Interval History: The patient’s CKD continues to worsen. GFR is down
to 26 mls/min. Proteinuria has also not improved and is now well above
the nephrotic range. HTN is currently well controlled with systolic pressures
running in the 120s at home.
PMH: remarkable for CAD. FH negative for hereditary renal disease.
ROS: Constitutional: Negative for fevers or chills, positive for fatigue.
GU: Negative for gross hematuria or flank pain. GI: Negative for nausea
or vomiting. All other systems reviewed and are negative.
Exam: BP 130/78, HR 85, RR 18. Lungs are clear. Heart RRR. There is
significant lower extremity edema.
Labs: creatinine 2.8, prot/creat ratio is 3700 mg/g. LDL 130.
Impression:
1. Worsening nephrotic range proteinuria
2. Worsening stage IV CKD
3. Worsening hyperlipidemia
Plan:
1. Renal biopsy will be scheduled for this week.
2. Continue current ARB/ACE inhibitor unchanged.
3. Increase SIMVASTATIN to 80 mg PO QD.
4. RTC next week to go over results of biopsy.
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