Summative

Good Luck!

Ben Luke & Evelyn

Clarifications on ACE Inhibitors

Sorry this is a bit late. Mr Benny Efendie emailed me with some clarifications from his lecture, I'm pasting the relevant parts directly from the email :

Actually proposed mechanisms of ACEI reducing proteinurea is because they reduce the pressure on glomerulus, so minimizing the damage and also recent studies reveal that they may reduce mesangial cell growth and matrix production which contribute to the proteinurea.
This is the positive side of ACEI/ARB.

But at the same time they will cause decrease in GFR, and then acute renal failure or deterioration of renal failure. This drug-induced nephropathy is likely to occur if the patient already has risk factors, like hypovolaemia or already got severe renal failure, or bilateral renal artery stenosis (unilateral is still ok, not too bad) or using other concurrent nephrotoxic drugs like NSAIDs. And contraindication here is more for patients with renovascular disease, not other type of renal diseases. This is the negative side of ACEI/ARB.

In conclusion: as in other drugs, ACEIs are like a double-edged sword, doctors must weigh the risk and benefit before prescribing them. According to BNF 55 (latest version): For Captopril, the dosage must be reduced according to the degree of renal impairment.

max. initial dose 25 mg daily (do not exceed 100 mg daily) if creatinine clearance 20*40 mL/minute;
max. initial dose 12.5 mg daily (do not exceed 70 mg daily) if creatinine clearance 10*20 mL/minute;
max. initial dose 6.25 mg daily (do not exceed 37.5 mg daily) if creatinine clearance less than 10 mL/minute

Below is the explanation about ACEI and proteinurea from the Goodman & Gilman pharmacology:

Diabetes mellitus is the leading cause of renal disease. In patients with type 1 diabetes mellitus and diabetic nephropathy, captopril prevents or delays the progression of renal disease (Lewis et al., 1993). Renoprotection in type 1 diabetes, as defined by changes in albumin excretion, also is observed with lisinopril (Euclid Study Group, 1997). The renoprotective effects of ACE inhibitors in type 1 diabetes is in part independent of blood pressure reduction. Specific renoprotection by ACE inhibitors is more difficult to demonstrate in type 2 diabetics, with some studies providing positive results (Ravid et al., 1993, 1996, 1998), whereas others do not demonstrate blood pressure-independent renoprotection (Brenner and Zagrobelny, 2003). In addition to attenuating diabetic nephropathy, ACE inhibitors also may decrease retinopathy progression in type 1 diabetics (Chaturvedi et al., 1998). ACE inhibitors also attenuate the progression of renal insufficiency in patients with a variety of nondiabetic nephropathies (Maschio et al., 1996; GISEN Group, 1997; Ruggenenti et al., 1998, 1999b; Kshirsagar et al., 2000; Praga et al., 2003) and may arrest the decline in GFR even in patients with severe renal disease (Ruggenenti et al., 1999a).

Several mechanisms participate in the renal protection afforded by ACE inhibitors. Increased glomerular capillary pressure induces glomerular injury, and ACE inhibitors reduce this parameter both by decreasing arterial blood pressure and by dilating renal efferent arterioles. ACE inhibitors increase the permeability selectivity of the filtering membrane, thereby diminishing exposure of the mesangium to proteinaceous factors that may stimulate mesangial cell proliferation and matrix production, two processes that contribute to expansion of the mesangium in diabetic nephropathy. Since angiotensin II is a growth factor, reductions in the intrarenal levels of angiotensin II may further attenuate mesangial cell growth and matrix production.

Happy Studying

Ben Luke

Dr Srikumar's Lecture

Dr Srikumar's Lecture today is Obstructive Uropathy and not Cystic Diseases. Cystic Diseases will be given tomorrow.

Ben Luke

Drugs and the Kidney Lecture Slides

I emailed Mr Benny Efendie to request him to put up the slides into the appropriate folder but he replied saying that he is in GHKL this morning and would not be able to do so. Nevertheless, he emailed me the slides which I have passed to IT and they will upload them into the RENAL folder before 1.00pm.

Alternatively, the slides for the lecture he gave in June 2007 (that's M205) are in the Pharmacy Lecturers Folder for those who cannot wait.

Ben Luke

Alumni Talk

There will be a talk by IMU Alumni who are currently studying in University of Edinburgh and University of Southampton. The details are as follows:

Date: Thursday, 19th June
Time: 12PM to 2PM
Venue: LT3.
Refreshments served

If you are interested in attending, please leave a comment or come see me by Tuesday.

PS. Pre Matching Forms due tomorrow.

Ben Luke

Pre Matching II

Evelyn and I have distributed most of the forms today, if you have not gotten yours, do get them from us. The deadline is next Monday the 16th of June 2008.

Some additional information about Matching :

1. The University of Auckland will not be accepting non-Malaysians from IMU.

2. According to information from AAD at this point in time, it looks like Calgary is not in the list of PMS for M206.

3. The University of Nottingham is in the list for our Matching.

Points 2 and 3 are reflected in the Pre Matching Form.

This is our second Pre Matching and we will be doing our final one a week before the real Matching.

Have fun filling up the form and give it back to me on by Monday!

PS. According to Dr Annie Tay, her lecture tomorrow will be up in the I:Drive tomorrow morning.

Ben Luke

Alumni Talk - Canada and the United States

An IMU Alumni from Dalhousie University, Dr Tai Ken Lin will be in IMU tomorrow to give a talk. 

Dr Tai is due to start her Internship in New York next month and will continue with her Residency in Preventive Medicine and Public Health next year in The Johns Hopkins University.

Details of the talk :

Venue : SR3

Time : 12.00pm - 2.00pm

Lunch will be provided.

To those interested in going to Canada or the US / taking the USMLE / doing postgraduate studies in Public Health, I would highly encourage you to go.

See you there.

Ben Luke

Histopathology Lab

Please be informed that the Histopathology Lab sessions for the last week of the Renal System have been canceled, fortunately [Yay! More time to study!!!] or unfortunately [But I need more Histopath...], depending on how you see it.

I will most probably hold a second Pre-Matching this week, be ready.

To Dr Sushela Devi's Tutees/Mentees, she wants to see you guys this week, please set up a meeting with her.

PS. Opinions in the square brackets are not necessarily my own, just an opinion on what people may think.

Ben Luke

Polls, IMS & ECA Briefing

Please be reminded that the Polls sheet for the Convocation magazine is due tomorrow, 6th of June 2008. You do not have to fill up all the spaces but do try your best to. A box will be put in front of the Audi for you to put your sheet into so be assured of the confidentiality of your choices.

For the people whose names I announced in relation to the Integrated Medical Seminar, Professor Jai Mohan will be briefing us after Professor Hla Yee Yee's lecture tomorrow at 5.15pm. To those that have been chosen, your attendence is compulsory, fortunately or unfortunately, depending on how you see it.

For the rest, May Kuan from the Student Affairs Department will be giving a talk about how to fill in your Extra Curricular Form in preparation for the end of Phase 1 at the same time. Do note that it does not matter if you are headed for the Clinical School or a Partner Medical School, you will have to fill in the form either way. So, do attend.

Ben Luke

Parking

The Roadworks Department needs to retar the road between IMU and Vista Komanwel. Please refrain from parking there for at least the next 2 days until they are done.

Ben Luke

ME/DT108 Buddies

For those who signed up to be buddies for ME/DT108, I hope you already wrote down your contacts on the boards in the Atrium when they were up.

The first meeting will be held this Wednesday, the 4th of June (which is also the deadline for the Reproduction AIR Topic) from 1.00pm - 2.30pm. Drinks and light foods will be served.

See you there.

Ben Luke