Case Study Jennifer, 58-year-old female farmer presents to her GP with generalised weakness and fatigue. She also complains of feelings of pins and needles in her fingertips. She has been a known diabetic for 22 years. On careful history taking, the GP realises that Jennifer has not been compliant with her diabetes medications for the last 2-3 years. She doesn't smoke and has no history of intoxicants abuse. Her appetite is good, and according to her she has been gaining some weight during the past few months. On physical examination, her body weight is 65 kg, pulse is 78/minute, BP is 141/85 mmHg, temperature is 36.8 o C. GP orders a few tests. Jennifer is called back to the clinic a few days later and after discussing the lab reports (shown below) with her, the GP refers her to a nephrologist. Protein Urinalysis 2+ Blood Neg Glucose 2+ Casts Neg Bacteria Neg Blood report RBC 3.5 × 1012/L Haemoglobin WBC Platelets Blood sugar (fasting) HbA1c 102 g/L 7.7 x 109/L 270 x 109/L 7.2 mmol/L 8.4 % 31.2 mmol/L 453 μmol/L Urca Creatinine Sodium 139 mmol/L Potassium 5.4 mmol/L Calcium 1.75 mmol/L Reference range 3.8-5.8 x 10: /L (adult female) 120-160 g/L (adult female) 4.5-11 x 10, /L 150-400 x 109/L <5.6 mmol/L < 6.1 % 3.0-8.0 mmol/L 45-90 μmol/L (adult female) 135-147 mmol/L 3.4-5.6 mmol/L 2.10-2.60 mmol/L Please answer the following TWO questions: Q1. What is the pathophysiological basis of chronic kidney disease in a patient with poorly controlled long-standing diabetes mellitus? How has this patient developed hypocalcaemia? (500 words approx.) Q2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage? (300 words approx.) S Ask Al Please use APA referencing style (7th edition). Number of references: between 5-10. Support your answers with appropriate evidence (references). This task tests your ability to search scientific literature and present your answer in a scientific language.

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