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BP Measurement Methods CKD — ESENeph MCQ

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HardHypertensionBP Measurement Methods CKDESENeph

A patient with type 2 diabetes, eGFR 42 mL/min/1.73m² and persistent ACR 48 mg/mmol remains albuminuric on maximally tolerated losartan and an SGLT2 inhibitor. Potassium is 4.6 mmol/L. Which additional disease-modifying therapy is most appropriate?

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

Reveal the answer and explanation

Correct answer: C — Finerenone initiation with four-week potassium and eGFR reassessment

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

E is correct. This patient has type 2 diabetes, eGFR above 25, residual albuminuria despite tolerated RAS blockade and a potassium concentration that permits initiation of a non-steroidal mineralocorticoid-receptor antagonist. Finerenone is layered with SGLT2 and RAS therapy, with early potassium and renal-function monitoring. A uses a steroidal MRA without acknowledging its higher hyperkalaemia burden. B exposes the patient to harmful dual RAS blockade. C discards complementary kidney protection. D reverses the eGFR eligibility boundary: falling below 25 prevents initiation rather than triggering it.

Reference: KDIGO 2022 guideline for diabetes management in CKD: https://kdigo.org/wp-content/uploads/2022/10/KDIGO-2022-Clinical-Practice-Guideline-for-Diabetes-Management-in-CKD.pdf