rifampin and Diabetic-Nephropathies

Esaxerenone is a novel, non-steroidal mineralocorticoid receptor (MR) blocker with improved selectivity and affinity for MR. The objectives of this study were to model the population pharmacokinetics of esaxerenone in a diverse population and to evaluate the effect of covariates on pharmacokinetics parameters.. A total of 8263 plasma esaxerenone concentrations from 166 healthy volunteers, 1097 hypertensive patients and 360 patients with diabetic nephropathy were pooled. A three-compartment model with sequential zero- and first-order absorption was used to describe the time-courses of plasma esaxerenone following single and multiple doses once daily for up to 12 weeks. Covariate effects were estimated using the full covariate modeling approach. Clinical relevance of covariates was ascertained using tornado plots.. Esaxerenone was estimated to have high bioavailability (85.3%), low clearance (3.28 L/h) and relatively large distribution volume at steady state (94.8 L). Body weight (-26 to +36%) and coadministration of itraconazole (+64%) or rifampicin (-68%) were associated with a greater influence on esaxerenone exposure.. The most influential covariates on esaxerenone exposure were coadministrations of itraconazole and rifampicin, followed by body weight. The clinical relevance of effects of renal impairment, mild to moderate hepatic impairment, and age is limited.

Topics: Body Weight; Diabetes Mellitus; Diabetic Nephropathies; Essential Hypertension; Healthy Volunteers; Humans; Itraconazole; Receptors, Mineralocorticoid; Rifampin

Though pulmonary tuberculosis (TBC) remains the commonest clinical presentation, extrapulmonary TBC is an increasingly important clinical problem. Among the extrapulmonary sites, primary liver tuberculosis seems to be an extremely rare location. Fewer than 100 cases of TBC hepatic abscesses have been reported whereas most of them have been originated from other sites, usually the lung and the gastrointestinal track. Therefore, in the absence of any particular symptom this infrequent location may lead to a delayed or missing diagnosis. The present study reports the difficulties in early diagnosis of an extrapulmonary TBC case, as it happened to a 53-year-old man with diabetic nephropathy who started on regular hemodialysis for 5 months. In such "atypical presentations" the clinicians should bear in their mind the possibility of the TBC occurrence, which usually responds well to the conventional antituberculous therapy.

Topics: Diabetic Nephropathies; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Mycobacterium tuberculosis; Pyrazinamide; Renal Dialysis; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Hepatic

Topics: Aged, 80 and over; Anti-Bacterial Agents; Cardiology; Daptomycin; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Endocarditis, Bacterial; Female; Humans; Incidental Findings; Interdisciplinary Communication; Lung Neoplasms; Medical Oncology; Pacemaker, Artificial; Patient Care Team; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Radiography; Referral and Consultation; Rifampin; Streptococcal Infections; Streptococcus sanguis; Thoracic Surgery