Case study
W.B. is a 48 y.o. male who presents with a two-week history of SOB, fatigue, and anorexia. He describes dyspnea on exertion and orthopnea. He denies all
signs of infection or weight loss, but complains his skin has become itchy. PMH is significant for hypertension (untreated), known creatinine elevation, peptic
ulcer disease, and chronic tension headache for which he frequentlytakes Ibuprofen. Physical exam reveals BP 180/110, AV-nicking and cotton-wool spots
perfundoscopy, fine crackles (rales) at lung bases bilaterally, and 2+ pitting edema to knee-levelbilaterally. Diagnosis: Chronic kidney disease.