Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 61-year-old man suffering from active generalized scleroderma developed pemphigus foliaceus after 9 months of D-penicillamine therapy, 900-1200 mg daily. At the same time, he developed proteinuria. Upon discontinuation of the drug, the proteinuria quickly resolved, but the bullous disease was still active one year later, with development of fresh blisters and intercellular deposits of immunoglobulin G and complement C3. The theory is proposed that D-penicillamine alters the epidermal cement substance, rendering it antigenic and thus initiating a vicious circle.
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PMID:Penicillamine-induced pemphigus foliaceus. 7 71

In 6 of 24 courses of a disease a nephrotic syndrome appeared under the application of penicillamine. An acute renal failure with exitus letalis developed under the penicillamine therapy of a scleroderma. In the treatment of a mercurial poisoning by penicillamine the nephrotic syndrome increased to a proteinuria of 50 g/24 hours which receded after discontinuation of the remedy. In one group of patients with chronic pyelonephritis could be demonstrated that penicillamine in a primarily damaged kidney must not lead to a secondary glomerular lesion. These findings led to the conclusion that in the appearance of a proteinuria under penicillamine a strong observation of the renal function is necessary, if a continution of the therapy is given from vital indication.
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PMID:[Penicillamine-induced glomerulonephritis]. 84 41

We conducted a retrospective study of 86 patients with systemic sclerosis (SSc) to clarify the initial predictors of survival at the first visit to the hospital. A life-table analysis of survival was performed concerning 137 items from their histories, physical examinations, and laboratory data. The observed cumulative survival rates were 78.0 percent at 5 years and 68.2 percent at 10 years. Ten items were found to be the initial predictors of survival in patients with SSc. Of these 10 items, 9 items showed significant differences within 5 years of the first visit to the hospital. Patients with resting electrocardiographic abnormalities, such as atrial or ventricular arrhythmias, or conduction disturbances, pulmonary fibrosis on the chest x-ray films, or decreased vital capacity had significantly lower survival rates. However, patients with anti-centromere antibody had a significantly better survival rate. In addition, males, aged patients over 65 years old, and patients with proteinuria, leucopenia, or hypergammaglobulinemia had significantly lower survival rates. Only patients with proximal scleroderma at the first visit to the hospital had a significantly lower survival rate after 8 years. These results are useful in predicting individual patients at risk of shortened survival and in managing these patients.
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PMID:Initial predictors of survival in patients with systemic sclerosis (scleroderma). 143 8

The renal impairments were studied clinicopathologically in 57 patients with progressive systemic sclerosis (scleroderma). Proteinuria, hematuria, azotemia and hypertension, used as markers for renal involvements, were observed in 3 (5.3%), 4 (7.0%), 2 (3.5%) and 6 patients (10.5%) respectively, at the initial examination. Hypertension was increased 2.6 times at the last observation, although the incidence of other three markers have not changed during the follow-up period. Finally, 17 out of 57 patients (29.8) revealed more than one of these clinical markers throughout the study. The decrease of GFR (CThio) was noticed in 3 out of 36 cases (8.3%), however that of RPF (CPAH) in 11 of 36 patients (30.6%), including 5 without abnormal clinical markers. Histological studies were performed in 12 patients. One showed crescentic glomerulonephritis, two membranous nephropathy, and the remaining 9 minor glomerular abnormalities. On the other hand, the vascular changes such as intimal proliferation of interlobular arteries were frequently observed. The frequency of pulmonary involvements, skin ulcer and gastro-intestinal involvement in the patients with renal lesions were not significantly different from that of the non-renal group. The level of RPF was significantly lower in the patients with skin ulcer than that of those without skin ulcer. No significant difference was noticed in the frequency of renal involvements between the patients with or without anti-Scl-70 antibody.
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PMID:[Clinicopathological studies of renal disorders in patients with progressive systemic sclerosis]. 174 19

Adverse effects of converting enzyme inhibitors are either substance-specific (neutropenia, proteinuria, skin rashes, taste disturbances) or due to the converting enzyme inhibition (hypotension, functional renal insufficiency, hyperkalemia, cough, angioedema). They are rare nowadays because of better knowledge of the pharmacokinetics and -dynamics of the converting enzyme inhibitors, resulting in lower dosage, and because of identifying patients at high risk. The dosage must be adjusted according to renal function, in order to prevent accumulation and toxicity. In addition to patients with renal insufficiency, patients at high risk are those with a stimulated renin-angiotensin-aldosterone system, i.e. patients with renovascular hypertension or heart failure. Patients with collagen vascular disease, for example, systemic lupus erythematosus or scleroderma, should not be considered for long-term therapy with converting enzyme inhibitors because of the increased risk of neutropenia. Life-threatening angioedema may develop, mainly during the first few hours after drug administration.
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PMID:[Angiotensin-converting enzyme inhibition: side effects and risks]. 285 Jun 87

Since their introduction in clinical practice in 1980, ACE inhibitors have been found useful in the treatment of hypertension and CHF. In hypertension, they are effective as monotherapy in 40% to 50% of the patients, and in combination with diuretics or calcium antagonists, they are effective in up to 85% of the patients. They are well tolerated, are not associated with depression, impotence, bronchospasm or metabolic derangements such as hypokalemia, hyperuricemia or hyperglycemia, and do not have adverse effects on the quality of life. As a result, they are preferred in hypertensive patients with CHF, left ventricular dysfunction, mental depression, older age, coronary artery disease, metabolic disorders, chronic destructive pulmonary disease, and peripheral vascular disease. In CHF they cause long-lasting hemodynamic and symptomatic improvement, improve exercise tolerance, and may lower mortality in certain patient subsets. Evolving new indications for ACE inhibitors include the diagnosis of renovascular hypertension, the prediction of surgical success, the treatment of scleroderma renal crisis, the reduction of proteinuria, renal protection, cardioprotection, the improvement of arterial compliance, in Bartter's syndrome and idiopathic edema, etc. ACE inhibitors are usually well tolerated but in some instances they may cause class-specific side effects such as hypotension; usually reversible azotemia or renal failure, especially in patients with renal artery stenosis or with CHF with low blood pressure; cough; angioedema; and hyperkalemia. Differences among ACE inhibitors are emerging and include chemical class (e.g., zinc ligand), biotransformation, potency, pharmacokinetics, prodrugs, tissue effects, additional pharmacologic properties, and drug interactions.
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PMID:Angiotensin converting enzyme inhibitors. II. Clinical use. 305 46

Captopril is an orally active inhibitor of angiotensin-converting enzyme (ACE) and has been widely studied in the treatment of patients with mild to moderate essential hypertension, severe hypertension not responsive to conventional diuretic/beta-adrenoceptor blocker/vasodilator regimens, and patients with chronic congestive heart failure refractory to treatment with a diuretic and digitalis. In patients with mild or moderate essential hypertension, titrated low doses of captopril used alone or in conjunction with a diuretic are similar in efficacy to usual doses of hydrochlorothiazide, chlorthalidone, or beta-adrenoceptor blocking drugs, as well as to the other ACE inhibitors. In addition, captopril improved well-being to a greater extent than methyldopa or propranolol in a study designed specifically to determine the effect of treatment on the quality of life of patients with mild or moderate essential hypertension. The earlier demonstrated efficacy of captopril, used with a diuretic and often also with a beta-adrenoceptor blocking drug, in the treatment of severe hypertension refractory to conventional 'triple therapy' has been confirmed in more recent trials which illustrate the generally marked antihypertensive effect of captopril-containing regimens in such patients. Results of initial trials in patients with scleroderma are promising, with control of hypertension and stabilization of renal function in these patients when treated at an early stage of the disease. Several comparative and long term trials of captopril in patients with chronic congestive heart failure refractory to treatment with a diuretic/digitalis regimen clearly demonstrate that initial haemodynamic improvement is maintained and correlates with clinical benefit. A tendency for overall clinical response to captopril to be better than the response to prazosin, hydralazine, nisoldipine or enalapril has been reported. Results of a multicentre comparison with digoxin and placebo indicate that captopril is a suitable alternative to digoxin in patients with mild to moderate heart failure who are receiving maintenance diuretic therapy. The tolerability of captopril has now been studied in many thousands of patients involved in formalized trials and the early impression of poor tolerability can no longer be justified. The use of generally lower dosages of captopril in patients with normal or slightly impaired renal function has resulted in a generally low incidence of rash (0.5 to 4%), dysgeusia (0.1 to 3%), proteinuria (0.5%), neutropenia (0.3% during first 3 months) and symptomatic hypotension (0.1 to 3%). Cough is an infrequent but troublesome effect resulting from ACE inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Captopril. An update of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. 306 99

The main clinical, biologic, immunologic and morphologic changes characteristic of the sclerodermic nephropathy have been investigated during a mean period of 3.8 years in 21 patients with scleroderma, 19 women and 2 men, with a mean age of 36.1 years. The results obtained have revealed the frequent (38.1%) and early renal involvement, with constant arteriolar and glomerular lesions. Proteinuria was the most frequent (28.6%) and early sign of renal damage. The urinary sediment was poor and the immunologic investigations unconclusive. Dosage of urinary proteins by sensitive techniques (immunoquantitation) and renal biopsy have proved to increase the accuracy of studies for the detection of sclerodermic nephropathy in its initial stage.
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PMID:The renal involvement in scleroderma. A clinical and morphologic study. 380 61

The occurrence of renal scleroderma (RSc) was sought retrospectively in 36 consecutive patients with scleroderma, seen in a single rheumatology unit, over a 12-year period. The diagnosis RSc was considered when at least one of the following findings was present: systolic blood pressure greater than or equal to 95 mmH, proteinuria greater than or equal to 0.5 gr/24 hr., and creatinine clearance less than or equal to 50 ml/min.: at least one of these features was found in 16 patients. Hypertension was the most frequent feature of RSc (15 out of 16 patients). Two forms of hypertension were observed. Firstly: malignant hypertension occurring early in the course of RSc, seen in 5 patients, 4 of whom rapidly developed terminal renal insufficiency. Secondly: a moderate hypertension, seen in 10 patients with a more favourable outcome, occurring on average 53 months after the diagnosis of scleroderma was made. Proteinuria was only seen in association with malignant hypertension. Renal impairment occurred in 7 patients. Of the 36 patients with scleroderma, 14 died; 10 of these 14 patients had RSc. Thus the death rate in patients with RSc was very high, whereas only 4 out of 20 died in the group without RSc.
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PMID:Renal scleroderma, value of clinical markers. 408 59

A new case of the rare association of scleroderma and pregnancy is reported. The pregnancy was complicated by renal failure in the last month of gestation which was initially well controlled by anti-hypertensive therapy but then suddenly progressed to pre eclampsia with signs of foetal distress necessitating emergency caesarian section. A moderately hypotrophic child was delivered. The mother progressively recovered; diuresis and blood pressure returned to normal and the proteinuria disappeared. In the light of previously reported cases and of recent advances in our knowledge of scleroderma, especially scleroderma renal disease, the authors discuss their attitude to the management of women with scleroderma wishing to become pregnant. They review the role and place of renal biopsy in the detection of subclinical renal lesions due to the scleroderma, the presence of which would be a decisive factor in assessing the risks of pregnancy. Scleroderma renal disease is, in fact, a major contraindication to pregnancy because of the very poor foetal prognosis and the risk of maternal death due to a lethal progression of renal failure.
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PMID:[Scleroderma and pregnancy. New case and review of the literature]. 650 47


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