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Diabetic Nephropathy — RACP Paediatrics MCQ

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HardEndocrinologyDiabetic NephropathyRACP Paediatrics

A 15-year-old has had type 1 diabetes for eight years. Three first-morning urine tests over four months show albumin:creatinine ratios of 4.8, 5.2 and 5.0 mg/mmol despite improved glycaemia and normal urine microscopy. Blood pressure is at the 88th centile and eGFR is normal. What is the next renoprotective treatment?

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

Reveal the answer and explanation

Correct answer: B — Start an ACE inhibitor for persistent diabetic albuminuria

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

D is correct. Albuminuria is persistent because at least two of three first-morning samples are abnormal after confounders and glycaemia have been addressed. ISPAD recommends an ACE inhibitor, with blood pressure, creatinine and potassium checked after initiation. E is not the first-line recommendation for adolescent type 1 diabetic albuminuria. A is unnecessary without severe albuminuria, active sediment, falling eGFR or another atypical feature. B risks impaired growth and is not a substitute for renin–angiotensin blockade. C invites hypoglycaemia and does not address residual albuminuria independently. The longer duration and age make this a valid screening context, unlike the original seven-year-old with only two years of diabetes.

Reference: Sydney Children’s Hospitals Network: Diabetes clinical care guidelines: https://www.schn.health.nsw.gov.au/clinical-hub/diabetes-clinical-care-guidelines ISPAD 2022: Microvascular and macrovascular complications in children and adolescents with diabetes: https://www.ispad.org/static/9b777e83-ba2c-4b2e-a2edf977f3e12e61/2022CGCh18-Vascularcomplicatio.pdf