What treatment is indicated for a patient with elevated Blood Urea Nitrogen (BUN) of 24, impaired renal function with creatinine level of 1.35, low carbon dioxide (CO2) level of 19, and an estimated Glomerular Filtration Rate (eGFR) of 38?

From the Guidelines

Based on the laboratory values provided (BUN 24, creatinine 1.35, CO2 19, eGFR 38), I recommend a nephrology consultation for management of moderate chronic kidney disease (CKD stage 3b). Initial treatment should include optimizing blood pressure with a target of <130/80 mmHg, preferably using an ACE inhibitor or ARB such as lisinopril 10mg daily or losartan 50mg daily, as suggested by the national kidney foundation practice guidelines for chronic kidney disease 1. Dietary modifications are essential, including:

• Sodium restriction to <2g daily
• Moderate protein intake (0.8g/kg/day)
• Adequate hydration The low CO2 of 19 suggests mild metabolic acidosis, which may benefit from oral sodium bicarbonate 650mg twice daily if confirmed with additional testing. Nephrotoxic medications should be avoided, including NSAIDs and certain antibiotics. Regular monitoring of kidney function every 3-6 months is necessary. These interventions aim to slow CKD progression by reducing intraglomerular pressure, minimizing proteinuria, and addressing metabolic complications. The treatment approach addresses both the reduced kidney function (eGFR 38) and the early metabolic derangements (low CO2) while working to prevent further deterioration, as supported by the guidelines for chronic kidney disease evaluation, classification, and stratification 1.

From the FDA Drug Label

Asymptomatic hyperuricemia can occur and gout may rarely be precipitated. Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency Serum electrolytes (particularly potassium), CO2, creatinine and BUN should be determined frequently during the first few months of Furosemide tablets therapy and periodically thereafter.

The patient's elevated BUN and impaired renal function with a creatinine level of 1.35 and low CO2 level may be managed with furosemide to reduce the risk of further renal deterioration.

• The patient's eGFR of 38 indicates impaired renal function, and furosemide should be used with caution to avoid dehydration and electrolyte imbalance.
• Furosemide may help reduce BUN and alleviate symptoms associated with impaired renal function.
• However, careful monitoring of the patient's serum electrolytes, CO2, creatinine, and BUN is necessary to avoid complications.
• The patient should be advised to report any symptoms of excessive fluid and/or electrolyte losses, and potassium supplements and/or dietary measures may be needed to control or avoid hypokalemia 2.

From the Research

Patient Treatment

The patient has elevated Blood Urea Nitrogen (BUN) of 24, impaired renal function with creatinine level of 1.35, low carbon dioxide (CO2) level of 19, and an estimated Glomerular Filtration Rate (eGFR) of 38.

• The patient's eGFR indicates impaired renal function, which may require dose adjustment of certain medications 3, 4, 5.
• The use of estimated glomerular filtration rate (eGFR) is a key component in drug therapy management (DTM) in patients with renal impairment 5.
• For patients with renal impairment, a gradual drug dose adaptation according to the renal function is suggested, taking into account the reliability of the eGFR and the therapeutic window of the drug 5.

Medication Considerations

• Many drugs are eliminated by the kidneys and may require dose adjustment in patients with renal impairment 3, 4.
• The choice of medication and dosage should be based on an ongoing assessment of clinical status and risk versus the benefit of the used regimen 5.
• Considerations about the drug dose may be different at the start of the therapy or during the therapy and depending on the indication 5.

Monitoring and Assessment

• Monitoring effectiveness and adverse drug reactions are important, especially for drugs with a narrow therapeutic window 5.
• The patient's renal function, as indicated by eGFR, should be regularly assessed to adjust medication dosages as needed 3, 4, 5.
• A 24-h urine creatinine clearance collection may be performed to achieve the best approximation of the true GFR when needed 5.