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Hypertension and Renal Disease

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Salt Sensitivity

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Patients with CKD are often salt-sensitive, worsening hypertension. Management includes reducing salt intake, often to less than 2 grams of sodium per day.

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Lifestyle Factors

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Lifestyle factors such as obesity, smoking, and sedentary lifestyle can contribute to hypertension and CKD progression. Management strategies include weight loss, smoking cessation, and increased physical activity.

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Proteinuria

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Proteinuria is both a marker and mediator of kidney damage in hypertension. Management involves controlling blood pressure and using ACE inhibitors or ARBs to reduce protein excretion.

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Hypertensive Retinopathy

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Hypertensive retinopathy indicates end-organ damage which may correlate with kidney disease. Management includes strict blood pressure control.

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Blood Pressure Targets in CKD

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Aiming for a blood pressure target below 130/80 mmHg is recommended for most patients with CKD. Management strategies involve individualized medical therapy and lifestyle modifications.

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Secondary Hypertension

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Kidney disease can cause secondary hypertension, which may worsen renal outcomes. Managing the underlying kidney disease and controlling blood pressure are crucial.

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Systemic Hypertension

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Chronic kidney disease (CKD) can be both a cause and a result of hypertension. Manage with lifestyle changes, medications (ACE inhibitors or ARBs), and blood pressure monitoring.

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Volume Overload

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CKD patients with hypertension often have difficulty managing fluid balance, leading to volume overload. Management includes diuretics and sodium restriction.

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Hypertensive Urgency/Emergency

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In CKD, severe elevations in blood pressure may lead to a hypertensive urgency or emergency. Requires immediate management with IV medications and close monitoring.

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Renin-Angiotensin-Aldosterone System (RAAS)

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Overactivity of RAAS can lead to hypertension and exacerbate kidney damage. Management includes using RAAS inhibitors like ACE inhibitors or ARBs.

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