Patients with hypertension and/or diabetes are at high risk for CV and renal disease. How can the busy primary care provider stay a step ahead of potential renal deterioration? Here, a look at a quick, inexpensive, and reliable screening test.
Adding aliskiren to antihypertension regimens that already include losartan reduced blood protein levels from 19% to 22% in hypertensive type 2 diabetic patients with nephropathy.
Chronic kidney disease (CKD) has become a burgeoning epidemic. Patients with various stages of CKD initially seek care from their primary care physician; some of these patients sustain acute, reversible renal injuries as well.
A 48-year-old woman sought medical attention after an episode of gross hematuria associated with mild right-sided loin discomfort. She did not have urinary frequency, urgency, or dysuria. Her history included 3 urinary tract infections; a Proteus species was cultured on each occasion. The family history was unremarkable. Other than mild loin tenderness, physical findings were normal.
An 83-year-old man examined on admission for end-of-life care due to profound dementia. His wife states that his penis has not changed in appearance, but knows that he always had concerns about it. To her knowledge he never had trouble voiding. Patient too impaired to discuss any topic coherently. Wife considers it unlikely he would have disclosed any symptom of this type to her.
Benign prostatic hyperplasia (BPH)—histologically defined as stromal and epithelial hyperplasia beginning in the periurethral transitional zone of the prostate—affects up to 80% of 80-year-old men.[1,2] With progressive prostatic enlargement, bladder outlet obstruction can result. Although the exact mechanism is unknown, lower urinary tract symptoms (LUTS) can signal progressive BPH.
Non-ST-Segment Elevation MI and Unstable Angina: What Role for Anticoagulants and Antiplatelet Agents?
ABSTRACT: Antiplatelet agents used to treat non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina include aspirin, clopidogrel, and glycoprotein (GP) IIb/IIIa inhibitors. Aspirin is recommended for all patients with acute coronary syndromes (ACS). Clopidogrel can also be used in all patients with ACS, although this agent increases the risk of major bleeding complications if coronary artery bypass grafting is performed less than 5 days after the last dose. Early use of a GP IIb/IIIa inhibitor provides additional benefit in patients with NSTEMI, particularly those who undergo percutaneous coronary intervention. Agents used for anticoagulation in patients with NSTEMI or unstable angina include unfractionated heparin, low molecular weight heparins (LMWHs), and the direct thrombin inhibitor bivalirudin. Enoxaparin—the only LMWH currently indicated for treatment of patients with NSTEMI—can be considered as an alternative to unfractionated heparin, particularly in those who do not require urgent cardiac catheterization.
Is it appropriate to routinely order urinalysis for patients in a nursing home (both with and without dementia) when they exhibit behavioral changes but show no signs or symptoms of urinary tract infection (UTI)?