Latest Blogs

NEW - Transplant Online Course

Transplantation Online Course (TOC)

Brand new 6 month online course in renal transplantation -> the OLA TOC

  • a faculty of 10 experts
  • 31 brand new, up-to-date video lectures
  • more than 110 questions and cases studies
  • a focus on reflective practice and critical appraisal of literature
  • discussion and tutoring via OLA forum and Facebook microsite

  • 65 70 78 students have just started. THIS COURSE CLOSED
  • email us for details of the next course after you have signed up to OLA

Case of the Month

  April 2016

55 yr old male presents via ED with severe thoracic back pain which is tearing in nature. He is agitated and does not speak English. He has a raised BMI but unknown past medical history and unknown drug history. The clinical examination is unremarkable but he is found to be grossly hypertensive with a systolic of 195/100 mmHg with a heart rate of 80bpm. ECG is normal. His initial bloods are as follows: 

Hb 150 g/L
WCC 7.2 x109/L
Plts 230 x109/L 

Na 143 mmol/L
K 4.8 mmol/L
Ur 8.2 mmol/L
Cr 110 µmol/L

A CT thorax with contrast reveals an extensive Stanford Type B aortic dissection which extends from the arch of the aorta into both iliac vessels. There is significant flow within the false lumen and the left renal artery arises from the false lumen. Other major blood vessels arise from the true lumen. There is evidence of atherosclerotic disease and narrowing of both renal arteries.

The dissection is for conservative management with the primary goal to achieve rapid blood pressure control aiming for a systolic blood pressure of 120mmHg. Consequently, he is admitted to critical care for close monitoring.

What is the most appropriate first line pharmacological treatment for his hypertension?

Read: 647 times Answered: 119 times Top score: 100%

Current Discussions

    • elnahas's Avatar
    • Endoplasmic Reticulum Stress P...
    • Increasingly, one observes research for the sake of research and ensuing publications for the sake of publications...this is an example of such research with little clinical relevance as the clinical...
    • 21 hours 52 minutes ago
    • elnahas's Avatar
    • Metabolomics of Chronic Kidney...
    • Of course, you are very correct. We can "predict" outcomes in most patients with CKD, using simple parameters such as age, gender, ancestry, GFR, albuminuria-- the "added value" of Metabolomics and...
    • 22 hours 18 minutes ago
    • elnahas's Avatar
    • Metabolomics of Chronic Kidney...
    • The search for biomarkers of CKD progression from proteomics to metabolomics seems futile considering that around 60-70% of progression is predicted by proteinuria...very few "new biomarkers" seem to...
    • 1 day 8 hours ago
    • elnahas's Avatar
    • Reduced Cardiovascular Mortali...
    • Is it a case of confounded by indication; meaning that those who were well enough to have a functioning VA had almost by definition better vasculature and better CVD outcomes, compared to those who...
    • 1 day 8 hours ago
    • yvonne's Avatar
    • Metabolomics of Chronic Kidney...
    • Metabolomics of Chronic Kidney Disease Progression: A Case-Control Analysis in the Chronic Renal Insufficiency Cohort Study
    • 1 week 21 hours ago

OLA activity

  • nabeel mahdi
    Logged in
    2 hours ago
  • saddam hassan abdel aziz
    Logged in
    3 hours ago
  • Mostapha Habib Allah
    Logged in
    6 hours ago
  • achraf hendawy
    viewed Regenerating kidneys - are RAS blockers the answer?
    7 hours ago
  • achraf hendawy
    viewed Arif Khwaja
    7 hours ago
  • achraf hendawy
    Logged in
    7 hours ago
  • Mostapha Habib Allah
    Logged in
    9 hours ago