HTN + CKD + RA

A 45 year old female housewife by occupation Chief Complaints Pain in legs Dysuria Brown coloured urine Decreased urine output than before She is experiencing these symptoms for past 5 days and she has stopped all her RA drugs too History Known case of HTN with CKD with RA with Hyperuricemia She was on - Leflulonamide 20 Methotrexate 7.5 weekly HCQ 200mg BD Folic Acid 5mg OD She stopped all these drugs thinking of drugs being cause of urine colour change and infection Vitals BP 150/90 Pulse 90 Investigations Ordered investigations - Urine R,M,CS S Urea, S Cr S Uric Acid Management My concerns - 1) Safest anti hypertensives that can be given in this case of hyperuricemia with CKD with RA ? 2) Is any drug of RA a culprit for her urinary tract problem that she is facing? 3) Can't sulphasalazine could be given before thinking about HCQ or Leflulonamide? Thank you

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1.Calcium channel blockers are the safest anti- hypertensives in CKD Options in this case are Cilnidipine, Benedepine , and Amlodepine Among ARB's - Azilsartan is the safest . Beta - blockers like Metoprolol , nebivolol are also safe 2.Methotreaxate is a toxic drug - although hepatic damage is the commonest side effect- but it should not ne used in CKD HCQS is comparatively safe except for ocular side effects 3.Leflunomide is an effective drug for rheumatoid arthritis. Alone it can be used for RA,

1. Azilsartan. Or Cilnidipine 2. Methotrexate can reduce immunity.. also uric acid or other calculi are reasons 3. Leflunomide is better drug , Sulfasalazine is equally good but safety concerns are there.

Your concerns 1 you can use ACE/ARB SAFELY 2yes Lefonamide or hcqs can cause nephrotoxicity and need to be evaluated 3yes salphasalazine can be used but it too has nephrotoxicity

punarnavadi guggul gkshuradi guggul dashmularishta panchkolasava r some preparations which showa little bit improvement

CLONIDINE .. METHOTREXATE.. LEFLUNOMIDE .. FOLLOW UP WITH EXPERTS OPINION.. OVERALL GOOD HEALTH AND HYGIENE..

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