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Abstract: This 55-year-old patient had elevated glucose for 20 years, proteinuria for 2 years, and bilateral lower extremity edema for 6 months. Recently, he visited our hospital due to the aggravation of grade 3 hypertensive edema, which lasted for 1 month, and was examined for chronic kidney disease stage 4 with a variety of comorbidities. After 1 month of medication treatment, the indicators were stabilized and the disease was effectively controlled at the follow-up examination.
Basic information】Male, 55 years old
Disease Type】Chronic kidney disease stage 4
Hospital】People’s Hospital of Peking University
Date of consultation】December 2021
Treatment plan】Oral medications (roxacostat capsules, furosemide tablets, spironolactone tablets, aurolol hydrochloride tablets, benidipine hydrochloride tablets, doxazosin mesylate extended-release tablets, compound alpha-keto acid tablets)
[Treatment period] Hospitalization for 2 weeks, regular review
Treatment effect】The disease has been controlled, and all indicators are improving
I. Initial consultation
The patient is a middle-aged male with chronic disease. The patient was diagnosed with type 2 diabetes mellitus for 20 years. 2 years ago, a routine urine examination revealed 24h urine protein of 0.72g/d, and a renal function test revealed blood creatinine of 61umol/L. The patient was also diagnosed with diabetic retinopathy by fundus fluorescence angiography and underwent laser surgery for retinal hemorrhage.
Six months ago, the patient’s blood creatinine rose to 110umol/L, blood albumin 29g/L, urine protein ++, and a renal puncture indicated diabetic nephropathy. In the last month, the patient’s edema increased and his blood pressure rose to 200/110 mmHg and he came to our hospital again. After consultation, it was clear that he had a history of hypertension and diabetes mellitus, sulfa allergy, and the rest was not special. The patient was initially diagnosed as having “chronic kidney disease”, the onset of which was related to diabetes mellitus.
II. Treatment history
After admission, the patient’s blood biochemical examination was completed, and it was found that albumin was 23.9g/L, potassium ion concentration was 2.94mmol/L, and all index levels were decreased. Using renal function tests, it was found that the creatinine level was 284umol/L, which was high, and the estimated glomerular filtration rate was 20.57ml/min×1.73m2, which was significantly lower. In addition, the patient’s 24h urine protein quantification of 16.64g/d was measured, which was significantly high, along with the presence of severe edema and high blood pressure. Based on the examination results, the diagnosis of chronic kidney disease stage 4 could be clarified.
Considering the following complications of chronic kidney disease, the patient was given the following therapeutic measures: 1. anemia of chronic kidney disease, with the addition of rosarostat capsules to improve anemia; 2. volume problems: strict salt and water restriction, with the addition of furosemide tablets combined with spironolactone tablets for diuresis; 3. hypertension: firstly, the presence of volume problems was considered, and until the volume problems were completely solved, the application of aurolol hydrochloride tablets, benidipine hydrochloride tablets, mesylate Doxazosin extended-release tablets combined with antihypertensive; 4. Nutritional status: add compound α-keto acid tablets to improve nutrition.
Treatment effect
After 2 weeks of hospitalization, the patient’s indexes improved well, and the edema improved significantly after strict salt and water restriction. After standardized medication, the patient’s blood pressure was stable, with systolic blood pressure basically controlled at 130-140 mmHg and diastolic blood pressure basically controlled at 80-90 mmHg. Meanwhile, the bone metabolism level was still relatively stable, and the patient was discharged from the hospital and advised to pay attention to review.
IV. Notes
We are glad that the patient’s condition is stable and controlled, but we need to advise the patient to pay attention to the following points.
1, pay attention to rest, avoid cold, infection, nephrotoxic drug application.
2, regular monitoring of blood pressure and blood sugar, monitoring of urine volume, weight, edema, attention to low salt, low fat, high quality protein, diabetic diet.
3, regular application of drugs after discharge from the hospital, avoid increasing or decreasing the amount of drugs on their own.
4. Pay attention to a low-sugar, low-fat diet and avoid eating greasy and high-sugar foods, so as not to affect blood sugar control.
V. Personal insight
This patient is in stage 4 chronic kidney disease. Although her condition was controlled stably during hospitalization, she still needs long-term medication to control blood glucose and blood pressure, and all complications need to be monitored regularly and treated accordingly. In addition to medication, lifestyle guidance is also very important, and sometimes the role of prevention is much greater than treatment.
In addition, these patients need to pay attention to the treatment of the original disease, as well as blood pressure, nutritional status, whether anemia, etc. The follow-up is not just a simple “take medicine and test”, but also needs to adjust the type or dose of drugs according to the indicators of each period of examination, which can help to slow down the progress of kidney function.