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HPN in CKD
HPN in CKD
TO BLOOD PRESSURE
MANAGEMENT IN CKD
PATIENTS
LEILANI ROSALIND CARAGOS-MERIN, MD
OUTLINE
• HPI
• Patient has been having increased blood pressure readings at home for 2 weeks
• BP: 150-160/ 90-100 mmHg
• No dizziness, no vomiting, no blurring of vision
• No change in urinary and bowel habits
• Referred by primary care physician due to increasing BP and a drop of eGFR to 35
ml/min /1.73m2 from 60ml/min/1.73 m2 last year
• and a urine spot protein to creatinine ratio of 30 mg/g
• Physical examination
• BP 170/100 mmHg HR: 70bpm RR: 20
• BMI 27.2kg/m2
• C/L : Equal chest expansion, clear breath sounds
• CVS: DHS , normal rate, regular rhythm
• Abdomen: Flat, normoactive bowel sounds, soft, nontender
• Ext: grade 1 bipedal edema
CLINICAL SCENARIO
• Medication Non-adherence
DIAGNOSIS
Loop: Fluid overload Heart failure; Hearing loss Gout; Bumetanide and
Furosemide Hypercalcemia Hypokalemia sulfonamide-related torsemide have
Bumetanide Hypocalcemia hypersensitivity better intestinal
Torsemide Hyponatremia absorption than
furosemide
Potassium- Fluid overload Refractory Hyperkalemia Pregnancy Avoid in patients
sparing: Hypokalemia hypomagnasemi Metabolic with significant
Triamterene a; acidosis CKD
Amiloride Lithium toxicity/ (GFR<45mL/min)
NDI
NO
YES
Start ACEi or ARB or CCB
Continue Monitoring BP Monitor eGFR and K
Manage Lifestyle Continue BP monitoring
Manage Lifestyle
Exlude pseudo-resistance
Not at goal BP
>140/90