GP Vivas · kidney-and-urinary-health
Chronic kidney disease — structured viva
Structured oral on CKD: defending the confirm-before-labelling rule, the two-axis CGA stage, the SGLT2 evidence against scepticism, the death of dual RAAS blockade, and the medication-stewardship systems that keep early CKD out of hospital.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'Half your diabetic patients have an eGFR under 60 on one result and you are not referring any of them. Justify your triage — and then tell me what you actually prescribe that changes their trajectory.' The viva branches through diagnosis, staging, drug therapy with trial numbers, referral thresholds and medication safety.
Stem
You are the GP. A partner says automated eGFR reporting has created "a epidemic of worry" among well patients with eGFR 55 and wants to ignore the lot. [20]
References10ShowHide
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- [8]Shlipak MG, Matsushita K, Ärnlöv J, et al. Cystatin C versus creatinine in determining risk based on kidney function. New England Journal of Medicine, 2013.PMID 24004120
- [9]Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 2020.PMID 32970396
- [10]Herrington WG, Staplin N, Wanner C, et al. Empagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 2023.PMID 36331190
- [14]Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. New England Journal of Medicine, 2013.PMID 24206457
- [15]Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. New England Journal of Medicine, 2008.PMID 18378520
- [17]Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection). Lancet, 2011.PMID 21663949
- [19]Truong M, Van C, Sud K, 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]Martinez YV, Benett I, Lewington AJP, et al. Chronic kidney disease: summary of updated NICE guidance. BMJ, 2021.PMID 34489303
- [20]Noble E, Johnson DW, Gray N, et al. The impact of automated eGFR reporting and education on nephrology service referrals. Nephrology Dialysis Transplantation, 2008.PMID 18632591