Original case exhibits · faculty and assessment review
Kidney Health Is Heart Health
Progressive cases and proposed transfer decisions
These original review exhibits make the grant’s teaching method concrete. The existing learner activity and scored assessment are unchanged. New vignettes are proposed parallel forms, not validated instruments or additional completion requirements. Faculty should revise or reject any item that changes the clinical construct or adds unintended difficulty.
Application narrative bank · Proposed transfer items · CSV · Case design map · CSV
Case 1
Denise: preserved filtration does not complete screening
The case develops
The annual checklist is marked complete because creatinine was measured; there is no quantitative urine albumin result.
Faculty reasoning and feedback
Identify the missing UACR, consider transient influences if abnormal and assign result review.
Try a different patient
A 55-year-old woman with type 2 diabetes has eGFR 82 mL/min/1.73 m². Her chart says kidney screening is complete, but no UACR has been recorded during the past year. Which action completes the two-marker assessment?
- Obtain a spot UACR and review it together with eGFR.
- Use a routine urine protein dipstick to complete the annual quantitative kidney assessment.
- Order cystatin C instead of urine albumin because eGFR is above 60.
- Repeat creatinine in three months and defer urine testing until filtration declines.
Review the proposed answer and rationale
A. Obtain a spot UACR and review it together with eGFR.
Annual assessment in type 2 diabetes includes both eGFR and UACR. Preserved filtration does not exclude albuminuria. [1]
Assessment map: baseline K1 → proposed TR1; objective 1. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 2
Rosa: choose an organ-risk objective
The case develops
A1C is at the agreed target, but confirmed CKD persists.
Faculty reasoning and feedback
Compare patient eligibility, clinical-event evidence, safety and preferences instead of treating glucose control as the final organ-protection decision.
Try a different patient
At follow-up, a woman with type 2 diabetes and confirmed CKD says that her at-target A1C means no further treatment review is needed. Which principle should guide the discussion of kidney and cardiovascular protection?
- Select the glucose-lowering medicine with the largest weight effect as the kidney-protection strategy.
- Defer the organ-protection discussion until a nephrology visit, while leaving the current regimen unchanged.
- Assess therapies with demonstrated kidney and cardiovascular benefit, alongside eligibility, adverse effects and preferences.
- Focus on current glucose control and revisit organ protection only if A1C rises.
Review the proposed answer and rationale
C. Assess therapies with demonstrated kidney and cardiovascular benefit, alongside eligibility, adverse effects and preferences.
The organ-risk decision is not settled by A1C. Match the actual evidence and current indication to the patient. [1,4–7]
Assessment map: baseline K3 → proposed TR2; objective 2. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 3
Carol: the referral is pending, responsibility is not
The case develops
The receiving practice cannot yet offer an appointment and repeat results need review.
Faculty reasoning and feedback
Specify interim responsibility, clinically appropriate timing and the patient communication route rather than handing off to an unconfirmed appointment.
Try a different patient
A woman’s kidney measures have repeatedly worsened and her nephrology referral is still awaiting scheduling. Which addition to the handoff best maintains safe continuity while urgency is reassessed?
- Confirm urgency, a clinician who owns interim care, test dates, result review and a patient contact route.
- Send the kidney-function trend and medication list; leave further test orders to the specialist.
- Give the patient the referral number and ask her to call primary care if she still has no appointment in two months.
- Arrange repeat testing but defer assigning result review until the receiving clinic confirms an appointment.
Review the proposed answer and rationale
A. Confirm urgency, a clinician who owns interim care, test dates, result review and a patient contact route.
A referral order alone does not confirm an accepted handoff. This workflow applies referral guidance to continuing care; timing depends on clinical urgency. [1,2]
Assessment map: baseline K6 → proposed TR3; objective 3. The current course reference list supports the key; verify the current guideline or label during clinical review.
Full proposal, objectives and clinical source register
Review the assessment before release
The current baseline and first posttest share three items. Report paired n, absolute percentage-point change, item-level results and uncertainty, with retries separate. The 15-percentage-point gain is a planning target; high baseline scores may create a ceiling. Repeated items measure immediate learning with recall limitations. The proposed transfer form changes the clinical surface while preserving the mapped concept. Before using it for a Moore level 4 claim, independent clinical and assessment reviewers must approve the key, equivalence, difficulty and analysis, then pilot it with representative learners. Use it to replace matched posttest slots only after approval, preserving six final questions and the time target. It is not an additional required test in the present activity. Report unpaired data and nonresponse; do not infer causality, observed clinical performance or patient benefit.
For each case, check clinical realism, fair balance, one defensible best answer, comparable option length, plausible distractors and absence of irrelevant reading burden. Review safety errors separately. Keep a versioned record of reviewer decisions and pilot findings; unresolved ambiguity blocks use of that item.