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A 70-year-old man has visited you with an incidental finding of elevated creatinine and urea of 1.3 mg/dL and 75 mg/dL respectively. By using Medscape, you estimated his GFR to be 55 mL/min/1.73 m². He is a known case of diabetes mellitus, hypertension, and osteoarthritis. His recent HbA1c is 6.8. He takes chronic medications which are amlodipine, metformin, glimepiride, paracetamol, diclofenac, and vitamin D3. Which of the following would be your next step?

a. Withhold diclofenac and send for urine albumin-creatinine ratio
b. Withhold metformin and send for urine albumin-creatinine ratio
c. Withhold diclofenac and send for kidney biopsy
d. Withhold amlodipine and send for kidney biopsy
e. Stop metformin and start insulin



Answer :

clerisek321

Answer:

The next step would be to withhold diclofenac and send for urine albumin-creatinine ratio. Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can potentially worsen kidney function, especially in individuals with pre-existing kidney issues like your patient. Checking the urine albumin-creatinine ratio can help assess for any signs of kidney damage or dysfunction. It is important to monitor kidney function closely in patients with diabetes, hypertension, and osteoarthritis, as they are at higher risk for kidney complications.

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