dependent criteria: (1)kidney damage(structural or functional seen on laboratory, pathology, or imaging studies) for more than 3 months with our without a decreased GFR and/or (2) GFR less than 60mL/min//1.73m2 for more than 3 months with or without kidney damage. Chronic Kidney Disease also has 5 stages that is classified according to level of renal function. Stage 1 is kidney damage with normal or increased GFR, GFR >90 mL/min/1.73m2. Stage 2 is kidney damage with mild decrease in GFR, GFR is 60-89 mL/min/1.73m2. Stage 3 is moderate decrease in GFR, GFR is 30-59 mL/min/1.73m2.Stage 4 is severe decrease in GFR, GFR is 15-29 mL/min/1.73m2. Stage 5 is kidney failure, GFR <15 mL/min/1.73m2 or dialysis.
Patient’s history of diabetes and HTN contributes to CKD. Hyperglycemia,hyperperfusion, and increased glomerular pressure damages the nephrons. Vascular changes in hypertension causes a decrease in circulation to the kidneys, gradually damaging the nephrons, causing nephrosclerosis. EPIC states patient is in stage 3 of CKD but his GFR is 16/18/15, which puts him in Stage4/5.
(Osborn, 2014 p1227-1228)
COPD
Chronic obstructive pulmonary disease encompasses two types of obstructive airway disease: emphysema (enlargement of air spaces and destruction of lung tissue) and chronic obstructive bronchitis( increased mucus production, obstruction of small airways, and a chronic productive cough). Chronic bronchitis is caused by inflammation and fibrosis of the bronchial wall causing mismatching of ventilation and perfusion. Hypertrophy of the sub-mucosal glands and hyper-secretion of mucus are symptoms of COPD. There is loss of elastic lung fibers(which normally provides traction and hold the airways open, impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse). With loss of lung elasticity and hyperinflation of the lungs, the airways often collapse during expiration because pressure in surrounding lung tissues exceeds airway pressure. Destruction of alveolar tissue decreases the surface area for gas exchange. Patients with predominant emphysema are referred to as (pink puffers), a reference to the lack of cyanosis. Chronic bronchitis involves the use of accessory muscles and pursed-lip(“puffer”) breathing. Air becomes trapped in the alveoli and lungs, producing an increase in the antero-posterior dimensions of the chest; “barrel chest” is typical in patients with emphysema.