Nondiabetic Kidney Disease

A 66-year-old man without diabetes has worsening hypertension. He has a serum creatinine level of 1.8 mg per deciliter (159 μmol per liter), proteinuria (2+), and a fasting serum low-density lipoprotein cholesterol level of 140 mg per deciliter (3.6 mmol per liter). He smokes half a pack of cigarettes per day. Ultrasonography reveals small, symmetric kidneys without hydronephrosis or cysts. How should this patient be evaluated and treated to slow the progression of kidney disease?

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