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Diabetic Microalbuminuria — RACP Adult Medicine MCQ

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EasyNephrologyDiabetic MicroalbuminuriaRACP Adult Medicine

A 50-year-old man with type 2 diabetes has a routine urine ACR of 5 mg/mmol (confirmed on two occasions 3 months apart). eGFR is 80 mL/min/1.73m². BP is 140/85 mmHg. He is not on RAAS inhibition. What is the most appropriate management?

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Correct answer: B — Start ACEi or ARB

Confirmed albuminuria (ACR 3-30 mg/mmol = A2/microalbuminuria) in a diabetic patient with hypertension warrants ACEi or ARB initiation. RAAS inhibition reduces proteinuria and slows CKD progression. KDIGO 2024 recommends ACEi/ARB as first-line antihypertensive in CKD with albuminuria (Grade 1B). BP target <130/80 mmHg. SGLT2i should also be added.

Reference: KDIGO – 2024 – CKD Guidelines; ADS 2024