Renal Case: 49-year-old Man with Increased Serum Creatinine

by Amy Sussman, MD

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    00:01 Okay, let's move to another clinical case.

    00:04 You're asked to see a 49-year Old Gentleman who is noted to have a serum creatinine of 1.9 milligrams per deciliter.

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

    00:12 Four years ago, his serum creatinine was 1.1.

    00:16 He has a history of type 2 diabetes mellitus, hypertension and dyslipidemia.

    00:21 His labs are remarkable for a serum creatinine of 1.9.

    00:24 We can see that that's elevated has estimated GFR by ckd-epi is 40 mils per minute and he has 2 plus dipstick positive proteinuria.

    00:33 His actual protein to creatinine ratio is estimated at 1.2 grams per gram.

    00:38 So he has a fair amount of protein in his urine also of important note his hemoglobin A1c which measures his blood glucose activity over a three month period of time is quite high at 9.4 percent.

    00:51 So the question is, what is the most likely cause of this gentleman's chronic kidney disease.

    00:56 Let's go back through our case and see if we've got some clues for our diagnosis.

    01:00 So he's got a creating of 1.9 that is indicative of CKD.

    01:05 We know that that's been sustained over time.

    01:08 He also has a clinical marker for kidney damage.

    01:12 This gentleman has proteinuria on his spot protein to creatine ratio, but I think the big thing that really helps us is this gentleman has a history of diabetes and not only does he is he a diabetic he is likely not controlled because that A1C is 9.4% and where we'd really like that to be as less than 7%.

    01:31 So taken together, the proteinuria which is seen in diabetic kidney disease and that uncontrolled diabetes mellitus is like the the cause of this gentleman's underlying chronic kidney disease.

    01:43 So again, our answer is diabetic kidney disease.

    About the Lecture

    The lecture Renal Case: 49-year-old Man with Increased Serum Creatinine by Amy Sussman, MD is from the course Chronic Kidney Disease (CKD).

    Included Quiz Questions

    1. Diabetes mellitus
    2. Systemic lupus erythematosus
    3. Staghorn calculi
    4. Polycystic kidney disease
    5. Unresolved acute kidney injury

    Author of lecture Renal Case: 49-year-old Man with Increased Serum Creatinine

     Amy Sussman, MD

    Amy Sussman, MD

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