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htn + GN Flashcards

1
Q

first line therapy

A
  1. long acting thiazide/thiazide like diuretics > hctz
  2. ACEi
  3. ARB
  4. BB ( Long acting)
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2
Q

what medication should you not use in isolated systolic HTN

A

acei

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3
Q

electrolote abN with thiazides monotherapy ?

A
  1. HypoNA
  2. Hypo K
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4
Q

age cut off for BB consideration?

A

60

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5
Q

second line regimen

A

thiazide + DHPCCB
ACEI + DHPCC

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6
Q

r/a pt wth uncontrolled BP how often

A

q1-2 months

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7
Q

first line options if isolated systolic htn

A
  1. long acting DHP CCB
  2. Thiazide
  3. ARB
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8
Q

diastolic HTN options

A
  1. TZD
  2. BB ( < 60 y)
  3. CCB
  4. ACE/ARB
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9
Q

what meds do you not use in isolated systolic htn

A

alpha B
BB`
ACEi

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10
Q

LVH htn meds

A

thiazide
acei/arb
long acting ccb

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11
Q

non t2dm , CKD + proteinuria

A

ACEI
Thiazide ( if EGFR ok)

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12
Q

CAD + HTN< what to use ?

A

ACE/ARB
BB
CCB

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13
Q

med to avoid in CAD + HTN

A

short acting nifedipine

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14
Q

stable angina + HTN ? what;s the caveat ?

A

CCB
BB

no hx of MI, cabg, or CHF

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15
Q

recent MI /+ HTN

A

BB + ACEi

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16
Q

first line in HFrEF

A

BB + ACEI

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17
Q

if can’t use ACEI, optins?

A

Hydralazine or ISDN

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18
Q

high risk patients defined as what . target ?

A
  1. 50
  2. SBP 130-180
  3. following risk factors
    * Clinical or subclinical cardiovascular disease
    * CKD (non diabetic, proteinuria < 1g/day, GFR 20-60 ml/min)
    * Estimated 10 year global cardiovascular risk ≥15% * Age≥75

Target : 120 sbp

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19
Q

excluded from sprint

A

Diabetes
history of stroke
GFR < 20
proteinuria > 1g/day
GN
PKD

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20
Q

target BP for polycystic kidney disease ?

A

SBP <110

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21
Q

DB + HTN, first line ? if do combvinbation which one ?

A

acei/ARB
dhp ccb
tzd

combo : dhp ccb + ace

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22
Q

prefered regimen long term for ischemic stroke ?

A

Acei and tzd

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23
Q

hmrg stroke target

A

acute <SBP 140-160 first 24-48H

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24
Q

long term hmrg stroke target

A

130/80

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25
Q

who to screen for hyperaldosteronism

htn + 1 out of 3

A
  1. Unexplained spontaneous hypokalemia <3.5 or marked diuretic related hypokalemia <3.0
  2. Htn & resistant to treatment with ≥ 3 drugs
  3. Incidental adrenal adenoma AND Htn
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26
Q

how to screen for hyperaldosteronism

A
  1. plasma aldosterone
  2. plasma renin activity or plasma renin concentration
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27
Q

who do you avoid measuring plasma renin concentration and why ?

A

women on ocp bcs high rate of false +

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28
Q

drugs that interfere wth hyperaldosteronism testing and drugs that it’s fine

A
  1. MRA > ACE/ARB > BB/CCB
  2. alpha blockers, non dhp ccb , hydralazine
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29
Q

how long should hold MRA/ k wasting and K sparing diuretics ?

A

at least 4 weeks

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30
Q

how long should hold ace/arb , dhp/ccb ?

A

at least 2 weeks

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31
Q

plasma aldost to renin ratio with plasma aldost values

A

1400 pmol/L/ng/ml/h ( or 270 pmol/l/ng/l)
w/ plasma aldosterone >440 pmol/L

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32
Q

what to do before adrenalectomy and why

A

adrenal vein sampling to check laerilization of aldosterone hypersecretion

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33
Q

what’s the difference between hyperaldosteronism that and primary aldosteronism when it comes to adrenal venous sampling ?

A

differentiate unilateral frm bilat aldost production

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34
Q

who to screen pheo

A

– Paroxysmal,unexplained,labile,and/orsevere(≥180/110)sustainedHTNrefractorytousual
therapy
–HTN+symptomsofcatecholamineexcess(headaches,palpitations,sweating,flushing)
– HTNtriggeredbybeta-blockers,MAO-Is,surgery,anesthesia,micturition
– Incidentaladrenaladenoma
– Hereditarycauses–suchasVon-Hippel-Lindau,MEN2Aor2B,neurofibomatosistype1

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35
Q

how to sceen pheo the best way

A

24H urine and catecholamine ( and creat)

36
Q

who to screen renovasc htn

A
  • Sudden onset or worsening HTN age >55 or <30
  • Abdominal bruit
  • HTN resistant to ≥ 3 drugs
  • Increase in Cr ≥ 30% with ACEi or ARB
  • Other atherosclerotic vascular disease, particularly in smokers or dyslipidemia
  • Recurrent pulm edema associated w/ Hypertension emergency
37
Q

how to screen renovasc htn

A
  1. renal doppler US
  2. captopril renogram
  3. MRA, CTA
38
Q

when do you avoid captopril renogram test in renovasc HTN ?

A

when GFR <60

39
Q

angioplasty/stenting considered in renovascuklar htn per guideline?

A
  1. uncontrolled htn resistnat to max tol pharmacotherapy
  2. decline in renal function
  3. acute pulmo edema
40
Q

in FMD, what procedure for renovascular htn ?

A

angioplasty without stent bcs risk of periprocedural dissection

41
Q

work up for FMD if htn and what else ? ( 1 out of 4 )

A

kidney assym >1.5 cm
fam hx of FMD
confirmed FMD in another bed
abdo bruit without atherosclerosis RF

42
Q

conditions requiring rapid bp decrease ? 2 ex

A
  1. aortic dissection
  2. eclampsia
43
Q

general rule for htn emergency management ?

A

decrease 20-25% in first 1-2 hours
then aim <160/110 for next 2-6 hpurs and progressively lower after that

44
Q

IV med options for hypertensive emergency

A

IV labetalol
Hydralazine
nitro, nicardipine, esmolol

45
Q

HTN urgency meds : cocaine user

A

IV phentolamine + benzo
- if no phentolamine IV labetalol

46
Q

HTN urgency meds : MI/CHF

A
  1. nitroglycerin
47
Q

HTN urgency meds : dissection

A

IV labetalol then iv nitro

48
Q

HTN urgency meds : preeclampsia

A

IV labetalol/hydrralazine
chew IR nifedipine

49
Q

if have scleroderma renal crisis , what do you give ?

A

IV enalapril or captopril

50
Q

what do you expect to observe with

  1. nephritic
  2. nephrotic
  3. AIN/pyelo
  4. ATN
A
  1. RBC cast , dysmorphic rbc
  2. oval fat bodies or fatty casts
  3. WBC casts
    4, muddy brown casts
51
Q

bp target for kidney bx

A

<140-160 SBP

52
Q

in nephritic syndrome
- low c3
- low c4
- low c3 and c4
- normal complement

A
  • PIGN
  • MPGN
  • lupus
  • IgA
53
Q

difference between anti gbm vs good pastures

A

antigbm = only kidneys
goodpastures = renal + pulmo hmrg

54
Q

tx of antigbm ?

A

steroid + cyclophophamide + pLEX

55
Q

maintenance therapy in anti GBM ?

56
Q

if serology and clinical presentation compatible wiht anca vasculitis, do you need bx ?

57
Q

ANCA TX
- induction
- maintenance

A
  • induction
    *steroids + ritux
    *steroids + cyclophosphomide
  • maintenance ( while you taper steroids)
    *ritux ( continue)
    *azathioprine ( continue)
58
Q

ritux in anca prefered when ?

A

young, fertility preservation, relpase, pr3 anca, frail old

59
Q

alternative to steroids in anca vasculitis tx ?

60
Q

when to consider plex in anca vasculitis?

A

rapidly rising creat, cr >300, new need for HD, alv hmrg w/ hypoxemia , co positive with anti gbm

61
Q

when do PSGN manifest

A

usually 2-3 post infection ( strep, strep cellulitis, chronic abscess, endocarditis, etc)

62
Q

low C4 means what

63
Q

MPGN is associted with what

A

hep C
HIV
cryo
infection

64
Q

low c4 and etiology is complement mediated, what do you tx with

A

MMF+steroids/eculizumab

65
Q

if have low c4, and not immune complex or complement mediated, what are your etiologies

A
  1. APLA
  2. TMA
  3. Sickle cell
66
Q

subtype of MPGN

A
  1. immune complex mediated - supportive + tx underlying cause
    *infection
    *autoimmune
    *monocolonal gammopathy
    *fibrillary GN
  2. complement mediated : c3 GN, DDD
  3. non immune, non complement
    -TMA, APLA< sickle cell
67
Q

so if havce hep C + CKD , how to tx ?

A

antiviral + immunosuppresson (ritux) +/- plex

68
Q

low c3, low c4 = which time of issue ?

69
Q

cyclophosphamide safe in pregnancy ?

70
Q

lupus nephritis drug option safe in pregnancy

A

hydroxytchloro
tacro
azathio
cyclosporin
steroids

71
Q

pregnancy delay in Lupus nephritis ?

A

> 6M-1Y after LN inactive

72
Q

lupus nephritis treatment for all ?

A

hydroxychloroquine and bp control

73
Q

class 3-4 lupus tx ?

A

induction : steroid + MPAA/Cyclophosphamide

maitain : MPAA + taper steorids

74
Q

class 5 lupus tx
- non nephrotic
- nephrotic

A
  • RAAS, immunosup if extra renal
  • RAAS, steroid MPA/cyclophosphamide/azathi/ritux/cnI
75
Q

if class 5 with worsening AKI , what do you want to rule out ?

A

rule out renal vein thrombosis

76
Q

lupus wth TMA - tx
- low adamst
- normal adamst with no APLA
- normal adamst13, + apla

A
  • plex + gc + ritux
  • consider eculizumab if primary or secondary complement mediated TMA
  • anticoagulation & plasma exchange
77
Q

immune complex - normal c3-c4

A

IgA nephropathy

78
Q

IgA nephropathy S&S

A
  1. microscopic hematuria
  2. gross hematuria
  3. proteinuria
  4. RPGN or nephrotic syndrome
79
Q

management of IgA nephropathy
- usual
- high risk pt

A
  • usual
    *bp<120
    *AceI/ARB if proteinuria >0.5

high risk patients
*6M steroids
*gfr <30 : mmf, hydroxychloroquibne , tonsilectomy

80
Q

2nd cause of minimal change nephrotic syndrome

A

Heme Cancer-
Hodgkins & Leukemias
Drugs- NSAIDs, COX2i, Li,
Infections (rare), including TB

81
Q

2nd cause of fsgs

A

Infxn: HIV,
parvoB19, EBV
Drug: heroin, pamidronate, anabolic ‘roids
Hyperfiltration: obesity, single kidney, reflux nephropathy

82
Q

2nd causes of membranous nephrotic syndrome

A

SLE CANCER- solid
tumors> heme malignancy (CLL)
Infection: HBV, HCV, Syphilis, HIV
Drugs: NSAIDs, anti TNFs, gold, penacillamine
Sarcoidosis

83
Q

why doacs not ideal in NS ?

A

bcs highly protein bound and not cool if hypoalbuminemia

84
Q

when do you want to ppx full anticoag with warfarin in nephrotic syndrome

A

hypoalb <20-25
any of the following
* obese
*thrombophylia
*prolonged immobilization
*prot > 10
*ortho surgery or abdo surgery

nephrology (3 decks)

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