skip to main content

Diabetic CKD Finerenone — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardNephrologyDiabetic CKD FinerenoneRACP Adult Medicine

A 40-year-old man with CKD stage G3a (eGFR 55 mL/min/1.73m²) and proteinuria (ACR 80 mg/mmol) is on ramipril 10 mg daily and dapagliflozin 10 mg daily. BP is 135/85 mmHg. HbA1c is 55 mmol/mol. Recent evidence supports an additional agent for cardiorenal protection. K⁺ is 4.5 mmol/L. What is the most appropriate additional agent?

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

Reveal the answer and explanation

Correct answer: C — Finerenone

Finerenone (a non-steroidal MRA) has demonstrated significant renal and cardiovascular benefit in patients with T2DM and CKD on maximised RAAS inhibition (FIDELIO-DKD and FIGARO-DKD trials). Unlike spironolactone, finerenone has lower hyperkalaemia risk and is specifically indicated for cardiorenal protection in diabetic CKD. It is now recommended in KDIGO 2024 guidelines.

Reference: KDIGO – 2024 – CKD Guidelines; FIDELIO-DKD/FIGARO-DKD Trials