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Diabetic Kidney Disease — RACP Adult Medicine MCQ

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ModerateNephrologyDiabetic Kidney DiseaseRACP Adult Medicine

A 45-year-old woman with CKD stage G3a (eGFR 55 mL/min/1.73m²) and type 2 diabetes has an ACR of 45 mg/mmol on ramipril 10 mg daily. BP is 132/82 mmHg. HbA1c is 58 mmol/mol. What is the most appropriate additional agent for kidney protection?

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Correct answer: E — Add dapagliflozin

SGLT2 inhibitors (dapagliflozin, empagliflozin) are recommended for patients with T2DM and CKD with eGFR ≥20 and albuminuria for kidney protection, independent of glycaemic control. DAPA-CKD and EMPA-KIDNEY trials demonstrated significant reduction in kidney disease progression. This is additive to RAAS inhibition.

Reference: KDIGO – 2024 – CKD Guidelines; Australian Diabetes Society 2024