Skill Checkup: A 64-Year-Old Man With Type 2 Diabetes, Dyspnea, Pruritus, and Pitting Edema of the Bilateral Extremities

Anne L. Peters, MD; Pradeep Arora, MD


December 20, 2022

A 64-year-old White man in the United States presents with shortness of breath, pruritus, and pitting edema of the bilateral extremities, present for 1 month. He has a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia, and a 40 pack-year history of smoking. His blood pressure is 160/95 mm Hg, heart rate of 97 beats/min (regular rate and rhythm), and respiration of 26 breaths/min. He also has proliferative retinopathy. He is 6 ft (1.83 m) tall and weighs 195 lb (88.46 kg; body mass index [BMI] of 25.8). He is currently taking metformin 2550 mg/day. A year ago, his estimated glomerular filtration rate (eGFR) was 66 mL/min/1.73 m2, and he had 1+ proteinuria. He was referred to a nephrologist but didn't go.

Laboratory tests reveal hemoglobin level of 8.7 g/dL, creatinine of 3.4 g/dL, eGFR of 32 mL/min/1.73 m2, serum albumin of 3.3 g/dL, A1c of 8.8%, low-density lipoprotein of 143 mg/dL, high-density lipoprotein of 43 mg/dL, random glucose of 186 mg/dL, albumin-creatinine ratio of 3250 mg/g, calcium of 8.7 mg/dL, phosphorus of 4.2 mg/dL, plasma parathyroid hormone of 77 pg/mL, and C-reactive protein of 12.


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