Chronic Kidney Disease
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Case Study 1
A Female aged 44 has a history of chronic back pain and has well controlled hypertension.
Her BMI is 42. BP 130/80
Current medications include trandolapril and Indapamide.
She has had some raised fasting BSL at 6.2 (normal <5.4)
Cholesterol 4.8, TG 1.6
Her eGFRs ranged between 55 and 70 over the past 5 years, with the numbers being stable about 66 recently.
Her urine is clear on dipstick.
Case Study 2
Neville, aged 78 has had NIDDM for 20 years. He has been well controlled on Metformin. His BP has been difficult to control. Since 1998 he has had proteinuria that was variable on timed results, but has been persistently elevated since 2005 and rising.
He has had some prostatism and has seen a urologist and renal ultrasound scan is normal.
His Hb is reducing over time and is now 105 g/l
His HbA1c has been under 7 for years and the fructosamine is only mildly elevated.
On atorvastatin his Chol is 4.5, TG 0.7 and LDL 1.7 and HDL 2.5
In 2006 eGFR was 58, in 2008 it was 36 ml/min and in 2010 was 30.
What further management issues need addressing?