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
"I am worried about going fishing with my grandson. I don't feel like eating supper and have just not felt well lately."
History of Present Illness
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.
HTN: diagnosed 20 years ago, untreated
Osteoarthritis: diagnosed 15 years ago
Kidney stones: 1981, 1990, and 1996
Father: Deceased from MI in his 80s
Mother: Deceased from cervical cancer in her 60s
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.
The patient denies taking any prescription, OTC, or herbal medications.
Elderly African-American male in no acute distress
BP 160/98 mm Hg, P 96 bpm, RR 13, T 36.5°C, pain 0
Cool-to-touch, dry-appearing skin and scalp; no rashes/lesions
PERRLA; conjunctivae normal; wears bilateral hearing aids