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1. A 65-year-old man with a history of hypertension,
diabetes, and chronic kidney disease presents to the clinic
with fatigue, dyspnea, and edema. His blood pressure is
180/100 mmHg, his blood glucose is 250 mg/dL, and his
serum creatinine is 3.5 mg/dL. What is the most
appropriate initial management for this patient?
A) Start intravenous furosemide and insulin
B) Refer to nephrology for dialysis evaluation
C) Adjust his antihypertensive and antidiabetic medications
D) Order an echocardiogram and a chest x-ray
Answer: C) Adjust his antihypertensive and antidiabetic
medications
Rationale: This patient has poorly controlled hypertension
and diabetes, which are the main risk factors for chronic
kidney disease. The first step in managing his condition is
to optimize his blood pressure and blood glucose levels,
which may improve his symptoms and slow down the
progression of kidney damage. Intravenous furosemide and
insulin may be indicated in cases of acute decompensated
heart failure or diabetic ketoacidosis, respectively, but there
is no evidence of these conditions in this patient. Referral
to nephrology for dialysis evaluation may be necessary in
the future, but it is not the first priority at this stage. An
echocardiogram and a chest x-ray may help to assess the
cardiac function and rule out pulmonary causes of dyspnea,
but they are not essential for the initial management.
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