Thursday, 09 February 2017
  1 Replies
  8.9K Visits
a 52 years old female , with uncontrolled diabetes type 2 , HTN , came to the clinic with overt nephrotic syndrome with 24 hr urinary protein of 5 g .
on ex her blood pressure 180/95 with regular pulse, bilateral lower limb edema is noticed .
labs were as follows :
creat 1.56 mg% , blood sugar 391 mg% HBA1C 10.3 Hb 8.9 showing microcytic hypchromic anemia .
other investigations were unremarkable regardless of increased cholesterol and trigycerides .
she is on atacend 32 mg OD , dilatrend 25 mg OD,Natrilix SR OD as well as insulin therapy .
apart from controlling her blood sugar , my inquiry is about replacing her dilatrend with diltiazem 90 mg to be increased to 180 mg as antiproteinuric beside atacand ..
is there other suggestions?
is depression a common adverse effect for this drug ?

Adding a non-dihydropyridine calcium channel blocker in this setting is unlikely to have significant efficacy at lowering her marked proteinuria. Assuming it is all from diabetic nephropathy, I would consider adding spironolactone here with careful monitoring and control of serum potassium. This drug likely adds blood pressure control but more importantly, adds specific anti-proteinuric effects along with the Atacand.

Dr. Jordan Weinstein
  • Page :
  • 1
There are no replies made for this post yet.
Be one of the first to reply to this post!
Submit Your Response
Upload files or images for this discussion by clicking on the upload button below.
Supported: gif,jpg,png,zip,rar,pdf,jpeg,doc,docx,xls,xlsx
· Insert · Remove
  Upload Files (Maximum 10MB)

Sharing your current location while posting a new question allow viewers to identify the location you are located.