F-4-05-08
DISABILITY PREVENTION OF CHRONIC RENAL FAILURE: INTRODUCTION OF AN ANIMAL RENAL FAILURE MODEL TO THE STUDY OF REHABILITATION MEDICINE
Masahiro Kohzuki, Masahiro Kamimoto, Xue-Min Wu, Kazunori Yoshida, Mihoko Watanabe, Tokutaro Sato. (Section of Internal Medicine & Disability Prevention, Tohoku University Graduate School of Medicine, Sendai, Japan)
We assessed the renal benefits of antihypertensive drugs in rats remnant kidney model of chronic renal failure (CRF). Eight-week old spontaneously hypertensive rats (SHR) were subjected to 5/6 nephrectomy (NX). In SHR-CRF, systolic blood pressure (SBP), urinary protein excretion, or serum creatinine level all increased significantly when compared with those of sham-operated SHRs. One week after Nx, chronic effects of antihypertensive drugs on renal function were studied. An ACE inhibitor, cilazapril (CIL; lmg/kg/day p.o.) alone significantly decreased systolic blood pressure, urinary protein excretion, heart weight and serum creatinine, whereas a kinin receptor antagonist, icatibant (70μg/kg/day i.p.), alone for 4 weeks did not induce any significant changes in these parameters. CIL in combination with icatibant (7 and 70μg/kg/day i.p.) did not induce any additional changes in these parameters. Treatment with angiotensin converting enzyme inhibitors |ACEIs: captopril (50mg/kg/day p.o. ), ramipril (10mg/kg/day p.o. )1 or calcium channel blockers |CCBs: nilvadipine (10mg/kg/day p.o.), benidipine (6mg/kg/day p.o.) l for 12 weeks induced the significant reduction of SBP by the same degree in SHR-CRF. Despite the similar antihypertensive effects, deterioration of renal function and structure in this model was prevented with the ACEIs, but not with the CCBS. An angiotensin II receptor antagonist, Iosartan (LOS; 10 mg/kg/day i.p.), significantly attenuated the increase in SBP, urinary protein excretion. However, an ACEI, enalapril (6 mg/kg/day J.p.), did not modify the antihypertensive and renoprotective effects of LOS. These results indicate that the kallikrein-kinin system might not play major roles in the cardioprotective and renoprotective effects of ACE inhibitors in rats with CRF. ACEIs may have both hemodynamic and nonhemodynamic effects that protect against progressive renal injury. These results indicate that responses of this model to these drugs are very similar to those of human CRF. Studies using this model may offer insight into rehabilitation medicine, such as effects of exercise on renal function and optimun/forgiven exercise level.
F-4-06-01
Postoperative ADL in cervical spondylotic myelopahy
Chiaki Hamanishi, Seisuke Tanaka (Kinki University, Osaka, Japan)
To predict the postoperative goal of ADL training for the patients with multilevel cervical spondylotic myelopathy (CSM), postoperative transverse MR imaging (MRI), taken 3 months to 15 years after laminectomy, were analyzed in 22 patients. The patients were classified into the following three groups according to the patterns of asymmety and atrophy of the gray and white matter: elliptoid (6 patients), trigonal and asymmetrical (T&A, 10 patients), and flattened (6 patients). In all patients in the T&A group, unilateral lateral, posterolateral or posterior column were atrophic, and ipsilateral spastic motor paresis and sensory deficit remained in seven of them. In those with apparent hyperintensity of the unilateral gray matter on T2-weighted MRI, associated ipsilateral muscle weakness and atrophy still remained. In the postoperative rehabilitation of CSM, we should realize that the atrophic changes in the lateral or postero-lateral column indicate permanent ipsilateral hyper- reflexia, abnormal reflexes, sensory disturbances, posterior column atrophy indicate disturbed vibratory sensation, positive Romberg sign and gait disturbance, and that cystic change of the gray matter indicate permanent ipsilateral muscle atrophy. These postoperative transverse MRI findings should be taken into account for the estimation of physiotherapy and goal-setting of ADL training.
