There are 3 available mineralocorticoid antagonists (MRAs) Spironolactone: This is a steroidal MRA derived from steroids that is nonselective for the mineralocorticoid (MR) receptor, it also can inhibit other steroid receptors specifically progesterone and androgen receptors Eplerenone: Is a second generation steroidal MRA that is more selective for the MR receptor, but less
I’m often referred patients with difficult to control hypertension and here’s my approach, things I think about when assessing these patients. I’m always considering a 24 hour ambulatory blood pressure monitor to exclude white coat effect. I need to make sure to do a careful medication review including over the counter medications.
Pseudoresistant hypertension, hypertension that appears resistant to treatment, but really is controlled. This article will review six things to consider when evaluating apparent resistant hypertension. Resistant Hypertension First, what is resistant hypertension? Resistant hypertension is defined as: Blood pressure above target despite use of three medications of different classes at maximally tolerated
Plasmapheresis is a procedure that I did not manage during my nephrology fellowship, it was run by hematology. When I entered clinical practice I found out it was my responsibility to prescribe. I don’t think this experience is unusual, plasmapheresis is often managed by hematology at academic university centers and nephrology
Is there a role for dialysis in acute liver failure? Hepatic failure can be associated with acute kidney injury and dialysis may be indicated in these situations, that’s not what this article will address. Instead we will explore a role for dialysis in acute liver failure even if there is not kidney failure.
I’m going to review 5 sets of equations that I often use in the evaluation of hospitalized patients with acid base and electrolyte disorders. I believe that familiarity with these is not only helpful for board testing, but also in clinical practice. Although there are apps that make it easy to do
Most people don’t like having kidney stone attacks and are motivated to prevent recurrences. However, there are some misconceptions. Some of the interventions patients try such as a low oxalate diet, avoiding tea, drinking citrus containing beverages or restricting dietary calcium are of minimal benefit or counter productive. What does the data show? 8 dietary
Tolvaptan is a vasopressin receptor antagonist, specific for the V2 receptor. This impairs urinary concentration and increases water excretion. Tolvaptan is classified as an aquaretic. In contrast to diuretics, aquaretics stimulate water excretion without significant electrolyte loss. What is Vasopressin? Vasopressin is the same thing as antidiuretic hormone (ADH). It is a hormone
A normal sodium on a lab test is 140 mEq (or mmol) / liter, but normal saline (which is purportedly isotonic to plasma) is 154 mEq/liter. What gives? This article will describe how sodium is measured clinically and explain this apparent discrepancy. How Sodium is Measured Historically sodium was measured by flame photometry,
Primary hyperaldosteronism is the most common modifiable cause of secondary hypertension with an estimated prevalence as high as 20%. This article will review normal aldosterone secretion and oversecretion, indications for screening, how to screen and confirm the diagnosis. Normal Aldosterone Secretion and Mechanism of Action Secreted by the zona glomerulosa of the adrenal
