What is the interpretation of the following lab results: impaired fasting glucose (101 mg/dL), normal Blood Urea Nitrogen (BUN) (16 mg/dL), mildly elevated creatinine (1.06 mg/dL), decreased estimated Glomerular Filtration Rate (eGFR) (66 mL/min/1.73), elevated chloride (108 mmol/L), low carbon dioxide (15 mmol/L), and mildly elevated Alanine Transaminase (ALT) (33 IU/L)?

From the Guidelines

The patient's laboratory results indicate mild hyperglycemia, kidney function impairment, and metabolic acidosis, requiring prompt attention and management to prevent progression of kidney disease and other complications. The glucose level is elevated at 101 mg/dL (normal range 70-99 mg/dL), indicating mild hyperglycemia. Creatinine is also elevated at 1.06 mg/dL (normal range 0.57-1.00 mg/dL), suggesting some degree of kidney function impairment. The eGFR is 66 mL/min/1.73m², which falls into Stage 2 chronic kidney disease category according to the KDOQI classification provided 1. There are also electrolyte imbalances, with chloride being elevated at 108 mmol/L (normal range 96-106 mmol/L) and carbon dioxide significantly low at 15 mmol/L (normal range 20-29 mmol/L), indicating a possible metabolic acidosis. Additionally, ALT is slightly elevated at 33 IU/L (normal range 0-32 IU/L), which may suggest mild liver stress.

Key Findings and Recommendations

• The patient's eGFR indicates Stage 2 chronic kidney disease, and they may benefit from receiving metformin and an SGLT2 inhibitor to reduce risks for CKD and CVD, as recommended by the 2020 KDIGO clinical practice guideline 1.
• Lifestyle modifications, including dietary changes, adequate hydration, and regular exercise, are essential for managing mild hyperglycemia and kidney function impairment 1.
• The patient should be monitored for progression of kidney disease, and further evaluation of the cause of metabolic acidosis is recommended.
• Glycemic targets should be individualized for patients with diabetes and CKD, and appropriate targets may vary from as low as less than 6.5% to as high as less than 8%, depending on patient factors that place them at risk for hypoglycemia 1.

Management and Treatment

• The patient should be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance 1.
• Sodium intake should be limited to less than 2 g of sodium per day, and protein intake should be maintained at 0.8 g protein/kg (weight)/d for those with diabetes and CKD not treated with dialysis 1.
• The patient's medication regimen should be reviewed, and consideration should be given to adding an SGLT2 inhibitor or a GLP-1 RA to their treatment plan, as recommended by the 2020 KDIGO clinical practice guideline 1.

From the Research

Laboratory Results Interpretation

• Glucose level is 101 mg/dL, which is above the high normal range of 70-99 mg/dL 2.
• BUN (Blood Urea Nitrogen) level is 16 mg/dL, within the normal range of 6-24 mg/dL 2.
• Creatinine level is 1.06 mg/dL, above the high normal range of 0.57-1.00 mg/dL, indicating potential kidney function impairment 3, 4.
• eGFR (estimated Glomerular Filtration Rate) is 66 mL/min/1.73, within the normal range, but the creatinine level is above normal, which may indicate a need for further evaluation 4, 5.
• BUN/creatinine ratio is 15, within the normal range of 9-23, but this ratio can be influenced by various factors, including dehydration and heart failure 2.
• Sodium, potassium, and calcium levels are within normal ranges, but chloride and carbon dioxide levels are above and below normal, respectively 2.
• Liver function tests, including alkaline phosphatase, AST, and ALT, are mostly within normal ranges, but ALT is slightly above normal, which may indicate liver stress or damage 2.

Kidney Function Assessment

• The eGFR estimate is based on serum creatinine levels, which may not always accurately reflect kidney function, especially in patients with extreme body composition or severe chronic illness 4, 5.
• The use of cystatin C as an alternative endogenous marker or direct measurement of GFR using an exogenous marker may be necessary in certain clinical scenarios to accurately assess kidney function 5.
• Patients with chronic kidney disease (CKD) require regular monitoring of kidney function, including eGFR, to stage and manage their disease effectively 6, 4.

Clinical Implications

• The patient's laboratory results indicate potential kidney function impairment, which may require further evaluation and monitoring 3, 4, 5.
• The patient's glucose level is above normal, which may indicate a need for diabetes screening or management 2.
• The patient's liver function tests are mostly within normal ranges, but the slightly elevated ALT level may require further evaluation 2.