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  Thursday, 30 January 2014
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56 years old female patient with a history of hypertension, diabetes for 22 years back, was presented to me complaining of headache as well as bilateral LL edema. O/E she was hypertensive BP 160/95, fasting blood sugar was 222, otherwise everything was ok. Her lab investigations revealed creatinine 2.3 mg/dl and potassium 5.4 mmol/l Urine albumin was ++ with no pyuria or RBCs. her doctor gave her anti hypertensive in the form of CCB (amilodipine) once daily, ARB (Irbesartan 150 mg) once daily, with loop diuretic (furosemide 40 mg) twice daily. Please I need your advice for her medication: should we continue on ARBs despite her hyperkalemia, or can we change to carvidelol 25 mg? Does she need to proceed for more investigations concerning her albuminuria?
10 years ago

I would generally allow patients taking ACEi or ARBs to stay on these medications if, while one them, the potassium remains below 6. I would not start them or increase their dose if they already have potassium levels in the 5-6 mmol/L range. I would also ensure that the patients continue to follow a potassium restricted diet, linked below.

As for further investigations of the proteinuria, it seems that 22 years of diabetes could account for it, particularly if glycemic control has not been adequate over the years. But if there was extreme proteinuria (> 5 grams/day), if significant hematuria or an active urine was present, or signs of systemic disease, then perhaps further investigation would be warranted.

Dr. Jordan Weinstein
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