Reinforcing Activity

RACGP QI&CPD ALM (Active Learning Module) requirements include completion of a predisposing activity, attendance at the workshop and completion of a reinforcing activity. GPs will be awarded 40 Category 1 QI&CPD points on completion of predisposing activity (prior to workshop), full workshop attendance and completion of reinforcing activity (within two weeks after the workshop).

Please complete Activity 1 & 2 below

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Activity 1

Please state where you can find:

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Activity 2

Case Study 1

Bob, 75 years of age, a male smoker, presents with several months of progressive lethargy. In the last 15 years he has been treated for hypertension with perindopril 5 mg/day. On examination he has a BMI of 35 kg/m2 with a BP of 165/95 and heart rate of 82 bpm. Serum creatinine is 144 µmol/L; eGFR (42 mL/min/1.73 m²) and haemoglobin (131 g/L). Fasting total cholesterol is 7.5 mmol/L (HDL-cholesterol 0.9 mmol/L) and fasting glucose is 5.0 mmol/L.

What other baseline investigations would you carry out for Bob?
What is the most important focus of his ongoing CKD management?

Case Study 2

Wendy, a 55-year-old woman with type 2 diabetes mellitus and coronary heart disease is seen in consultation for albuminuria. Three separate measurements of the urine ACR over the past 6 months have yielded results in the 3.5 to 35 mg/mmol range. Her BP has been well controlled on irbesartan. Her haemoglobin A1c has remained >9% despite aggressive lifestyle interventions and therapy with metformin and glipizide. Other medications are aspirin and atorvastatin. On physical examination, the BP is 128/80 mmHg. The BMI is 38 kg/m2. There is mild background diabetic retinopathy. The remainder of the examination is normal. Laboratory studies show a serum eGFR is 37 ml/min per 1.73 m2, normal liver chemistries, and a haemoglobin A1c of 9.5%. She is reluctant to start insulin, and you decide to prescribe empagliflozin. You counsel her regarding the benefits and risks of empagliflozin therapy.

In addition to improved glycaemic control, weight loss, and a reduction in the risk of progression to macroalbuminuria, which ONE of the following should you advise is an additional possible benefit of empagliflozin therapy?
After 3 months you repeated her bloods and found her eGFR has deteriorated down to 27 ml/min per 1.73 m2. Which ONE of the following is the MOST appropriate management?
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