This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the author's clinicalrecommendations.
A 66-year-old man without diabetes has worsening high bloodpressure, to 160/100 mm Hg. He has a serum creatinine levelof 1.8 mg per deciliter (159 µmol per liter), an estimatedglomerular filtration rate of 40 ml per minute per 1.73 m2 ofbody-surface area, proteinuria (2+), and a total protein levelof 84 mg per deciliter and a creatinine level of . . . [Full Text of this Article]
The Clinical Problem
Strategies and Evidence
Proteinuria as a Marker of Kidney Damage
Glomerular Filtration Rate
The Clinical Plan of Action
Strict Blood-Pressure Control
Angiotensin-ConvertingEnzyme Inhibitors
Areas of Uncertainty
Therapy with Antihypertensive Agents
Dietary Protein Restriction
Lipid-Lowering Agents
Cessation of Tobacco Use
Guidelines
Conclusions and Recommendations
Source Information
From the Division of Nephrology, TuftsNew England Medical Center, Boston.
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