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Type 2 Diabetes — MRCGP AKT MCQ

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EasyEndocrinology & DiabetesType 2 DiabetesMRCGP AKT

A 55-year-old man with type 2 diabetes has a persistent urine albumin:creatinine ratio of 42 mg/mmol. eGFR is 75 mL/min/1.73 m², potassium 4.3 mmol/L and blood pressure 132/84 mmHg on amlodipine. Which medication change best addresses renal risk?

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Correct answer: D — Start an ACE inhibitor and monitor creatinine and potassium

Diabetes with persistent ACR at least 3 mg/mmol is an indication for renin-angiotensin system blockade even when clinic blood pressure is not markedly raised. Start an ACE inhibitor, or an ARB if ACE inhibition is not tolerated, and titrate as tolerated while checking creatinine/eGFR and potassium before and after initiation and dose changes. A loop diuretic is for congestion, not albuminuria. Beta-blockade and aspirin do not provide the same albuminuria-directed renal protection. Waiting for eGFR decline misses an opportunity to slow progression.

Reference: NICE. Chronic kidney disease: assessment and management (NG203), recommendations. https://www.nice.org.uk/guidance/ng203/chapter/recommendations