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Chief Complaint

“I’m here because my dentist said my blood pressure was high”

History of Present Illness

A 55-year-old female presents to clinic for uncontrolled hypertension. Today she is found to Type 2 Diabetes and have multiple risk factors for chronic kidney disease.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. Identify the patient’s risk factors for developing CKD? Explain the mechanism by which these factors may progress the patient’s CKD?

    Hint: See Epidemiology and Etiology, Pathophysiology, Assessment, Table 27-3, and Figure 27-1 in PPP

  2. Which stage of CKD would you classify the patient’s CKD, assuming that she has stable kidney function? What are the goals of therapy?

    Hint: See Assessment and Table 21-1 in PPP

  3. According to the KDIGO guidelines, what is the patient’s blood pressure goal? What is the HbA1c goal?

    Hint: See Treatment in PPP

  4. List the nonpharmacological and pharmacological therapy that may help in slowing the progression of the CKD.

    Hint: See Treatment in PPP

  5. What education points should be provided about this therapy? How would you monitor the efficacy and safety of these therapies in this patient?

    Hint: See Consequences of CKD and ESKD in PPP


The patient returns for follow-up appointment. She is adherent to her medication but is complaining of a dry cough since starting her ACEI. Her labs are unremarkable except her fasting blood glucose is 155 mg/dL. Her in-clinic blood pressure is 128/76. What alternative pharmacologic recommendations would you make for this patient for treatment of CKD?

Hint: See Treatment in PPP


Global Perspective

The World Health Organization reported diabetes and kidney disease were the 9th and 10th leading causes of death in 2019, respectively. It is estimated that 422 million people worldwide have diabetes. Since diabetes is among the leading causes of kidney failure as well as risk factor for cardiovascular disease, preventative treatment strategies should be implemented to reduce progression of kidney failure and cardiovascular outcomes. Kidney Disease: Improving Global Outcomes (KDIGO) is updating the 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (CKD), but currently the guidelines recommend glycemic management for patients with Type 2 Diabetes and CKD to include lifestyle therapy, first-line treatment with metformin and a sodium-glucose cotransporter-2 inhibitor (SGLT2i), and additional drug therapy as needed for glycemic control.

Key References

1. +
The top 10 causes of death. World Health Organization (WHO). Accessed June 28, 2022.
2. ...

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