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A 60-year-old patient comes into your office with a history of hypertension and a myocardial infarction 13 years ago

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A 60-year-old patient comes into your office with a history of hypertension and a myocardial infarction 13 years ago. You notice that both of her ankles are swollen and that her skin seems shiny. She first noticed her ankle swelling 9 months ago and it has gotten progressively worse. She has a smell of ammonia on her.  She also has a 2 year history of diabetes.

  •   What are at least five systemic effects of chronic kidney disease?

  •   How would you modify the diet and what is the rationale to the changes of the diet that you make?

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