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  Thursday, 09 February 2017
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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
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