Combination of clonidine and sotalol in hypertension.

Abstract

loin.His initially raised blood pressure soon returned to normal, and no other abnormal features were noted on physical examination.Investigations showed: haemoglobin 10-7 g/dl; leucocytes 6-8 x 109/1; platelets 169 x 109/1; sternal marrow, active haemopoiesis with no increase in plasma cells; blood urea 34 mmol/I (204 mg/100 ml); serum creatinine 1350 1mol/l (15 mg/ 100 ml); serum potassium 7-1 mmol/l (7-1 mEq/l); serum albumin 3-4 g/l; creatinine clearance 1 ml/min; and 24-hour urine output 150 ml.Serum electrophoresis in cellulose acetate was normal but immunoelectrophoresis of plasma and urine showed free kappa light chains.There was mild im- munoparesis (IgA 63 x I03 IU/l; IgG 81 x 103 IU/I; IgM 64 x 103 IU/1), and the serum complement (C3) was 1-58 g/l.Radiography showed a soft-tissue mass embracing the bodies of the eighth to tenth thoracic vert- brae.Bronchoscopy, mediastinoscopy, barium swallow, and skeletal survey were non-contributory.At thoracotomy two tumours were found in the posterior mediastinum.Histologically there was dense plasma cell infiltration with many binucleate and multinucleate cells.High-dose intravenous pyelography with nephrotomography showed poorly functioning, normal sized kidneys.Ascending ureterograms were normal.Renal biopsy showed the characteristic histology of a myeloma kidney, with brittle, laminated casts and tubules surrounded by multinucleate giant cells.The patient was maintained on haemodialysis twice a week using a hollow fibre dialyser.At the time of writing he had survived for 14 months.During that time he had had more than 100 dialyses, an initial three-week course of radiotherapy to the mediastinum (total dose 3070 rads), five courses of melphalan 5 mg daily for not longer than seven days, infrequent blood transfusions, and the routine management of chronic renal failure.Although his weight had decreased from 81 to 58 kg, his general condition was satis- factory apart from some transient subcutaneous swellings, particularly at the site of the arteriovenous fistula.Blood pressure remained normal.Latterly fragmented erythocytes appeared in the peripheral blood but coagulation studies showed no evidence of intravascular coagulation.Recent skeletal survey showed no lytic lesions or generalised decalcification, and bone marrow biopsy of the posterior iliac crest showed active haemo- poiesis with no increase in plasma cells.Free kappa light chains were detected in the serum on five occasions and the mild immunoparesis persisted.