A 71-year-old male with a history of CKD 4 presents to clinic with BP of 220/112. His examination is unremarkable with normal heart sounds and no crackles upon chest auscultation. His Cr is stable at his baseline of 2.8 and last UA was bland with no hematuria, just hyaline cast. Pt denies any complaints and…
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Ask anyone that knows me can tell you I love potassium. Its physiology, treatment of its disturbances, and its magical effects. I’ve also used it myself in my armamentarium to treat my own hypertension. When I tell people I sprinkle potassium on everything, the look at me like I’m crazy but potassium has some impressive…
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There exist a normal physiologic variation in blood pressure and the wake-sleep cycle. There should be a normal decrease of approximately 20% in BP during sleep due to a decrease in sympathetic activity. Conversely there is an increase in BP just before waking and this is believed to be associated with an increase incidence of myocardial infarctions,…
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I recently came across the concept of aldosterone breakthrough in my readings and confused it with aldosterone escape, so I though it would be a good topic to clear up really quickly. Aldosterone Escape This concept explains why we don’t ever see edema in our primary hyperaldosteronism patients. Remember aldosterone typically causes an initial decrease…
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After much adieu, JNC8 has finally been released and here are some of the new reccommendations: In patients 60 years or over, start treatment in blood pressures >150 mm Hg systolic or >90 mm Hg diastolic and treat to under those thresholds. In patients 18 years with either chronic kidney disease (CKD) or diabetes. In…
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Here is the latest board review from last Friday. Most of the questions of from NephSAP, with only 2-3 created by me. The plan is to post Nephrology Board-like questions to help prepare fellows for the in-service exam and national exam. -Adrian
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