Nephrology Flashcards
This test is used to distinguish primary versus secondary etiologies of membranous nephropathy
Phospholipase A2 receptor staining on kidney biopsy (positive = primary, negative = secondary, such as malignancy, lupus, etc)
What is the ACC/AHA definition of hypertension?
Ambulatory blood pressure monitoring: normal daytime, normal nighttime, normal 24 hour average?
How to make the diagnosis?
HTN: >/= 130/80 Ambulatory: -Daytime normal <120/80 -Nighttime normal < 100/65 -24 hour average <115/75 Make the diagnosis: average of two or more elevated systolic and/or diastolic BP's obtained on two or more occasions.
How often to screen for HTN in the following populations, per USPSTF:
1) Age 18 or over
2) Age 18-39 with BP<130/85, no cardiovascular risk factors
3) Age 40 or over
4) BP 130-139/85-89
5) Overweight
6) Black
Per ACC/AHA:
7) BP 120-129/<80 or 130-139/80-89 not yet on BP therapy
1) Screen all
2) Every 3-5 years
3) Annual
4) Annual
5) Annual
6) Annual
7) Repeat within 3-6 months
Habitual high X and low Y intake contribute to worldwide high prevalence of hypertension:
High sodium, low potassium
Definition of stage I and stage 2 HTN
Stage 1: 130-139/80-89 (office) or >/= 125/75 ambulatory
Stage 2: >/= 140/90 (office) or >/= 130/80 ambulatory
Patients in which stage(s) of hypertension should initiate pharmacologic therapy?
Stage 1 (130-139/80-89 office readings) with clinical cardiovascular disease or 10 year cardiovascular risk >/= 10% Stage 2 (>140/90 office readings): all
What is/are the initial recommended antihypertensive medication(s) for treatment of hypertension in:
- non-black population, including those with diabetes?
- black patients?
Non-black: thiazide diuretic, CCB, ACE-i, or ARB
Black: thiazide diuretic or CCB
Preferred initial anithypertensive agent with symptomatic heart failure or CKD with eFR<30:
Loop diuretic
Which patients with hypertension should receive combination therapy with two first-line antihypertensives?
Stage 2 HTN (>140/90 office)with average blood pressure 20/10mmg Hg above BP target
What is ‘masked hypertension’?
When should antihypertensive medication be initiated?
Definition: BP normal in office but elevated ambulatory.
Treat if ambulatory BP is >/= 130/80 despite 3 months of lifestyle modification
Blood pressure target with HTN and CKD?
Preferred antihypertensive for stage G3 CKD or higher, or G1/G2 CKD with severe albuminuria?
BP target <130/80
Ace-i or ARB, low sodium diet, and PRN diuretic
What are the two types of renovascular disease and which ages are they most common?
1) Atherosclerotic, age > 45
2) Fibromuscular dysplasia: young, especially female
Therapies for renovascular hypertension
Treatment of underlying cardiac risk factors
ACE-i or ARB
Perc angioplasty and stenting or surgical intervention for select patients (EG short period of hypertension, recurrent severe hypertension or flash pulmonary edema)
Triad of findings raising concern for primary hyperaldosteronism
1) Resistant hypertension
2) Metabolic alkalosis
3) Hypokalemia
How to screen for primary hyperaldosteronism
How to treat primary hyperaldosteronism
Plasma aldosterone concentration (PAC)/plasma renin activity (PRA) ratio.
-High ratio suggestive of the dx
Then, dedicated adrenal CT.
- hyperplasia: aldosterone receptor antagonist (EG spironolactone)
- adenoma: surgical rsxn
