Read the Beforeitsnews.com story here. Advertise at Before It's News here.
Profile image
By Renal Fellow Network (Reporter)
Contributor profile | More stories
Story Views
Now:
Last hour:
Last 24 hours:
Total:

Ten Things Every Primary Care Physician Should Know

% of readers think this story is Fact. Add your two cents.


An article from a few years ago that might provoke some discussion. Some of the recommendations are a little out of date (I don’t think I would target a Hb of 12 anymore in patients with CKD) but overall it seems like good advice.

The Top 10 Things Nephrologists Wish Every Primary Physician Knew

  1. A “normal” serum creatinine level may not be normal.
  2. Know the medications that spuriously raise the serum creatinine.
  3. Patients with decreased GFR or proteinuria should be evaluated to determine the cause; positive urine dipstick results for protein should be followed up with a spot urine protein/creatinine ratio.
  4.  In patients with early-stage CKD, periodic evaluation and intervention are appropriate to slow the progression of renal disease and avoid complications.
  5. Do not automatically discontinue an ACEi or ARB solely because of a small increase in serum creatinine or potassium.
  6. Anemia in patients with CKD should be treated with ESAs but should not be over-treated.
  7. Phosphate-containing bowel preparation should be used with caution
  8. Patients with CKD should avoid magnesium or aluminum-containing oral preparation. Concomitant use of citrate-containing preparations and aluminum-containing oral preparation is hazardous because it can lead to acute aluminum toxicity
  9. Although most patients with hypertension should not be screened for secondary hypertension, certain clinical clues may suggest the presence of an underlying cause that, when addressed, may resolve or improve the patient’s hypertension
  10. In patients with recurrent stone disease, an in depth metabolic evaluation is needed to identify and treat modifiable risk factors, thereby preventing further episodes and/or promoting stone dissolution

I don’t see much to disagree with on this list – I might not put the knowledge that bactrim and cimetidine increase creatinine so high on the list. I particularly like number 10 – most patients with recurrent stone disease are unaware that more than 95% of stone recurrences can be prevented with proper medical therapy.

With regard to number 8, although we don’t really use aluminum-containing phosphate binders any more, it is still contained in some over-the-counter antacids. Citrate markedly increases the absorption of aluminum from the bowel and in patients with CKD, this has been associated with severe toxicity and death in one case series.

Are there any other things that we should add to this list?


Source: http://renalfellow.blogspot.com/2013/08/ten-things-every-primary-care-physician.html


Before It’s News® is a community of individuals who report on what’s going on around them, from all around the world.

Anyone can join.
Anyone can contribute.
Anyone can become informed about their world.

"United We Stand" Click Here To Create Your Personal Citizen Journalist Account Today, Be Sure To Invite Your Friends.

Humic & Fulvic Liquid Trace Mineral Complex

HerbAnomic’s Humic and Fulvic Liquid Trace Mineral Complex is a revolutionary New Humic and Fulvic Acid Complex designed to support your body at the cellular level. Our product has been thoroughly tested by an ISO/IEC Certified Lab for toxins and Heavy metals as well as for trace mineral content. We KNOW we have NO lead, arsenic, mercury, aluminum etc. in our Formula. This Humic & Fulvic Liquid Trace Mineral complex has high trace levels of naturally occurring Humic and Fulvic Acids as well as high trace levels of Zinc, Iron, Magnesium, Molybdenum, Potassium and more. There is a wide range of up to 70 trace minerals which occur naturally in our Complex at varying levels. We Choose to list the 8 substances which occur in higher trace levels on our supplement panel. We don’t claim a high number of minerals as other Humic and Fulvic Supplements do and leave you to guess which elements you’ll be getting. Order Your Humic Fulvic for Your Family by Clicking on this Link , or the Banner Below.



Our Formula is an exceptional value compared to other Humic Fulvic Minerals because...


It’s OXYGENATED

It Always Tests at 9.5+ pH

Preservative and Chemical Free

Allergen Free

Comes From a Pure, Unpolluted, Organic Source

Is an Excellent Source for Trace Minerals

Is From Whole, Prehisoric Plant Based Origin Material With Ionic Minerals and Constituents

Highly Conductive/Full of Extra Electrons

Is a Full Spectrum Complex


Our Humic and Fulvic Liquid Trace Mineral Complex has Minerals, Amino Acids, Poly Electrolytes, Phytochemicals, Polyphenols, Bioflavonoids and Trace Vitamins included with the Humic and Fulvic Acid. Our Source material is high in these constituents, where other manufacturers use inferior materials.


Try Our Humic and Fulvic Liquid Trace Mineral Complex today. Order Yours Today by Following This Link.

Report abuse

    Comments

    Your Comments
    Question   Razz  Sad   Evil  Exclaim  Smile  Redface  Biggrin  Surprised  Eek   Confused   Cool  LOL   Mad   Twisted  Rolleyes   Wink  Idea  Arrow  Neutral  Cry   Mr. Green

    MOST RECENT
    Load more ...

    SignUp

    Login

    Newsletter

    Email this story
    Email this story

    If you really want to ban this commenter, please write down the reason:

    If you really want to disable all recommended stories, click on OK button. After that, you will be redirect to your options page.