Forgotten CKD

I went to the clinic today at Fortmed. I usually don't talk about the cases I get there but I really can't pass this off. I saw a 45-year old female who was triaged to me because of cough, colds and sorethroat. So, I thought, it would be just a simple upper respiratory tract infection. However, upon review of her previous labs, I saw her kidney function to be way elevated. Her creatinine was 500+ in January of 2006, that's approximately 5.7 mg/dL. That is in essence a Stage 5 CKD. I dug deeper on what could have caused the renal problem and I found out that she has been hypertensive for 15 years and she also uses NSAIDs for her aches and pains - hypertensive nephrosclerosis and interstitial nephritis. On physical examination, she is hypertensive and tachycardic. She is very pale. Cardiac aulcultation has a murmur for mitral regurgitation. She has grade 3 pedal edema. I referred her eventually to the internist because the nephrologist was not available. She talked with her cardiologist and finally advised admission. Bottomline: Do not take for granted the silent killer hypertension. Also, use the pain relievers judiciously.