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INTRODUCTION

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LEARNING OBJECTIVES

  • List the risk factors for development and progression of chronic kidney disease (CKD)

  • Explain the mechanisms associated with progression of CKD

  • Outline the desired outcomes for treatment of CKD

  • Develop a therapeutic approach to slow the progression of CKD, including lifestyle modifications and pharmacologic therapies

  • Recommend an appropriate monitoring plan to assess the effectiveness and safety of pharmacotherapy for slowing the progression of CKD

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PATIENT PRESENTATION

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Chief Complaint

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"I am worried about going fishing with my grandson. I don't feel like eating supper and have just not felt well lately."

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History of Present Illness

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Alfred Statton is a 70-year-old African-American male who presents with complaints of "not feeling well," loss of appetite, and anxiety about his overall wellness. He has had a lack of energy for the past year, but has attributed it to old age. The patient denies nausea or vomiting, but has noticed over the past 6 months that food "just doesn't taste the same," and he has been eating only two small meals a day. He was last seen by a physician approximately 7 years ago, at which time he was started on HCTZ and amlodipine for HTN. The patient reports that he felt worse on the medications, stopped taking them, and decided never to go back. He is very anxious about taking care of his 5-year-old grandson next Saturday and wants to make sure that he is healthy.

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Past Medical History

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HTN: diagnosed 20 years ago, untreated

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Osteoarthritis: diagnosed 15 years ago

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Kidney stones: 1981, 1990, and 1996

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Family History

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Father: Deceased from MI in his 80s

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Mother: Deceased from cervical cancer in her 60s

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Social History

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The patient is retired but volunteers at the local food bank twice a week as a shelf stocker. Currently, he smokes 1½ ppd of cigarettes and denies alcohol or illicit drug use. His physical activity is limited by osteoarthritis.

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Medications

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The patient denies taking any prescription, OTC, or herbal medications.

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Allergies

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No known drug allergies

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Physical Examination

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General
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Elderly African-American male in no acute distress

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Vital Signs
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BP 160/98 mm Hg, P 96 bpm, RR 13, T 36.5°C, pain 0

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Weight 178 lb (81 kg)

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Height 70 in. (178 cm)

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Skin
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Cool-to-touch, dry-appearing skin and scalp; no rashes/lesions

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HEENT
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PERRLA; conjunctivae normal; wears bilateral hearing aids

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Neck and Lymph Nodes
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