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Suggest Treatment For Hypertension When Suffering From Chronic Kidney Disease
Question: my resting heart rate is in the mid to upper 80's to 90's. I am on 50mg of toprol xl for hypertension. I am told losartan (25mg) shunts blood away from the kidneys and need to switch to something else. I was told one of the choices is of Lasix or amlodipine besylate.
With my CKD stage 2, and my history of edema as well, what do you think?
With my CKD stage 2, and my history of edema as well, what do you think?
Brief Answer:
yes should replace losartan as you have CKD
Detailed Answer:
hello,Mr,XXXX,I am Dr.Rajesh Teli,MD
I have gone through your query.Thanks for using HCM.
first of all I would like to know your current BP reading and reports of kidney functions ,s.creatine and GFR.With this information i shall be able to guide you properly.
However,as you are having CKD stage 2,it is advisable to replace losartan by lasix as you have history of edema.Losartan many a times leads to rise in serum creatinine in CKD patients.your target of BP should be less than 130/80.you may add amlodipine if your BP target is not attained with Toprol XL and lasix.Amlodipine has side effects of edema,but not every patient using it gets edema and S-isomer of it,available as S-Amlodipine has less incedence of edema.so you may take above decision in consultation with your treating doctor,
I hope i have satisfied your query,
My best wishes
Dr.Rajesh Teli,MD
yes should replace losartan as you have CKD
Detailed Answer:
hello,Mr,XXXX,I am Dr.Rajesh Teli,MD
I have gone through your query.Thanks for using HCM.
first of all I would like to know your current BP reading and reports of kidney functions ,s.creatine and GFR.With this information i shall be able to guide you properly.
However,as you are having CKD stage 2,it is advisable to replace losartan by lasix as you have history of edema.Losartan many a times leads to rise in serum creatinine in CKD patients.your target of BP should be less than 130/80.you may add amlodipine if your BP target is not attained with Toprol XL and lasix.Amlodipine has side effects of edema,but not every patient using it gets edema and S-isomer of it,available as S-Amlodipine has less incedence of edema.so you may take above decision in consultation with your treating doctor,
I hope i have satisfied your query,
My best wishes
Dr.Rajesh Teli,MD
Above answer was peer-reviewed by :
Dr. Shanthi.E
The last blood test did not have GFR but it has been showing at <90. I have a new CMP in the works now.
as of 9 XXXXXXX 2015, my fasting glucose was 118 (ref 65-110)
BUN 20 (7-20)
Creatinine 1.3 (.6-1.3)
also
AST 48 (15-46) High
ALT 55 (7-56) High
Chol. tot 238 (100-200) High
HDL 33 (55-110) Low
LDL 177 (0-129) High
Chol/HDLC ratio 7.15 (0-4.49) High
RBC 6.47 (4.5-5.9) High
HCT 53.1% (37-53) High
RDW 17.7% (no range given)
PSA/Hyb 4.49 ng/mL (0 - 4.0) High
Testo 1.42 ng/'mL (2.62-15.90) Low
(note: I am on 150mg Test. Cypionate every other week and I am at the end of week two at this draw since my last IM Injection)
BP today is: 134/83
It has been right at 24hr since I last took:
50mg Toprol XL and 5mg Amlodipine Besylate.
please correct to mean GFR more than 90 mls/min/1.73m2.
Thank you!!
as of 9 XXXXXXX 2015, my fasting glucose was 118 (ref 65-110)
BUN 20 (7-20)
Creatinine 1.3 (.6-1.3)
also
AST 48 (15-46) High
ALT 55 (7-56) High
Chol. tot 238 (100-200) High
HDL 33 (55-110) Low
LDL 177 (0-129) High
Chol/HDLC ratio 7.15 (0-4.49) High
RBC 6.47 (4.5-5.9) High
HCT 53.1% (37-53) High
RDW 17.7% (no range given)
PSA/Hyb 4.49 ng/mL (0 - 4.0) High
Testo 1.42 ng/'mL (2.62-15.90) Low
(note: I am on 150mg Test. Cypionate every other week and I am at the end of week two at this draw since my last IM Injection)
BP today is: 134/83
It has been right at 24hr since I last took:
50mg Toprol XL and 5mg Amlodipine Besylate.
please correct to mean GFR more than 90 mls/min/1.73m2.
Thank you!!
Brief Answer:
you need to focus on cholestrol
Detailed Answer:
Hell,Mr.XXXX,
I have gone through your reports.I would like you to consider following facts.
1.Interestingly your kidney functions are very much normal,so you need not worry for that.
2.Your fasting blood sugar is marginally high, so i suggest you to got postmeal hours(PP2BBS)and glycoselated hemoglobin i.e.HBA1C.HBA1C wll give us information of last 3 month's average blood sugar.(As we need to know whether you need any teatment for blood sugar or not.)
3.Your cholesterol is high.your serum cholesterol total should be less than 150,LDL should be less than 100 and HDL above 35.I suggest you to start statin group of medicine in consultation with your treating doctor.
4.your BP with Toprol and Amlodipine is good enough.Follow healthy life style to maintain BP below 130/80.No need to add or increase dose of existing medicine.
you need to focus on cholestrol
Detailed Answer:
Hell,Mr.XXXX,
I have gone through your reports.I would like you to consider following facts.
1.Interestingly your kidney functions are very much normal,so you need not worry for that.
2.Your fasting blood sugar is marginally high, so i suggest you to got postmeal hours(PP2BBS)and glycoselated hemoglobin i.e.HBA1C.HBA1C wll give us information of last 3 month's average blood sugar.(As we need to know whether you need any teatment for blood sugar or not.)
3.Your cholesterol is high.your serum cholesterol total should be less than 150,LDL should be less than 100 and HDL above 35.I suggest you to start statin group of medicine in consultation with your treating doctor.
4.your BP with Toprol and Amlodipine is good enough.Follow healthy life style to maintain BP below 130/80.No need to add or increase dose of existing medicine.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
I was on Pravastatin and my liver functions went through the roof.
Ideas?
I will try to get the tests you have recommended w/r/t blood sugar.
Ideas?
I will try to get the tests you have recommended w/r/t blood sugar.
Brief Answer:
monitor liver functions
Detailed Answer:
hello MR.XXXX,
I would like to know whether you take alcohol or not?you have mildly deranged Liver enzymes,did you have hepatitis in past? in absence of alcoholic or significant liver disease we can use statin if SGPT is below 100.but you need to discuss with your treating doctor about use of statin(you may consider pitavastatin)
meanwhile please get your blood sugar and HBA1C done as suggested earlier
My best wishes
Dr.Teli,MD
monitor liver functions
Detailed Answer:
hello MR.XXXX,
I would like to know whether you take alcohol or not?you have mildly deranged Liver enzymes,did you have hepatitis in past? in absence of alcoholic or significant liver disease we can use statin if SGPT is below 100.but you need to discuss with your treating doctor about use of statin(you may consider pitavastatin)
meanwhile please get your blood sugar and HBA1C done as suggested earlier
My best wishes
Dr.Teli,MD
Above answer was peer-reviewed by :
Dr. Raju A.T
I will make a note and get the tests.
Do you know if they require fasting? I could get them now if not. Otherwise tomorrow.
I have been diagnosed also with non-alcoholic fatty liver disease by my gastroenterologist. This is from an ultrasound of my liver.
Also, while on the subject, I have frequent seemingly intractable sinusitis with congestion that is not helped by antihistamines. I think it is dues to frequent aspiration during my sleep due to GERD. I also believe I have sleep apnea although not diagnosed, my wife says I stop breathing during my sleep. I also think that due to the long period of repeated aspiration and repeated cases of aspiration pneumonia, I have some decreased lung function and I get out of breath quite easily.
I am trying to loose weight as I am told that everything that is wrong with me should respond to that.
Just let me know if the blood tests require fasting and I will get them as soon as possible.
Thank you!!!
Do you know if they require fasting? I could get them now if not. Otherwise tomorrow.
I have been diagnosed also with non-alcoholic fatty liver disease by my gastroenterologist. This is from an ultrasound of my liver.
Also, while on the subject, I have frequent seemingly intractable sinusitis with congestion that is not helped by antihistamines. I think it is dues to frequent aspiration during my sleep due to GERD. I also believe I have sleep apnea although not diagnosed, my wife says I stop breathing during my sleep. I also think that due to the long period of repeated aspiration and repeated cases of aspiration pneumonia, I have some decreased lung function and I get out of breath quite easily.
I am trying to loose weight as I am told that everything that is wrong with me should respond to that.
Just let me know if the blood tests require fasting and I will get them as soon as possible.
Thank you!!!
Brief Answer:
post meal sugar and HBA1C dont need fasting Sample
Detailed Answer:
Hello,Mr.XXXX,
I got an additional information that you have non alcoholic fatty liver.This may be marker of insulin resistance and you may develop diabetes in future we are getting HBA1C for that.
You take proper care for GERD Avoid heavy and spicy meal.go for small frequent meals Avoid supine position at least for 3 hrs after meal.
You must get your sleep test done,quite possible that you have sleep apnoea .
Stations may be given in non alcoholic fatty liver if enzyme level are acceptable
Waiting for your reports
Dr.Teli.
post meal sugar and HBA1C dont need fasting Sample
Detailed Answer:
Hello,Mr.XXXX,
I got an additional information that you have non alcoholic fatty liver.This may be marker of insulin resistance and you may develop diabetes in future we are getting HBA1C for that.
You take proper care for GERD Avoid heavy and spicy meal.go for small frequent meals Avoid supine position at least for 3 hrs after meal.
You must get your sleep test done,quite possible that you have sleep apnoea .
Stations may be given in non alcoholic fatty liver if enzyme level are acceptable
Waiting for your reports
Dr.Teli.
Above answer was peer-reviewed by :
Dr. Yogesh D
new labs:
HgA1C 5.5% (0.00-6.00%)
**********************
GLUCOSE 86 (65-110)
BUN 22 (7-22)
Creatinine 1.1 (.6-1.3)
AST 39 (15-46)
ALT 44 (7-56)
Alkaline Phosphatase 73 (38-126)
please know I made a mistake in the eGFR.
The last test, it was >60 not 90.
This was 05 January 2015. A new lab including this is in process.
HgA1C 5.5% (0.00-6.00%)
**********************
GLUCOSE 86 (65-110)
BUN 22 (7-22)
Creatinine 1.1 (.6-1.3)
AST 39 (15-46)
ALT 44 (7-56)
Alkaline Phosphatase 73 (38-126)
please know I made a mistake in the eGFR.
The last test, it was >60 not 90.
This was 05 January 2015. A new lab including this is in process.
Brief Answer:
your reports are satisfactory
Detailed Answer:
Hello,Mr.XXXX,
eGFR more that 60 is normal,your BUN and S.Creatinine suggest your kidney functions are normal.
your HBA1C and Blood sugar are normal so you are not diabetic as on today.
your liver enzymes are normal too,so you may start statin.
Finally i suggest you to continue your BP medicines as they are,start statin and get your sleep test done.weight reduction is ofcourse very essential but it is long term process.
I hope we have practically completed entire discussion
My best wishes
Dr.Teli,MD
your reports are satisfactory
Detailed Answer:
Hello,Mr.XXXX,
eGFR more that 60 is normal,your BUN and S.Creatinine suggest your kidney functions are normal.
your HBA1C and Blood sugar are normal so you are not diabetic as on today.
your liver enzymes are normal too,so you may start statin.
Finally i suggest you to continue your BP medicines as they are,start statin and get your sleep test done.weight reduction is ofcourse very essential but it is long term process.
I hope we have practically completed entire discussion
My best wishes
Dr.Teli,MD
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Above answer was peer-reviewed by :
Dr. Yogesh D
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