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Diabetic Kidney Disease — RACP Adult Medicine MCQ

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HardNephrologyDiabetic Kidney DiseaseRACP Adult Medicine

A 48-year-old man with type 2 diabetes, hypertension, and CKD stage 3a (eGFR 52 mL/min/1.73 m²) has a urine ACR of 35 mg/mmol on ramipril 10 mg daily. His serum potassium is 4.2 mmol/L. According to current KDIGO/CARI guidelines, which additional agent should be considered to further reduce CKD progression?

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Correct answer: B — Finerenone

Finerenone (a nonsteroidal MRA) is recommended for patients with T2DM and CKD with residual albuminuria despite maximised RAS blockade and SGLT2 inhibitor therapy. FIDELIO-DKD and FIGARO-DKD trials demonstrated reduced CKD progression and cardiovascular events. Key prerequisite: non-elevated serum potassium. It has a favourable hyperkalaemia profile compared to spironolactone.

Reference: KDIGO – 2024 – Diabetes in CKD Guideline; ADA – 2026 – Standards of Care