From the Guidelines
The workup for new onset kidney disease in a 60-year-old woman with a creatinine of 1.45 and normal renal ultrasound should include a comprehensive approach to identify the underlying cause, starting with a review of her current medications, such as rosuvastatin and Eliquis, which can affect kidney function, as suggested by 1 and 1.
Initial Steps
The initial steps in the workup should include:
- A complete urinalysis to check for proteinuria, hematuria, or signs of infection
- A urine protein-to-creatinine ratio to quantify any protein excretion
- Blood tests, including a complete metabolic panel, complete blood count, and markers for inflammation (ESR, CRP)
- Testing for diabetes with HbA1c and fasting glucose
- Specific serologic tests for autoimmune conditions, such as ANA, ANCA, anti-GBM antibodies, complement levels, and immunoglobulins
Calculating eGFR
Calculating her estimated glomerular filtration rate (eGFR) is crucial to determine the stage of kidney disease, as recommended by 1.
Nephrology Consultation
If these initial tests do not reveal the cause, a nephrology consultation should be considered for possible kidney biopsy.
Considerations
This comprehensive approach is necessary because kidney disease can result from various causes, including medication effects, diabetes, hypertension, glomerulonephritis, or systemic diseases, and early identification allows for targeted treatment to prevent further kidney damage, as highlighted by 1 and 1.
Medication Adjustment
Additionally, consideration should be given to adjusting her medications, such as Eliquis, which may need to be dose-adjusted based on her renal function, as suggested by 1 and 1.
Blood Pressure Management
Management of blood pressure is also crucial, with a goal of less than 140/90 mm Hg, as recommended by 1, especially since the patient has chronic kidney disease.
Conclusion is not allowed, so the response ends here.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Evaluation of New Onset Kidney Disease
The patient presents with a creatinine level of 1.45, which indicates impaired kidney function. According to 2, the Kidney Disease: Improving Global Outcomes (KDIGO) defines acute kidney injury (AKI) as an increase in serum creatinine level of 0.3 mg/dL or more within 48 hours, or an increase of 1.5 times or more of the baseline level within 7 days.
Medication Review
The patient is taking Eliquis, rosuvastatin, Vyvanse, and Lunesta. Rosuvastatin, a statin, has been shown to have beneficial effects on kidney function, including reducing proteinuria and glomerular filtration rate loss in chronic kidney disease patients 3, 4. However, the effect of rosuvastatin on kidney function in this patient is unclear.
Diagnostic Approach
The patient has undergone a renal ultrasound, which was normal. Further evaluation should include:
- Urinalysis with microscopy to narrow the differential diagnosis 2
- Assessment of fluid volume status through physical examination and laboratory tests
- Review of medication list to identify potential nephrotoxic agents
- Consideration of other potential causes of kidney disease, such as diabetes and hypertension
Management
Management of kidney disease should focus on:
- Control of underlying causes, such as hypertension and diabetes
- Achievement and maintenance of euvolemia
- Nutritional optimization
- Blood glucose control
- Pharmacotherapy, including potential adjustment of medications that may be affecting kidney function 2
- Consideration of referral to a nephrology subspecialist if the etiology of the kidney disease is unclear or if the patient has stage 2 or 3 AKI 2