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Diabetic Nephropathy — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseDiabetic NephropathyESENeph

A 66-year-old man with type 2 diabetes and CKD G3bA3 (eGFR 35 mL/min/1.73m2, uACR 85 mg/mmol) is already on Ramipril 10 mg and Dapagliflozin 10 mg. His potassium is 4.2 mmol/L. Albuminuria persists at 65 mg/mmol despite good BP control (126/74 mmHg). According to KDIGO 2024, what additional agent should be considered?

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Correct answer: E — Finerenone

KDIGO 2024 CKD guideline suggests nonsteroidal MRA with proven kidney or cardiovascular benefit (i.e. Finerenone) for adults with T2D, eGFR >25 mL/min/1.73m2, normal potassium, and albuminuria persisting despite maximum tolerated RASi (2A). Finerenone is the only nsMRA with demonstrated kidney and CV outcomes benefit (FIDELIO-DKD, FIGARO-DKD trials). Dual RAS blockade (ACEi + ARB) is specifically contraindicated.

Reference: KDIGO 2024 – Clinical Practice Guideline for CKD