56-year-old male patient presenting to the clinic for establishment of services and blood pressure management. Past medical history of hypertension and chronic kidney disease stage four. Surgical history is Dialysis fistula placement two years ago. He has moved to the area due to storm displacement three months ago and he does not have a nephrologist.

His vitals are as follows: BP: 180/98; heart rate 72; bpm 17; 02 Sat 98%

The patient states his blood pressure has been about the same on his home blood pressure cuff. His last labs drawn before he left revealed eGFR of 16 but has not seen the nephrologist since.

He is currently prescribed hydralazine 100 mg TID; Losartan 50 mg b.i.d., Amlodipine 10 mg qday, and Lasix 80 mg Qday.

1. What labs or procedures are you running to confirm your diagnosis?

2. What is your diagnosis?

3. What are your recommendations for the patient?

4. How many classes of medication is the patient currently prescribed?


5. Which medication is best diuretic for patients in kidney failure?


6. What lab finding would be most concerning if elevated in regards to his current medication?


7. Symptoms of worsening kidney function?


8. Which meal would you suggest the patient avoid?


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