Question

A 46-year-old man with long-standing hypertension and type 2 diabetes has chronic kidney disease with an eGFR of 32 mL/min/1.73 m2 and albumin-to-creatinine ratio of 450 mg/g. He is on lisinopril, amlodipine, and atorvastatin. BP is 132/78 mm Hg. Potassium is 4.8 mEq/L. What is the most appropriate next step to slow progression of his kidney disease?

Accepted Answer

Increase ACE inhibitor dose to maximally tolerated

Answer

Stop lisinopril because of reduced eGFR

Answer

Add a loop diuretic to further lower blood pressure

Answer

Start dual renin-angiotensin blockade with ACE inhibitor and ARB

Answer

Aim for a systolic blood pressure target less than 110 mm Hg

Practice question