Firstly, thanks in advance for the answers and it would very much appreciated if I can get the answers asap.
Today, I have a 25 year-old nurse who came in with pallor but not in distress. He came for his very severe hypertension (HTN) which cannot be controlled by amlodipine. He reports palpitation, headache, but not sweating. His blood pressure (BP) has been about 140/90 or 150/95 about 6 months ago, but it has been very high the last 15 days, especially the last week. No significant past medical history noted except mild dyspepsia for a few weeks which he took nothing. Physical exams are all normal except pallor, BP 230/125 mmHg, and mild tenderness at epigastrium. There is no edema at all. Labs: Hgb 7.5 g/dL, BG 98 mg/dL, total cholesterol 212 mg/dL, Uric acid 8.7 mg/dL, serum creatinine 7.05 mg/dL, serum K 4.24, Na 140.2, TSH normal, UA: blood 3+, protein 3+, leukocytes negative, nitrite negative, normal AST/ALT, abdominal US: small size kidneys (R 72 mm, L 74 mm) with loss of echo-structure. He reports HBs Ag negative and anti-HCV antibody negative a year ago. I just offer him 4 days of nifedipine, atenolol, candesartan, iron, albendazole, pantoprazole. I am reluctant to give him immunosuppressive drugs as I am not sure what to do, but I have told him that I will ask the experts first, so come back in 4 days to check BP again and to see what is recommended by the ISN experts. He says he cannot afford treatment abroad nor dialysis if he needs it in the future.
Thanks again for the answers.
With best regards,
Bunse