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Stage IV Chronic Kidney Disease
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Journal Article
Stage IV Chronic Kidney Disease
2010
Overview
A 54-year-old woman with type 2 diabetes presents for care. Her creatinine level has increased from 1.1 mg per deciliter (97 μmol per liter) 4 years ago to 3.1 mg per deciliter (274 μmol per liter) at the most recent measurement (estimated glomerular filtration rate, 26 ml per minute per 1.73 m
2
of body-surface area). Her urinary protein excretion is 2.8 g per 24 hours. Her blood pressure is 155/90 mm Hg, and the glycated hemoglobin level is 7.6 mg per deciliter. Her current medications include an oral hypoglycemic agent, an angiotensin-converting–enzyme inhibitor, a statin, and a thiazide diuretic. How should her case be managed?
A 54-year-old woman presents with advanced diabetic kidney disease and proteinuria. How should her case be managed?
Foreword
This
Journal
feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.
Stage
A 54-year-old woman with an 11-year history of type 2 diabetes presents for care. She was first noted to have proteinuria 4 years earlier; her serum creatinine level then was 1.1 mg per deciliter (97 μmol per liter). Her urinary protein excretion has progressively increased to 2.8 g per 24 hours, and her serum creatinine level to 3.1 mg per deciliter (274 μmol per liter). The estimated glomerular filtration rate (GFR) is 26 ml per minute per 1.73 m
2
of body-surface area. Her blood pressure is 155/90 mm Hg, and the glycated hemoglobin level is 7.6 mg per deciliter. . . .
Publisher
Massachusetts Medical Society
Subject
/ Angiotensin-converting enzyme inhibitors
/ Biological and medical sciences
/ Diabetes
/ Diabetes mellitus (non-insulin dependent)
/ Kidneys
/ Nephrology. Urinary tract diseases
/ Nephropathies. Renovascular diseases. Renal failure
/ Patients
/ Studies
/ Urinary system involvement in other diseases. Miscellaneous
