HLD and CKD Flashcards
hypertension diagnosis
- while waiting for confirmed diagnosis assess Qrisk and target end organ damage
- clinic BP - if > 140/90 mmHg take 2nd measurement,
- if still between 140/90-180/120 mmHg then offer ABPM/HBPM - if clinic BP >180/120 mmHg
3a. refer to same-day specialist assessment if signs of retinal haemorrhage/papilledema or lifeT symptoms
3b. investigations for target organ damage - if +ve start antihypertensive drugs immediately otherwise repeat BP measurement in 7 days.
Stages of HT
Stage 1
Clinical BP - 140/90 mmHg to 159/99 mmHg
+ABPM or HBPM - 135/85 mmHg to 149/94 mmHg
Stage 2
Clinical BP - 160/100 mmHg - < 180/120 mmHg
+ABPM or HBPM - 150/95 mmHg or >
Stage 3
Clinical systolic BP - 180 mmHg or >
Or Clinical diastolic BP - 120 mmHg or >
who’s BP do we regularly monitor?
and who to consider ABPM/HBPM?
- diabetes, >80’s, postural hypotension
2. white coat syndrome
HT management
advise:
diet & exercise,
smoking cessation,
reduce alcohol, dietary sodium and caffeine
drugs:
revise nice guidelines from before
offer from stage 2 HT
offer in stage 1 if target end organ damage, Qrisk >10%, renal disease, CVD, diabetes
HT w diabetes M
Type 1 - target 135/85 mmHg or 130/80mmHg if microalbuminuria
type 2 - target 140/80 or 150/90 if >80yrs
HT pregnant women
chronic hypertension puts them at risk of pre-eclampsia
labetalol if required and stop other anti-hypertensives
aspirin 75—150 mg daily is prescribed from 12 weeks’ gestation until birth
CKD diagnostic criteria
can also present as: Weight loss Swelling of the ankles Breathlessness Fatigue Blood in the urine Increased urination
usually spontaneously found in routine: also this used in staging
urine tests - ACR (albumin: creatinine ratio)
bloods - eGFR <90ml/min
staging ckd
table : eGFR split 90-15
G - 1(<15),2,3a,3b,4,5 (90 or >)
CKD M
- med: statin(lipid lowering) , antiplatelet drug (reduce CVS risk)
- imms: influenza and pneumococcal
- self-care: info, lifestyle, stop nephrotoxic drugs (NSAIDs), advise on AKI increased risk
- assess pt for co-morbidities:
- consider referral in pts:
CKD M - when to asses comorbidities and associated M
Assess for hypertension if pt isn’t diabetic and has:
- ACR 30mg/mmol or > prescribe low cost RAAS
antagonist (lisinopril or losartan)
- ACR < 70mg/mmol - BP <140/90
- ACR > 70mg/mmol - BP 130/80
Urinary ACR of 70 mg/mmol
- low cost RAAS antagonist (lisinopril or losartan)
- Referral unless proteinuria known to be associated
with diabetes
Diabetes
- Aim for BP < 130/80 mmHg
- If urinary ACR of 3 mg/mmol or > - low cost RAAS
antagonist (lisinopril or losartan)
- Optimize blood glucose control as much as possible
CKD - M - who to refer
- Urgent 2 week referral - persistent
haematuria/suspected uro cancer - to nephrology - genetic cause of CKD, suspected
CKD complications (malnutrition, persistent
hyperkalaemia, renal anaemia, persistent metabolic
acidosis), CKD stage 4/5, ACR > 70,
uncontrolled hypertension despite drugs - to urology - urinary obstruction suspected,
emergency if fluid overload, severe hyperkalaemia,
urinary retention
CKD - Explain diagnosis to pt
- kidneys are diseased or damaged in some way, or are ageing. As a result, your kidneys may not work as well as they used to. Reduced function not failure
- most cases are mild or moderate, occur in older people, do not cause symptoms and tend to become worse gradually over months or years.
- various causes - age, diabetes, hypertension
- Chronic means ongoing, persistent and long-term. It does not mean severe as some people think
CKD - explain what AKI is and increased risk
function of the kidneys is rapidly affected - over hours or days more likely if you already have kidney problem - e.g. CKD so another condition (e.g. heart failure) can cause this and more likely to result in AKI as kidneys already reduced function
