Background: In chronic kidney disease(CKD), renal dysfunction is associated with a loss of nocturnal blood pressure(BP) reduction. However, it remains unclear about the circadian rhythm of BP in CKD with hypoalbuminemia resulting from urinary protein excretion. We evaluated the relationship between the circadian BP rhythm and serum albumin level(S-Alb).
Methods: Non-diabetic CKD patients without progressive renal dysfunction(serum creatinine level<1.5mg/dl) were divided into two groups, based on S-Alb: nephrotic syndrome(NS) group(less than 3.0g/dl; n=30) and Hypoalbuminemia group(3.0 to 4.0g/dl; n=32). Age and sex-matched normal subjects with normal albumin level(more than 4.0g/dl; n=32) were enrolled as Control group. Ambulatory 24-hour BP monitoring was conducted in all subjects.
Results: There were no significant differences in 24-hour BP among three groups. However, sleeping/waking mean BP ratios were significantly increased gradually in the Control, Hypoalbuminemia and NS groups, in that order(0.85±0.07, 0.91±0.08, 0.96±0.08, respectively; p<0.05 for respective two groups). A significant reverse correlation was observed between S-Alb and sleeping/waking ratio of mean BP(r=−0.58; p<0.001).
Conclusion: In non-diabetic CKD patients, loss of nocturnal BP reduction occurred even in the early stage, correlating with S-Alb.

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Acute aortic syndrome is responsible for an over-production of inflammatory cytokines, due not only to the bodily onslaught brought about by its clinical condition, but also to the development of systemic inflammatory response syndrome(SIRS), leading to the onset of multiple organ failure and difficulties in postoperative management. In the current study, the efficacy of Sivelestat sodium, a neutrophil elastase inhibitor, was evaluated on sequential organ failure assessment(SOFA) after emergency surgery in acute aortic syndrome. The subjects were 21 patients who developed acute aortic syndrome and underwent emergency surgery between August 2006 and December 2007. Starting the administration of Sivelestat sodium before surgery to patients with acute aortic syndrome could reduce the augmentation of inflammatory mediator and factors related to the coagulation-fibrinolysis system. Although SOFA score and lung injury scores were not significantly different between pre-operative and post-operative use of Sivelestat sodium, DIC was significantly suppressed in the pre-operative use of Sivelestat sodium were effectively suppressed in the pre-operative use as compared with the post-operative use. It is suggested that pre-operative initiation of Sivelestat sodium may be effective for organ protection in acute aortic syndrome.

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A 62-year-old female was diagnosed of spinocerebellar degeneration four years previously. She was admitted to our hospital because of congestive heart failure. Echocardiography revealed severe aortic regurgitation and computed tomography showed dilatation of the sinus of Valsalva. She received aortic root replacement. Anesthesia was induced with fentanyl, propofol and vecuronium, maintained with propofol and remifentanil. There was no sign of postoperative exacerbation of neurological findings. She was discharged uneventfully 12 days after the operation.

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A 38-year-old woman underwent bilateral adnexectomy and partial omentectomy procedures for diagnosed ovarian cancer, and developed anaphylactoid shock after administration of 5% human serum albumin(HSA). She had no history of drug or food allergic reactions, nor any previous blood transfusions. Immediately after 5% HSA transfusion, blood pressure dropped to 60/35 mmHg and heart rate increased to 100 bpm. On the basis of her clinical course, we concluded that albumin had induced anaphylactoid shock. Consequently, we discontinued the albumin product transfusion and administered epinephrine, after which the symptoms improved. The concentration of plasma tryptase was remarkably elevated to 64.1μg·l^－1 at 1 hour after the occurrence of symptoms.

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