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Renal - ABIM

Hypertension

QuestionAnswer
Define pre-hypertension SBP 120 to 139 or DBP 80 to 89 and the absence of pre-existing and organ disease.
How do you treat pre-hypertension? Lifestyle modification low salt or DASH diet, exercise. Follow up in one year.
What is a DASH diet? A diet that emphasizes vegetables, fruits, whole grains, legumes, and low fat dairy products. It limits suites, redmeat, and saturated total fat, there is also a component of dedicated weight-loss planning.
How do you establish a diagnosis of hypertension? Blood pressure over 140/90, measured in at least three visits over the last week.
How is blood pressure related to risk of stroke and cardiovascular disease? There is an increased risk of stroke and cardiovascular disease for every level of blood pressure above 115/75. There is also increased risk hypertension and pre-hypertension.
How do you diagnose White coat hypertension? Use ambulatory blood pressure monitoring. White coat hypertension is defined as persistently elevated blood pressure readings in the office (normal blood pressures at home or during normal activities) without evidence of end organ damage.
When should you assess for masked hypertension? In a patient with normal blood pressures, but evidence the end organ damage.
What imaging to use for a patient with chronic kidney disease? Ultrasound
Which patients are more likely to get contrast induced nephropathy? Patients with elevated creatinine, diabetes, old age.
Who should not get MRI with gadolinium? Patients with GFR < 30 because of increased risk for nephrogenic systemic fibrosis
What is Balkan endemic nephropathy? A slowly progressive tubulointerstitial dz due to Aristolchia clematis, which has a nephrotoxic alkaloid endemic to the Balkan region. Causes tubulointerstitial injury, tubular dysfunction (polyuria, glycosuria, tubular proteinuria) , and anemia.
How does one get Balkan endemic nephropathy? Exposure to low levels of Aristolochia acid over many years, unlike the the more acute toxicity associated with ingestion of herbal preparations.
What disease: polyuria with decreased concentration ability, glucosuria without hyperglycemia, and tubular proteinuria? Balkan endemic nephropathy
Bolkan endemic nephropathy is associated with what cancer? Why? Aristolchic acid is mutagenic, so these pts are at increased risk of transitional cell CA of the renal pelvis, ureters, and bladder.
Autosomal dominant poly cystic kidney disease is associated with what? Intracranial cerebral aneurysms
Autosomal dominant poly cystic kidney disease is characterized by what? Large kidneys and multiple kidney cysts
How should you monitor a patient with Balkan endemic nephropathy? Annual urine cytology
Created by: christinapham