Atrial natriuretic peptide(Beijing SL Pharmaceutical)

A 16-year-old Japanese male diagnosed with congestive heart failure (CHF) due to dilated cardiomyopathy was treated by conventional intensive treatment such as intravenous infusion of diuretics, catecholamines, and phosphodiesterase inhibitors with vasodilators. However, he developed a low output syndrome with appearances of hyponatremia and hypochloremia. As a consequence, intravenous infusion of carperitide (synthetic atrial natriuretic peptide) was added to the therapy. Thereafter his symptoms and hemodynamic parameters promptly and dramatically improved without significant diuresis, and this amelioration persisted for more than 20 days without drug intolerance. This outcome suggests that use of carperitide may be a safe and efficacious means to reduce cardiac preload without hypotension and tachycardia in patients with refractory CHF in whom intensive treatment has already been performed.

Acute renal failure (ARF) occurs frequently in hospitalised patients, and is associated with significant morbidity and mortality. The most common and generalised forms of acute renal failure are pre-renal conditions and intra-renal acute tubular necrosis (ATN). Pre-renal ARF in its pure state should be entirely reversible by restoring renal perfusion, but in some cases ATN has already occurred. ATN remains a more vexing problem, and is seen most often with hypotension, perioperative or systemic inflammatory stresses, radiocontrast administration, and exposure to nephrotoxins. Among the available pharmacological options for prevention or treatment of ATN, there is a remarkable lack of definitive evidence supporting specific therapy in any setting. Although loop diuretics, mannitol, and dopamine are frequently used for prevention and/or treatment of ATN, clinical studies have failed to prove value. Other drugs with theoretical value, specifically atrial natriuretic peptide analogues, adenosine blockers, and calcium antagonists, have been insufficiently studied to recommend use. Other pharmacological options may arise in the future. Ensuring adequate intravascular fluid volume remains the only approach to managing ATN which can be considered relatively effective and safe. Given the abundant theoretical basis for the prevention and treatment of ATN with drugs, well conducted clinical studies with relevant outcome measures are clearly warranted.