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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify risk factors for progression of chronic kidney disease (CKD) or diabetic kidney disease (DKD).

  • Develop a care plan utilizing nonpharmacologic and pharmacologic interventions to slow the rate of progression of CKD.

  • Identify clinical and laboratory parameters utilized to evaluate progression of CKD, the efficacy of medication therapy, and to detect or prevent adverse effects.

  • Educate patients about the common medications prescribed for CKD.

PATIENT PRESENTATION

Chief Complaint

“I’m here to review the results of my labs.”

HPI

Christine Karter-Davis is a 38-year-old African-American woman with type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia who returns to her primary care physician (PCP) for a follow-up visit. At her routine physical examination 3 months ago, her annual nephropathy screening revealed 3+ protein and a urine albumin-to-creatinine ratio (UACR) of 659 mg/g. This is elevated from last year’s screening that showed mildly increased UACR and SCr of 1.2 mg/dL. A second spot urine test from 1 week ago showed a persistently elevated UACR of 673 mg/g. She has returned to the office today to review the results of this testing. Ms Karter-Davis arrives in the office today with no complaints and brought with her a list of her medications and self-monitoring blood glucose readings.

PMH

T2DM × 8 years

HTN × 6 years

Dyslipidemia × 5 years

Seasonal allergies

FH

Father had T2DM and cardiovascular disease (CVD) and died at age 50 secondary to myocardial infarction (MI); mother (age 62) has HTN and dyslipidemia. Has one brother (age 31) who also has T2DM.

SH

The patient is an administrative assistant and has medical coverage and prescription drug benefits. She reports occasional alcohol consumption on weekends or when out with friends (one to two alcoholic beverages per month). She smokes one pack per day (ppd); decreased from previously reported two ppd last year. No history of illicit drug use.

Meds

Metformin 1000 mg PO twice daily

Liraglutide 1.2 mg subcutaneously daily

Hydrochlorothiazide 25 mg PO daily

Atorvastatin 20 mg PO daily

Mometasone two sprays (100 mcg) in each nostril once daily PRN allergies

Cetirizine 10 mg PO daily PRN allergies

Naproxen 220 mg PO BID PRN headaches

Multivitamin PO daily

Immunizations

Tdap—4 years ago

All

NKDA, seasonal ...

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