CKD follow-up

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Returns for a chronic kidney disease follow-up

Last visit was ‍ ‍months ago



Current symptoms: ‍none

‍fatigue

‍shortness of breath

‍lower extremity edema, ‍rightleftsymmetrical

‍nausea

‍confusion

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍decreased urine output

‍decreased appetite

‍muscle cramps



Medications:

‍ACE inhibitors, ‍ARBs, ‍Beta blockers, ‍Calcium channel blockers, ‍Diuretics, ‍Erythropoiesis-stimulating agents, ‍Iron supplements, ‍Phosphate binders, ‍Vitamin D supplements

Adherence: ‍goodaveragepoor, ‍adverse effects



Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU

Caffeine: ‍ daily



Diet: ‍goodaveragepoor, ‍high in salt, ‍high in carbs, ‍high in fat, ‍vegan

Physical activity: ‍adequateaveragesedentary

Weight: ‍ ‍lbskg, ‍gainunchangedloss



Labs: ‍unremarkable

Creatinine: ‍ ‍normal

GFR: ‍ ‍normal

Na: ‍ ‍normal, K: ‍ ‍normal

Ca: ‍ ‍normal, Mg: ‍ ‍normal, Phosphate: ‍ ‍normal

PTH: ‍ ‍normal, Vitamine D: ‍ ‍normal

Albumin: ‍ ‍normal

Hb: ‍ ‍normal, Ferritin: ‍ ‍normal, B12: ‍ ‍normal

HbA1c: ‍ ‍normal

Lipids: ‍normal, Cholesterol: ‍, LDL: ‍, HDL: ‍, Triglycerides: ‍

TSH: ‍ ‍normal

Uric acid: ‍ ‍normal

Microalbuminuria: ‍ ‍normal

Urinalysis: ‍ ‍normalproteins



Vaccinations:

Pneumococcal: ‍up-to-dateincompleteunvaccinated

Influenza: ‍up-to-dateincompleteunvaccinated

Covid: ‍up-to-dateincompleteunvaccinated





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Chronic kidney disease ‍likelysuspectedpossible, ‍adequately controlled

DDx: chronic kidney disease, acute kidney injury, chronic glomerulonephritis, polycystic kidney disease, diabetic nephropathy, hypertensive nephrosclerosis, interstitial nephritis, renal artery stenosis, renal vein thrombosis, amyloidosis, systemic lupus erythematosus, multiple myeloma, chronic urinary tract obstruction, nephrolithiasis, drug-induced nephropathy, heavy metal exposure, rhabdomyolysis, HIV-associated nephropathy





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍eGFR, ‍calcium, ‍phosphate, ‍PTH, ‍albumin, ‍HbA1c, ‍lipid profile, ‍ferretin, ‍B12, ‍TSH, ‍uric acid

- Urine: ‍urinalysis, ‍microalbuminuria, ‍protein:creatinine ratio

- Renal ultrasound

Treatments:

- ‍ACEs

- ‍ARBs

- ‍Diuretics

- ‍Phosphate binders

- ‍Vitamin D analogues

- ‍Erythropoiesis-stimulating agents

- ‍Iron supplements

- Dietary counseling: ‍low sodium diet, ‍low potassium diet, ‍low phosphate diet, ‍protein restriction

- Blood pressure control

- Glycemic control

- Lipid control

- Smoking cessation

Further care:

- Referral to dietitian

- Referral to nephrologist

- Follow-up in ‍ ‍monthsyears

- Return if symptoms worsen or new symptoms develop such as swelling, shortness of breath, or decreased urine output