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Diabetic Nephropathy — ESENeph MCQ

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

ModerateChronic Kidney DiseaseDiabetic NephropathyESENeph

A 58-year-old woman with CKD G3bA3 (eGFR 38 mL/min/1.73m2, uACR 45 mg/mmol) and type 2 diabetes is on maximum dose Ramipril 10 mg daily and Metformin 500 mg BD. Her HbA1c is 58 mmol/mol, BP 128/76 mmHg. According to current KDIGO guidance, which additional therapy should be prioritised?

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Correct answer: A — Dapagliflozin

KDIGO 2024 CKD guideline recommends SGLT2i (1A) for patients with T2D, CKD, and eGFR ≥20 mL/min/1.73m2. This takes priority as a first-line add-on alongside RASi. Finerenone is suggested (2A) if albuminuria persists despite RASi and SGLT2i. GLP-1 RA is recommended (1B) for glycaemic targets not met despite metformin and SGLT2i.

Reference: KDIGO 2024 – Clinical Practice Guideline for Evaluation and Management of CKD