GP CCE Cases · kidney-and-urinary-health
New CKD finding at diabetic review — CCE clinical encounter
CCE-style clinical encounter: a 63-year-old with type 2 diabetes and a new eGFR of 52 with ACR 42 mg/mmol. The candidate must confirm chronicity, stage CGA, start RAAS blockade safely, plan SGLT2 addition, deliver sick-day rules, and agree the monitoring schedule.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 63-year-old man attends for his routine diabetes review feeling entirely well. Results just back: eGFR 52 ml/min/1.73 m² (first recorded below 60), urine ACR 42 mg/mmol on a random sample, HbA1c 7.6%, blood pressure today 146/86 mmHg. Medications: metformin 1 g twice daily, atorvastatin 40 mg. He has read online that 'stage 3 kidney disease means dialysis is next' and is visibly anxious.
Objectives
- Confirm the diagnosis properly — repeat eGFR within 2 weeks; repeat ACR on early-morning sample before staging. [24]
- Stage using cause, GFR category and albuminuria category, and explain risk without catastrophising. [24]
- Start an ACE inhibitor or ARB with correct safety monitoring, and set blood pressure targets. [24]
- Plan SGLT2 inhibitor addition with trial evidence and counselling points. [9]
- Deliver a written sick-day plan and agree the monitoring interval. [19] [24]
References3ShowHide
- [9]Heerspink HJL, Stefansson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 2020.PMID 32970396
- [19]Noble E, Johnson DW, Gray N, et al. Drug-Related Problems and Recommendations Made during Home Medicines Reviews for Sick Day Medication Management in Australia. Medicina (Kaunas), 2024.PMID 38792982
- [24]Khalid U, Shepherd A, Rathod J, et al. Chronic kidney disease: summary of updated NICE guidance. BMJ, 2021.PMID 34489303