CASE STUDY #2

A 62-year-old male with a history of Hypertension, Hyperlipidemia and Type 2 diabetes presents to your office to review his recent lab results. He is taking Metformin and Glyburide and his most recent A1C is 9.4. His blood pressure today is 164/96 and he is taking Lisinopril 20mg and HCTZ 50mg daily. He also takes Simvastatin 40mg daily.
His current BMI is 41.2 and he reports that he remains sedentary, despite promising that he would begin walking for 30″/day. He admits to smoking 1 ppd, drinking 1 glass of wine per day and eating a high carbohydrate, high fat diet.
At his last visit 6 months ago, his CMP and CBC were normal. His A1C was 9.8 and his lipid profile was basically the same as it is today.
His most recent lab results are as follows:
A1C 9.4
CBC: WBC 7.5, H&H 11.9/34 and PLTs 245
CMP: BS 175, Na 138, K 5.4, Cl 106 BUN 42 and Creatinine 2.1.
Lipid profile: Total chol 284, LDL 129, HDL 36 and TRGs 455.
You suspect that this patient is developing chronic kidney disease (CKD). Follow the guidelines of the rubric, and also be sure to please cover the following topics in your paper: What are the most common causes of chronic kidney disease? Describe the pathogenesis in which CKD develops and your treatment plan.

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