Masatoshi Fujishima

Pharmacokinetics of a new angiotensin I converting enzyme inhibitor (delapril) in patients with deteriorated kidney function and in normal control subjects

Pharmacokinetic properties of a new angiotensin‐converting enzyme inhibitor, delapril (CV‐3317), which converts to two active metabolites (M‐1 and M‐2) and one inactive metabolite (M‐3) after oral administration, were investigated in six subjects with normal, 10 subjects with slight (SRF), and six subjects with markedly (MRF) deteriorated kidney function. The elimination half‐life of M‐1 was prolonged significantly in subjects with MRF and that of M‐3 was also prolonged in subjects with SRF or MRF. The peak plasma drug concentration, time to reach peak concentration (tmax), and AUC were significantly larger in subjects with SRF and MRF than in normal subjects, except for Tmax in subjects with SRF. In M‐2 and unchanged delapril, no difference was observed. The 24‐hour cumulative urinary excretion of those metabolites was significantly lower in subjects with MRF than in normal subjects. Plasma angiotensin‐converting enzyme activity, suppressed at 4 hours in all subjects, remained significantly low in patients with MRF at 24 hours. Blood pressure was reduced more in subjects with chronic renal failure. It was concluded that delapril is excreted mainly through the kidney and its pharmacodynamics and biologic effects are affected by the renal dysfunction.

A case of chronic renal failure with ruptured aneurysm of the sinus of Valsalva treated by open heart surgery

Valsalva洞動脈瘤破裂は大動脈基部のValsalva洞が下外方に拡大突出し破綻する比較的稀な疾患である. 我々は本症を合併した慢性腎不全症例を経験した. 患者は44歳男, 昭和55年IgA腎症と診断され, 腎機能が低下傾向にあった. 昭和61年4月突然胸部圧迫感・労作時呼吸困難が出現, 連続性心雑音も認められ, 腎機能も急激に低下したため, 当科に入院した. クレアチニンクリアランスは6-8ml/minと比較的保たれていたが, 腎機能低下による心不全の増悪, ならびに心臓カテーテル検査・大動脈造影・開心術による腎不全の増悪の可能性を考慮し, 早期に血液透析に導入し, 根治術を施行し良好な結果を得た.