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

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.