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

On the basis of eGFR, this patient has nephropathy with type 2 diabetes. The stages of nephropathy are:

  • Stage I: Kidney damage with normal or increased eGFR (> 90 mL/min/1.73 m2)

  • Stage II: Mild reduction in glomerular filtration rate (GFR; 60-89 mL/min/1.73 m2)

  • Stage IIIa: Moderate reduction in GFR (45-59 mL/min/1.73 m2)

  • Stage IIIb: Moderate reduction in GFR (30-44 mL/min/1.73 m2)

  • Stage IV: Severe reduction in GFR (15-29 mL/min/1.73 m2)

  • Stage V: Kidney failure (GFR < 15 mL/min/1.73 m2 or dialysis)

Albuminuria category (calculated as albumin-creatinine ratio) is also used to determine the severity of chronic kidney disease (CKD):

  • Category A1 (normal to mildly increased): < 30 mg/g

  • Category A2 (moderately increased): 30-299 mg/g

  • Category A3 (severely increased): ≥ 300 mg/g

The patient has normal albumin levels and increased proteinuria with decreased eGFR. His glucose level and A1c are not controlled. In addition, he has anemia, with a hemoglobin level of 8.7 g/dL, a low serum albumin level, edema, and early signs of a bone and mineral metabolism disorder.

This patient is at risk for a cardiovascular event owing to his eGFR and long history of diabetes, hypertension, tobacco abuse, and hyperlipidemia. Intervention to control these risk factors should start immediately to prevent progression to CKD.


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