doyoudig
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A 15-year-old girl is brought to the physician 3
months after she had a blood pressure of 150/95 mm Hg at a routine examination prior to participation in school sports. She is asymptomatic and has no history of serious illness. Twelve months ago, she was diagnosed with a urinary tract infection and treated with oral trimethoprim-sulfamethoxazole. She currently takes no medications. Subsequent blood pressure measurements on three separate occasions since the last visit have been: 155/94
mm Hg, 145/90 mm Hg, and 150/92 mm Hg. She is at the
50th percentile for height and 95th percentile for weight. Her blood
pressure today is 150/90 mm Hg confirmed by a second measurement, pulse is 80/min, and respirations are 12/min. Examination shows no other abnormalities. Her hematocrit is 40%. Urinalysis is within normal limits. Cardiac and renal ultrasonography shows no abnormalities. Which
of the following is the most appropriate next step in management?
A) Exercise and weight reduction program
B) Measurement of urine catecholamine levels
C) Measurement of urine corticosteroid levels
D) Captopril therapy
E) Hydrochlorothiazide therapy
A or BBB?????
Pls explain ur rationale and steps in workup
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| cirus
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First why would u measure the catecholamines, nothing in the qs suggests pheochromocytoma..add to this that the renal analysis is normal so i guess no VMA or other metabolites of catechlamines
this is definetly an obese female (95 percentile), so even though its a temptation to give diuretics for her BL pr, the recommendations of ttt disagree as the first thing to try is weight reduction together with life style modif & monitor her blood pressure..
Captopril ttt---> excluded as her renal US is normal add to this renal func are normal and so this is not RAS
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| robin082006
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D--> Captopril test
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| robin082006
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D-->captopril test
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| robin082006
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Captopril test
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| cirus
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robin082006 wrote:
Captopril test
Robin, the choice isn't captopril test, its captopril ttt, & the U/S( diag for RAS) is normal
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| robin082006
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I remember this q from COnrad, this patient may have renal stenosis but negative ultrasound, captopril test is high sensitivity test for renal stenosis.
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| doyoudig
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what would Urine Anaylsis reveal for RAS?
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| Justice
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Yes, the Q is vague...
I am personally against RAS which would reveal increase in renin/aldosterone concentrations with concomitant electrolyte abnormalities...
My choice is A) Exercise and weight reduction program
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| Justice
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doyoudig wrote:
what would Urine Anaylsis reveal for RAS?
Low sodium high potassium and bicarbonates, I guess...
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| dr in trouble
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A
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| khorshid
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A
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| cirus
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doyoudig wrote:
what would Urine Anaylsis reveal for RAS?
In renal artery stenosis the blood supply will decrease to the kidney, so the recepters will misenterpret this as hypovolemia leading to increased renin secretion, so the aldosterone will rise leading to increased re-absorbtion of Na in-exchange to K---> 2ry Conns..
urine analysis will show decreased Na.. & decreased urine output..Late reaction
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| hanwin
Forum Senior
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15 yr old, obese, probably secondary HT.
Q is very vague.
C would be the answer.
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| dr19
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should we accept t as Primary HT,or investigate
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| dr19
Forum Senior
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She is 15 yo.
investigate or not?
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| cool doctor
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she is an obese young girl
I will go with C to r\o cushing
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| me007
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RAS especially common in pt <25 or >50 y.o. with recent-oncet HTN, (etiology - fibromuscular dysplasia in young and atherosclerosis in older).
Diagnose with MRA or renal arthery doppler ultrasound.
"renal ultrasonography shows no abnormalities" - probably excludes 1* renal disease but not RAS.
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| brutus25
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I would go for C - measurement of corticosteroid...
As there are 2 facts that point to this one
1. HTN ( in a person < 25 )
2. Obesity
Fibromuscular dysplasia with RAS is a diferential diagnosis but I see no tests
to look for it - Captopril renal scan
Could you please post the right answer
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