CLINICAL CASE STUDY Frd, a 67-year-old Caucasian man, is seen by his primary car

Question

CLINICAL CASE STUDY Frd, a 67-year-old Caucasian man, is seen by his primary care physician. Fred lives with a significant other and has an active lifestyle (golfing, biking, swimming) and a history of hemicolectomy, diverticulitis, and hypertension. His weight is 240 lb. His laboratory values show serum creatinine of 3.3 mg/dl, BUN of 72 mg/dl, albumin of 4.1 mg/dL, potassium of 5.5 mEa/L, phosphate of 6.7 mg/dl, calcium of 8.3 mg/dl, and his parathyroid hormone is 365 pg/ml. Blood pressure is 160/92 Nutrition Diagnostic Statement Altered laboratory values related to hypertension as evidenced by estimated glomerular filtration rate (eGFR) calculation. l. What is Fred's calculated eGFR? 2. What is his stage of chronic kidney disease (CKD)? 3. What is the first goal for your education of Fred? 4. What dietary factors would you address based on Fred's laboratory values? 5. What is the goal for his protein intake? 6. How would you assess Fred for improvement or stability of his CKD? 7. What would you expect for him during the next few years if no diet intervention is followed?

Explanation / Answer

(1)18 mL/min/1.73m2

GFR the finest general index of kidney function. A standard eGFR for adults is more than 90 mL/min/1.73m2. Also recognized as CKD-EPI creatinine equation.

(2)Since GFR rate is less than 60 mL/min/1.73m2 for more than or equal to 3 months, it is Stage 4 diagnoses of CKD.

(3)Education is as follows:

-Avoid smoking

-Exercise at intervals

-Avoid OTC drugs that are harmful for CKD patients. Take medications as prescribed by your doctor.

(4)Dietary factors:

-Limiting foods that are high in protein, saturated fats, phosphorus, potassium and sodium, all of which can put extra strain on your kidneys.

(5) Protein intake may be limited to 12 to15 percent of your calorie intake each day for stage 4 CKD. Reduce intake of proteins high in phosphorus as well.

(6)When the eGRF rates shows improvement, that’s a sign of stage 4 CKD disease in control.

(7)If no diet interventions are done/ not possible to be done, dialysis may be preferred.

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