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Metformin Contrast Precautions — ESENeph MCQ

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HardAcute Kidney InjuryMetformin Contrast PrecautionsESENeph

A biopsy-confirmed primary IgA-nephropathy patient has UPCR 96 mg/mmol despite optimised standard care including the highest tolerated RAS blockade. Which 2026 NICE option is now available at this proteinuria level?

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

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Correct answer: D — Add targeted-release budesonide alongside the patient’s optimised standard-care regimen

Explanation lettering: C = shown as A · A = shown as C · E = shown as D · D = shown as E

E is correct. NICE TA1128 widened routine access to targeted-release budesonide for adults with primary IgAN when UPCR is at least 90 mg/mmol or urine protein excretion at least 1 g/day. It is added to optimised standard care, which includes the highest tolerated licensed RAS inhibitor or a dual endothelin–angiotensin receptor antagonist unless contraindicated, with or without an SGLT2 inhibitor. The older 170 mg/mmol threshold has been replaced. Targeted ileal release reduces but does not abolish systemic glucocorticoid precautions, and response and toxicity still require specialist follow-up.

Reference: NICE TA1128: targeted-release budesonide for primary IgA nephropathy: https://www.nice.org.uk/guidance/ta1128/chapter/1-Recommendations