Reаd the fоllоwing medicаl recоrd documentаtion and answer the question below. Nephrology/Urology Note. History of Present Illness: The patient is a 57-year-old Asian male with a history of coronary artery disease, hypertension, Type 2 diabetes mellitus, and currently, at stage III CKD with a creatinine of 1.8 corresponding with the GFR of 40–41 mL/min. The patient had blood work done at his neighborhood clinic about a month ago, which revealed an elevation in his creatinine up to 2.3. He was referred in to see a nephrologist for further evaluation. I am, therefore, asked by Dr. Abernathy to see this patient in consultation for evaluation of acute or chronic kidney failure. The patient states that he has been consuming between 10 and 12 pills a day of Chinese herbs and dietary supplements over the past year. He states he stopped about two or three weeks ago. He also states that TriCor was added about one or two months ago, but he is not sure of the date. He denies having an ultrasound but has been diagnosed with benign prostatic hyperplasia by his primary care physician and placed on terazosin. He denies any reduction of his urinary dribbling and weak stream since beginning the terazosin. For the past couple of weeks, he has experienced vertigo in the morning. This is then associated with low glucose. However, the patient’s blood glucose this morning was 123 and he was still dizzy. This was worse on standing. Patient states that he has been checking his blood pressure regularly at home because he has felt so bad; however, he has noted readings under 100/60 on several occasions. His pulses remained in the 60s. Impression: 1. Acute or chronic kidney failure. Patient has underlying stage III CKD with GFR of approximately 41 mL/min. He has episodic hypotension at home and low diastolic pressure here. His weight is down 2 to 3 kg since September, and he may be prerenal. I am also concerned about his use of Chinese herbs that can cause chronic interstitial nephritis. There is no evidence of pyuria today, although this can present with a fairly bland sediment. An additional concern is that TriCor, prescribed for high cholesterol, can cause an artifactual increase in creatinine due to changes in metabolism. I think this would be a diagnosis of exclusion. 2. History of BPH. Patient has a history of prostatic hyperplasia, and this must be investigated. It should be noted that terazosin has been used to reduce hypertension and may be involved in the patient’s low blood pressure readings. 3. Orthostatic hypotension. He is maintaining systolic but his diastolic pressures are to a point where he may not be perfusing his brain well. 4. Elevated creatine kinase consistent with myositis. I do not think this is enough to cause rhabdomyolysis, however. Q: A creatinine test measures the efficiency of the kidneys in their process of filtering waste from the blood. This patient’s rising creatinine level of 2.3, up from 1.8, indicates that this patient’s kidneys:
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