Diagnosing acute otitis media

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Do the words nephrology or kidney evoke terrible memories of the renal section that you never completely understood? This article provides a step-by-step process for evaluating kidney function and offers information on early management of chronic kidney disease (CKD) in a primary-care setting. Identifying CKD facilitates appropriate treatment of this very destructive disease. The clinical scenario of Mr. H will be used throughout the article to illustrate this step-by-step process. Aged 55 years The patient's status one year post-coronary stenting included a history of obesity, type 2 diabetes mellitus, hypertension, and cardiovascular disease (CV D). Mr. H is a current tobacco user with a 30-pack year smoking history. Present medications include insulin, metoprolol (Lopressor, Toprol), and hydrochlorothiazide (HCTZ) (HydroDIURIL, Microzide). Mr. H has retinopathy, a fourth heart sound, +2 lower extremity edema, and peripheral neuropathy. Serum creatinine (sCr) 2.4 mg/dL (up from 2.0 mg/dL one year ago), blood urea nitrogen (BUN) 30 mg/dL, potassium 4.8 mEq/L, hemoglobin (Hb) 10.4 g/dL, HbA1c 9.8%, and spot urine albumin/creatinine 2,500 mg/g. When Mr. H returns for a four-month follow-up visit, should the focus be on weight management or on treating his diabetes? Do you provide advice on smoking cessation? Do you attempt to evaluate kidney function? Most clinicians have likely seen an increase in abdominal girth and obesity among the patient population. The rates of type 2 diabetes continue to increase as well, leading to a rise in the prevalence of CKD. Diabetes is the foremost cause of CKD and end-stage renal disease (ESRD) in the United States, followed closely by hypertension.1 Given this knowledge, it is unethical not to evaluate each at-risk patient for the potential development of CKD. Dialysis has made tremendous advances in prolonging patients' lives once ESRD is reached, but it is not an ideal way to live. Di

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