Secondary Hypertension - ?Renal Parenchymal Disease

A 40 year old male presented to OPD on two occasions Chief Complaints On 4th January, he presented with headache, vomiting and his BP was 180/100, Pulse - 100/min On 7th January(today), he again presented with headache and his BP was 175/99, Pulse - 105/min History Smoker, Non vegetarian, Alcoholic too Investigations RBS - 88mg/dl S.Cr - 1.62 BUN - 65 TGs, S. Cholesterol high LDL -C - 145 S. Uric Acid - 8.09 BUN:Cr Ratio is 40.12, which means cause is either Pre-renal or post-renal USG - W/A - Bilateral Kidneys with Grade II echogenicity with loss of corticomedullary differentiation, Pancreas is heterogeneous in echo texture This explains that the cause is mostly pre renal Management On 4th Jan, I had started him on - Rosuvas F 10 mg HS Concor AM OD On 7th January upon receiving reports, I had changed his medicines to - Tab Cilnidipine 10mg BD, Rosuvas F 10mg HS Febuxostat 40mg OD My concerns are - 1) Kindly advise management of this case of hypertension? 2) Probable diagnosis of this case?

(Edited)

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Sir it's a case of CKD,in CKD BP is usually high,pt had developed CKD because of chronic uncontrolled HTN. For bp we can give tb Amlong 5 mg bd Tab arkamine .1 mg tds What is his urine output and egfr,that will define need of HD,otherwise pt may land in encephalopathy

eGFR is 47
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Hypertension Lipidemia Urecemia Renal parenchymal disease Tab cilnidipine 10 + metoprolol 50- 1 od Tab acetylcysteine 600 mg- 1 bd Tab Nodosis 500 - 1 od Cap PPI tab multimitamine cont..Rosuvas F 10 & Febuxostat 40 Stop smoke & Alcohol avoid salt ; spicy; fatty food & less protein diet; water intake-below 2.5 litre adv for CBC; LFT; Amylase; Lipase and Electrolyte, URINE R/E role out constipation

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He is not young enough to look for surgical htn.At 40 it may well be an early onset essential htn. To be sure, a renal Doppleray be done.Clearly with grade II renal parenchymal changes, the renal impairment is of some duration. You may try ARBs and diuretics and watch and titrate the drugs to control the htn better.However avoid the temptation of rapid control of bp in quick time.

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LVH (v2) with strain Advise CECT - Abdomen with Renal arterial doppler Check Lytes level Like to add ACE / ARBB

Get urine RM done and review with report

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@Jayesh Kalbhande sir and @Parveen Yograj sir - please give me your valuable opinions too on this case

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