Renal Case: 57-year-old Man with Increased Serum Creatinine

00:01 Okay. So let's go to another case.

00:03 We're asked to see a 57 year-old African-American gentleman who's new to have a serum creatinine of 2.1 milligrams per deciliter.

00:10 We can see that that's elevated.

00:11 7 years ago, his serum creatinine was one point four milligrams per deciliter.

00:16 So still elevated.

00:17 He has a history of hypertension that was diagnosed over 17 years ago.

00:21 He has dyslipidemia and is a user of tobacco has a retinal exam interestingly have something that's called cotton wool spots due to retinal ischemia.

00:32 His serum creatinine is remarkable for 2.1 milligrams per deciliter.

00:36 Again, that's elevated and is eGFR by ckd-epi is 34 mils per minute.

00:41 He also has on urine analysis one plus positive dipstick for proteinuria and it's estimated at about six hundred and eighty milligrams per gram on the spot protein to creatinine ratio.

00:52 So the question is what type of chronic kidney disease does this patient have? Let's through our clinical case and answer that question.

01:00 So couple of things to note that are important.

01:02 Number 1. He has an elevated serum creatinine.

01:05 So he's gone from 1.4 to a 2.1 over a seven-year period of time.

01:10 So that's important to note that this patient does have chronic kidney disease, also on physical exam, He has these cotton wool spots that's important because that indicates that he has end organ damage from his hypertension.

01:23 So not only is he having retinal damage.

01:25 He's likely having chronic kidney disease damage as well.

01:28 And that decrease in GFR, that increase in proteinuria again is suggestive of chronic kidney disease.

01:35 So taken together.

01:36 This gentleman has hypertension or hypertensive vasculopathy.