These include over-the-counter agents such as Maalox and Mylanta
Use of these agents can lead to hypermagnesemia, acute aluminum toxicity, worsening
renal function, bone disease, and neurotoxicity
The preferred quantitative test is spot urine protein to creatinine ratio (accurate & more
convenient than 24-hr urine collection)
A urine protein to creatinine ratio ≥ 1 has a higher risk of progression of CKD
Pearl # 9: Most Patients With Hypertension Should NOT Be Screened for Secondary
Hypertension, But be Aware of Certain Clinical Clues
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In general 95% of patients have primary or essential hypertension, and only 5% have
a secondary cause
Clues include: Severe or difficult to control HTN, HTN that suddenly develops, or HTN
that is associated with other clinical findings are some clues
Hypokalemia: Consider primary hyperaldosteronism
Headaches, palpitations, and sweats: Consider Pheochromocytoma
Moon facies and/or striae: Consider Cushing Syndrome
History of snoring in obese patient: Consider Obstructive Sleep Apnea
Bruit on one side of the abdomen: Consider Renal Artery Stenosis
Over-the-counter medications (NSAIDs, Birth Control Pills, or Decongestants)
Non-compliance with Diet (High Sodium Intake)
Pearl # 10: Recurrent Nephrolithiasis, Needs a Metabolic Evaluation to Identify and