A 52-year-old man presents to the clinic with a history of fatigue, swelling in his legs, and occasional shortness of breath. He reports feeling generally unwell for the past several months and has recently noticed a decrease in his urine output. On examination, his blood pressure is elevated at 160/95 mmHg, and there is noticeable pitting edema in his lower extremities.

The patient has a history of untreated hypertension and type 2 diabetes, both of which he has had for over 10 years. He admits that due to financial difficulties, he has not been able to consistently afford medications for his conditions. Laboratory tests reveal an elevated serum creatinine of 2.5 mg/dL and blood urea nitrogen (BUN) of 55 mg/dL, with an estimated glomerular filtration rate (eGFR) of 28 mL/min/1.73 m², indicating stage 4 chronic kidney disease (CKD). Urinalysis shows significant proteinuria, and a renal ultrasound reveals bilateral kidney shrinkage.

The patient is counselled on the importance of blood pressure and glucose control to slow the progression of CKD. Due to limited access to specialized care and financial constraints, treatment focuses on lifestyle modifications, optimizing the use of affordable medications, and close monitoring of kidney function to manage his condition and prevent further decline.