CKD

CKD. Mr. David Miller, a 68-year-old male, presents with Stage 3 chronic kidney disease (CKD) secondary to hypertension and type 2 diabetes. His condition has been stable over the past three months, with no significant changes in symptoms. He denies any new onset of swelling, fatigue, or changes in urine output. He reports good adherence to his current medication regimen. Relevant medical history includes a 15-year history of hypertension, managed with lisinopril, and a 10-year history of type 2 diabetes, managed with metformin. He also has a history of hyperlipidemia, treated with atorvastatin. There is no family history of kidney disease. Current medications include: * Lisinopril 20 mg orally once daily * Metformin 1000 mg orally twice daily * Atorvastatin 20 mg orally once daily * Aspirin 81 mg orally once daily Recent laboratory results: * eGFR: 48 mL/min/1.73m² (October 28, 2024) * Creatinine: 1.6 mg/dL (October 28, 2024) * BUN: 28 mg/dL (October 28, 2024) * Potassium: 4.5 mEq/L (October 28, 2024) * Albuminuria: 150 mg/g creatinine (October 28, 2024) * Hemoglobin: 13.5 g/dL (October 28, 2024) No recent imaging studies have been performed. Management plan includes: * Dietary recommendations: Continue to follow a low-sodium, low-protein diet as advised by the dietitian. * Fluid management: Maintain adequate hydration, aiming for 2-3 liters of fluid per day. * Blood pressure control: Target blood pressure <130/80 mmHg. Continue lisinopril and monitor blood pressure at home. * Glycemic control: Continue metformin and monitor blood glucose levels regularly. HbA1c goal is <7%. * Anemia management: Monitor hemoglobin levels every three months. * Bone mineral disorder management: Ensure adequate calcium and vitamin D intake. Patient education provided regarding CKD progression, self-management strategies, warning signs, and the importance of adherence to treatment. The patient verbalized understanding of the information provided. Follow-up appointment scheduled with the nephrologist in three months. Labs to be performed prior to the next visit include a complete metabolic panel, CBC, and urinalysis.