CKD

Chronic kidney disease (CKD) is a very common medical problem on the wards in the US. Today I saw my first patient in at MRTH with CKD and this is how she looked: sick-appearing and unresponsive (GCS of 8), severe anasarca on a background of significant wasting giving the eerie appearance of a collection of stark, protruding bones surrounded by puffing, bloated tissue, and labs clearly demonstrating kidney failure (GFR of 7 and a BUN of 80). She was also severely hypertensive (BP 188/130). Now this is just one example of how sick patients often become before they end up in the hospital. And what could we do for her? Give her medications to lower her blood pressure (we did discuss the JNC 8 guidelines before doing this) and recheck her labs. Despite her likely uremic encephalopathy, urgent dialysis was not an option. Now contrast that to the many sometimes ill but generally well-appearing CKD patients we see every day in the US.