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ACEi Threshold Diabetic Albuminuria — ESENeph MCQ

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HardDiabetic Kidney DiseaseACEi Threshold Diabetic AlbuminuriaESENeph

A 58-year-old with CKD G3b A3 has stable blood pressure and no haematuria. The laboratory-integrated four-variable KFRE estimates a 5-year kidney-failure risk of 6.1%. Which action most closely follows NICE NG203?

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

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Correct answer: C — Discuss nephrology referral because five-year kidney-failure risk exceeds 5%

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

A is correct. NICE recommends specialist assessment when the four-variable KFRE predicts a greater than 5% risk of requiring renal replacement therapy within five years, while also considering the person’s wishes and comorbidities. The threshold triggers referral, not dialysis access or a prediction that kidney failure is imminent. KFRE is intended for adults with CKD G3a–G5 and requires an ACR; it should be repeated according to clinical change rather than deferred automatically until G4. Other referral criteria, such as rapid decline, resistant hypertension or suspected rare disease, remain relevant even when the KFRE is lower.

Reference: NICE NG203: chronic kidney disease assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations