A lifestyle medicine (LM) practice aims to treat the whole person, with a focus on addressing the root lifestyle causes of disease. Creating a practice in LM comes with an array of challenges. Utilizing different payment systems and practice models, such as cash, traditional insurance, Direct Primary Care model, or concierge systems, allows for the incorporation of more LM services and ensures sustainability in the practice. One must develop a sound business model and aim to keep costs low. Optimizing coding, taking advantage of additional LM services, and expanding service formats to group visits or telemedicine are all creative ways to incorporate and develop LM practices. Anticipation of new challenges and flexibility in practice models and payment systems allows one to be successful in starting or transitioning to an LM practice.
A 19-year-old male presented to the clinic and was found to be prehypertensive
and have proteinuria on urine testing. He was subsequently diagnosed with focal
segmental glomerulosclerosis (FSGS). Initial workup for pediatric hypertension
includes urinalysis, chemistry panel, lipid panel, and renal ultrasound.
Abnormalities on urinalysis, including proteinuria, hypercholesterolemia, and
low serum albumin in children are characteristic of nephrotic disease. FSGS is a
type of kidney pathology that often contributes to nephrotic disease and results
from a variety of causes. For the primary care provider, being aware of the
guidelines for pediatric hypertension screening and evaluation is important as
20% of children with hypertensive disease are due to kidney disease. FSGS is the
third leading cause of end-stage renal disease in children aged 12 to 19 years,
and its incidence was found to be rising in a study of Olmsted County, MN
residents. Treatment to complete or partial remission of the proteinuria can
slow the progression of renal disease. In this case report, we will discuss the
evaluation of pediatric hypertension workup with proteinuria, specifically due
to FSGS, and review current management strategies.
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