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

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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Cite this: Anne L. Peters, Pradeep Arora. Skill Checkup: A 64-Year-Old Man With Type 2 Diabetes, Dyspnea, Pruritus, and Pitting Edema of the Bilateral Extremities - Medscape - Dec 20, 2022.