Uncontrolled HTN leading to kidney damage

A 52 year female housewife by occupation presented to OPD on 17.01.2021 and today 20.01.2021 Chief Complaints Complaints of pain in right flank and right side lower abdomen on 17.01.2021 and BP was 205/105 Started her on cefolac O BD, Telista CL OD, PPI She even adds to have decreased urine output, but also adds intake of volume is less too over the day History History of uncomplicated cystitis in the last month She even states to consume analgesics for long time due to dental ailments Investigations Her urine R/M and KFT reveals - S. Cr - 2.19 RBC - 3 to 4/HPF USG W/A - Dilated Bowel Loops KUB - Normal on USG Management On today visit 21.01.2021 her bp was 180/110, changed her to telista trio CL OD Morning, cilacar 10 OD at night, levoflox 750 OD for a total of 7 days to review Stopped her cephalosporins as it is nephrotoxic BUN:Cr <20:1, RBC present too, both of which points towards intrinsic renal disease Would you suggest using a short course of steroids in this patient? Suggest appropriate line of management for her hypertension and kidney injury?

(Edited)

1 Like

LikeAnswersShare

Prerenal failure and doesnot looks a c/o renal damage but yes needs to evaluate RBC are 3to4 insignificant likely in a c/o cystitis Urea:creatinine ratio is normal Hence just needs good control of bp as pt is hypertensive You may adv ct abdomen Rx iv fluids Inj lasix Inj piperacillin+inj tazobactum for infection

Management of BP is the main treatment,to avoid hypertensive encephalopathy.if still BP is not controlled then HD is required to prevent hypertensive enchephalopathy

RENAL FAILURE AYURVEDIC TREATMENT? i think we can delay te process of crf, make frequency of the dialysis to lesser extent, with ayurvedic drugs, dr manish ji expained it very well, i hv heard about use of vazedi(sheep gut soup)can also reduces the dialysis frequency. will shall use ayurveda as a supportive therapy for crf patients . thankyu

Renal hypertension, also called renovascular hypertension, is elevated blood pressure caused by kidney disease. It can usually be controlled by blood pressure drugs. Some people with renal hypertension can be helped by angioplasty, stenting, or surgery on the blood vessels of the kidney. Causes of Renal Hypertension Renal hypertension is caused by a narrowing in the arteries that deliver blood to the kidney. One or both kidneys' arteries may be narrowed. This is a condition called renal artery stenosis. When the kidneys receive low blood flow, they act as if the low flow is due to dehydration. So they respond by releasing hormones that stimulate the body to retain sodium and water. Blood vessels fill with additional fluid, and blood pressure goes up. The narrowing in one or both renal arteries is most often caused by atherosclerosis, or hardening of the arteries. This is the same process that leads to many heart attacks and strokes. A less common cause of the narrowing is fibromuscular dysplasia. This is a condition in which the structure of the renal arteries develops abnormally for unclear reasons.

hi dr ajeetji.. my gdness aapke paas sub emergency cases khade haiin. all with either uncontrolled htn or dm..great.... coming to ur case. 52/F case of grade 3 hypertension. with increased creat. there is no agreement criteria to decide glomerular or nonglomerular haematuria. though above report sediment is positive. to assess kidney function parameter ,can go with such as egfr and 24 hrs creatinine clearance and cystatin c measurement for the evidence of acute kidney disease/ acute kidney injury./chronic kidney disease. normal creatinine excretion in male:20-25mg/kg/day females:15-20mg/kg/day secondly cephalosporin isnt nephrotoxic..its dose can be reduced to half only at when egfr reduced to 20-30ml/min.

Thank you for an elaborated opinion Sandeep ji Please refer to page 937 of CMDT 2020 INT'L Edition under the heading exogenous nephrotoxins, where it clearly states that Cephalosporins are known to cause or be associated with ATN
1

View 1 other reply

Treatments for Renal Hypertension Medications are used first to try to control high blood pressure in renal hypertension. The most important blood pressure medications to treat renal hypertension include: ACE inhibitors(angiotensin converting enzyme inhibitors). These include ramipril, benazepril, captopril, lisinopril, and others. ARBs (angiotensin II receptor blockers). Examples include candesartan, losartan, olmesartan and valsartan. CONTINUE READING BELOW For most people with renal hypertension due to renal artery narrowing, medications can effectively control blood pressure. More than one blood pressure drug is often needed, however. In some people with renal hypertension due to narrowing of the renal artery, even taking three or more medications every day may not adequately control blood pressure. In these situations, a procedure to improve blood flow to the kidneys may help. Possible procedures include: Angioplasty. A doctor threads a catheter through a large artery in the groin and advances it into the renal artery. A balloon is then inflated for a few moments. This widens the artery and improves blood flow. Antibiotics:-Novamax CV 624,zenflox UTI tab,Cefuroxime 500mg etc

In this case there is no evidence of any infection or need for antibiotics. To conclude this is renal or renovascular hypertension is highly premature and unwarranted. Treat for hypertension as idiopathic. Once a cause is identified then the correct title can be attributed. In the meantime she needs to consume at least 2 liters of fluids daily.

UNCONTROLLED HYPERTENSION IS A RISK FACTOR FOR KIDNEY DAMAGE

Considering she has long-standing habit of analgesic abuse,that might be the cause of elevated se.creatinine. Stop analgesics immediately.

If accelerated hypertension start arkamin.

Cases that would interest you