Primary care
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Medications are a common cause of acute kidney injury and chronic kidney disease. Older patients with multiple comorbidities and polypharmacy are at increased risk and require extra diligence. ⋯ Awareness of such medications and their mechanisms of nephrotoxicity helps decrease morbidity and mortality. If nephrotoxic agents cannot be avoided, hydration, avoiding concomitant nephrotoxic medications, and using the lowest effective dose for the shortest duration are strategies that can decrease risk of kidney damage.
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Nephritic syndrome is a constellation of hematuria, proteinuria, hypertension, and in some cases acute kidney injury and fluid retention characteristic of acute glomerulonephritis. Infection-related glomerulonephritis, IgA nephropathy, lupus nephritis, membranoproliferative glomerulonephritis, and antineutrophil cytoplasmic antibody-associated vasculitis are the most common diseases in nephritic syndrome that primary care physicians might encounter in practice such that a solid comprehension of these can lead to earlier detection. This article describes the pathophysiology, incidence, clinical presentation, treatment, and disease progression of these nephritic syndrome entities, and provides guidance for when to refer to a nephrologist.
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Renovascular hypertension (RVH) is relatively common but underrecognized cause of resistant hypertension in clinical practice. Most patients with RVH have suboptimal control of hypertension in spite of being on multiple anti hypertensive medications. Prompt diagnosis and management is crucial to prevent long term morbidity and mortality. ⋯ In addition to pharmacologic and nonpharmacologic measures, some patients may benefit from angioplasty. This article discusses various definitions of hypertension, approach to diagnosis of RVH, and management. Data from clinical trials are discussed with evidence-based medicine practice recommendations.