmed in a multicenter trial in which over 250 patients have been treated. The results indicate that rh EPO can effectively correct the anemia of ESRD and the rate of correction is dependent upon the initial dose given. The rHuEpo was well tolerated, produced few or no direct side effects, and was effective in greater than 95 percent of the patients. rh EPO should have a major role in the correction of the anemia of ESRD and contribute significantly to the rehabilitation of such patients.
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Abstract: Objective: To study the outcome of high dose erythropoietin (EPO) therapy in the elderly with the unexplained anemia Patients and Methods: The 60-year old or older participants with the unexplained anemia are treated with weekly subcutaneous injection of erythropoietin (EPO), seven with 30,000 units of beta-EPO (Recormon®) and one with 40,000 units of alpha-EPO (Eprex®). Results: There are eight patients with mean age of 72.4 + 8.2 years. Every case has complete recovery within 4-16 weeks, mean of hemoglobin level is raised from 9.9 + 0.6 g% to 13.2 + 0.6 g%. Four from seven (57.1%) participants of Recormon group respond well within the first four weeks. No side effect or complication is detected. Conclusion: High dose EPO can correct the unexplained anemia in all elderly people within 4-16 weeks. Key words: Erythropoietin, Unexplained Anemia of the Elderly บทคดยอ วตถประสงค : ศกษาผลการรกษาภาวะโลหตจางไมทราบสาเหตในผสงอายดวย erythropoietin (EPO) ความเขมขนสง ผปวยและวธการ : ผปวยอายมากกวา 60 ป ทมภาวะโลหตจางไมทราบสาเหตไดรบการรกษาดวยการฉด EPO เขาใตผวหนง โดย 7 ราย ฉดดวย beta-EPO (Recormon®) 30,000 หนวย อก 1 ราย ฉดดวย alpha-EPO (Eprex®) 40,000 หนวย ทกสปดาห ผลการศกษา : ผปวยทง 8 ราย อายเฉลย 72.4 + 8.2 ป ทกรายหายจากภาวะโลหตจางภายใน 4-16 สปดาห, ระดบ hemoglobin เฉลยเพมจาก 9.9 + 0.6 g% เปน 13.2 + 0.6 g% โดยผปวย 4 ใน 7 รายจากกลม Recormon (รอยละ 57.1) หายภายใน 4 สปดาหแรกของการรกษา ไมพบผลขางเคยง หรอภาวะแทรกซอนใด ๆ สรป : EPO ขนาดสงทำใหผสงอายทมโลหตจางไมทราบสาเหตทกรายหายได ภายใน 4-16 สปดาห คำสำคญ : erythropoietin, ภาวะโลหตจางไมทราบสาเหตในผสงอาย
Epoetin alfa
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