RAS Unmasked by ACEi — ESENeph MCQ
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Correct answer: B — Confirm the albuminuria with a subsequent early-morning urine ACR
The best answer is “Confirm the albuminuria with a subsequent early-morning urine ACR”. NICE confirms an initial ACR of 3-70 mg/mmol using a subsequent early-morning sample. A value of 70 mg/mmol or more does not require repeat confirmation before it is acted on. “Diagnose persistent albuminuria from this single random result without confirmation” is less appropriate because an initial ACR between 3 and 70 mg/mmol should be confirmed “Use a 24-hour urine collection as the required confirmatory test” is less appropriate because NICE specifies a subsequent early-morning ACR rather than routine timed collection “Ignore the result because ACR below 30 mg/mmol is normal” is less appropriate because ACR above 3 mg/mmol is clinically relevant albuminuria if confirmed “Repeat serum creatinine instead of reassessing urinary albumin” is less appropriate because creatinine monitoring does not confirm whether albuminuria is persistent
Reference: NICE NG203: CKD assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations