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Home BP vs Office BP Equivalence CKD — ESENeph MCQ

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HardHypertensionHome BP vs Office BP Equivalence CKDESENeph

A patient with proteinuric CKD has potassium 5.7 mmol/L after losartan was titrated. ECG is normal and there is no acute kidney injury. Which principle best preserves long-term kidney protection?

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

Reveal the answer and explanation

Correct answer: D — Reversible-cause treatment plus potassium-lowering measures to preserve RAS blockade

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

B is correct. KDIGO emphasises that RAS-inhibitor-associated hyperkalaemia can often be managed rather than automatically withdrawing a drug with kidney and cardiovascular benefit. Confirmation, medication review, constipation and dietary assessment, correction of acidosis, an appropriate diuretic and a modern binder are considered according to context. A makes one moderate result a lifetime contraindication. C adds a common precipitant of both AKI and hyperkalaemia. D intensifies the causal drug. E ignores the stable clinical setting. Acute severity, ECG change and treatment response still determine whether urgent hospital care is needed.

Reference: KDIGO 2024 guideline for CKD evaluation and management: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf