PRES Hypertensive Emergency Non-CNI — ESENeph MCQ

Correct answer: A — Lower blood pressure controllably while treating seizures and triggers

The best answer is “Lower blood pressure controllably while treating seizures and triggers”. PRES management addresses seizures, controlled blood-pressure reduction and precipitating renal, pregnancy, autoimmune or drug factors; follow-up confirms clinical and radiological recovery. “Lower blood pressure immediately with an uncontrolled intravenous bolus” is less appropriate because excessively rapid reduction can cause cerebral or myocardial ischaemia “Give glucocorticoids while maintaining the presenting blood pressure” is less appropriate because PRES is a vasogenic-oedema syndrome with multiple triggers “Continue calcineurin-inhibitor exposure while treating seizures alone” is less appropriate because offending medicines require urgent level and treatment review “Observe blood pressure while awaiting repeat neurological imaging” is less appropriate because early removal of the trigger improves reversibility

Reference: NICE NG203: chronic kidney disease assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations