The successful use of phosphodiesterase type 5 inhibitors to treat the syndrome of cor pulmonale and prerenal azotemia with diuresis of anasarca (CorPRADA).
BACKGROUND
The occurrence of deteriorating renal function test results along with the attempts at diuresis of anasarca has been described but not named, and no solution other than the standard treatment of related medical conditions such as congestive heart failure (CHF) and reducing or stopping diuretics has been offered. Phosphodiesterase type 5 inhibitors (PD5I) are known to reduce pulmonary hypertension (PH). The PD5Is sildenafil and, just recently, tadalafil, have FDA indications in primary pulmonary hypertension (PPH).


METHODS
In this observational study of CorPRADA patients treated with PD5I, 12 out of 19 cases met criteria for inclusion in statistical analysis. Medication reductions/discontinuations generally were made. Pre- and post-treatment data were analyzed using matched pairs.


RESULTS
There were significant improvements in edema, glomerular filtration rate (GFR), weight, and loop diuretic dosage required, while strong trends were seen in urine output per day and urine output per unit loop diuretic per day.


CONCLUSIONS
The identification of CorPRADA and the use of standard treatments for PH plus PD5I medication show promise in achieving successful diuresis of anasarca while stabilizing or improving renal function simultaneously.
Berez
Paul Bruce
PB
Anne Arundel Medical Center, Annapolis, MD, USA. BerezDanielPA@aol.com
D053099:Azotemia / Q000188:drug therapy*; D001794:Blood Pressure / Q000187:drug effects; D002243:Carbolines / Q000008:administration & dosage / Q000627:therapeutic use*; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004487:Edema / Q000188:drug therapy*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D011660:Pulmonary Heart Disease / Q000139:chemically induced / Q000188:drug therapy*; D011687:Purines / Q000008:administration & dosage / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use*; D000068581:Tadalafil
D002243:Carbolines; D004232:Diuretics; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068581:Tadalafil; D000068677:Sildenafil Citrate