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Multi-Pillar Nephroprotection Concept — ESENeph MCQ

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ModerateChronic Kidney DiseaseMulti-Pillar Nephroprotection ConceptESENeph

A 50-year-old man with CKD G3b on Ramipril and Dapagliflozin has proteinuria of 1.5 g/day from FSGS. His nephrologist discusses the concept of 'nephroprotection beyond RAS blockade'. What does KDIGO 2024 mean by this?

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Correct answer: B — multiple additive agents beyond RASi provide complementary nephroprotection

KDIGO 2024 represents a paradigm shift in CKD management: moving from single-agent RASi to a multi-pillar approach targeting different pathogenic mechanisms simultaneously. Each pillar addresses distinct pathways: RASi (haemodynamic – reduces intraglomerular pressure via efferent arteriolar dilation); SGLT2i (haemodynamic – reduces via afferent constriction, plus anti-inflammatory, anti-fibrotic, metabolic benefits); Finerenone (anti-fibrotic, anti-inflammatory via MR antagonism); GLP-1 RA (metabolic, weight, anti-inflammatory, direct kidney effects). This additive approach mirrors cardiovascular medicine's multi-drug strategy.

Reference: https://guidelines.ukkidney.org