HPI: This is an initial office visit for a patient with severe renal insufficiency (estimated GFR of 24 mls/min) found on routine labs about one month ago and associated with severe proteinuria.
PFSH/ROS: See today's intake form. Note is made of history of a NIRDM and hypertension.
Exam: See intake form. Note that the blood pressure is 156/80.
Labs: Electrolytes are normal. Creatinine is 2.3, prot/creat ratio is 3800 mg/g. LDL 130, HGBA1c 6.8.
Impression
Severe stage IV CKD most likely due to diabetic nephropathy
Poorly controlled HTN with SBP of 156 and target SBP of 130/80
Severe nephrotic range proteinuria
Well controlled diabetes
Well controlled hyperlipidemia
Plan
Add COZAAR 100 mg PO QD to current ACE inhibitor therapy.
Check renal profile across my desk this week to check potassium.
Patient was educated about current GFR and various stages of CKD.
We also discussed the modifiable risk factors to delay progression.
RTC in two weeks with renal profile and spot prot/creat.
We briefly discussed the indications for renal biopsy, but will hold off for now.
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