skip to main content

Diabetic CKD — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNephrologyDiabetic CKDABIM Board

A 63-year-old with type 2 diabetes mellitus, eGFR 42 mL/min/1.73 m², and urine albumin-to-creatinine ratio (UACR) 380 mg/g presents for review of his chronic kidney disease management. Which therapy is recommended to slow CKD progression?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Sodium-glucose cotransporter 2 (SGLT2) inhibitor if eGFR ≥20 mL/min/1.73 m²

This patient meets clear criteria for SGLT2 inhibitor initiation per 2024 KDIGO guidelines: eGFR 42 (≥20 threshold) and UACR 380 (≥200 mg/g). SGLT2 inhibitors are strongly recommended (1A evidence) as foundational therapy to slow CKD progression in type 2 diabetes with albuminuria. Dapagliflozin and empagliflozin are FDA-approved for diabetic kidney disease. Option A is incorrect: DPP-4 inhibitors lack proven renal protection. Option C reflects outdated guidance; eGFR ≥20 is the current threshold, not ≥60. Option D is wrong because SGLT2i provide substantial additive renal and cardiovascular benefit beyond RAAS inhibition alone. Option E is inappropriate: metformin remains preferred (safe at eGFR >30), and sulfonylureas offer no renal protection and increase hypoglycemia risk.

Reference: Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. https://www.ncbi.nlm.nih.gov/books/NBK576405/