ACEi ARB Non-Diabetic Albuminuria — ESENeph MCQ
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Correct answer: D — Titrated ACE-inhibitor or ARB therapy
The best answer is “Titrated ACE-inhibitor or ARB therapy”. Persistent ACR 8 mg/mmol is A2 albuminuria. RAS blockade reduces intraglomerular pressure and albuminuria, with creatinine and potassium checked after initiation and titration. “Continue amlodipine as the sole agent because RAS blockade is limited to diabetes” is less appropriate because KDIGO supports RAS blockade in non-diabetic albuminuric CKD “Combine an ACE inhibitor with an angiotensin-receptor blocker” is less appropriate because dual blockade increases AKI and hyperkalaemia without added benefit “Wait until ACR reaches the nephrotic range” is less appropriate because A2 albuminuria already supports RAS blockade “Use an NSAID to lower albumin excretion” is less appropriate because NSAIDs can worsen kidney perfusion and blood pressure
Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf