A 58-year-old woman with type 2 diabetes has A1c 6.8%, estimated GFR 38 mL/min/1.73 m2, and urine albumin-creatinine ratio 420 mg/g. She takes

Question

A 58-year-old woman with type 2 diabetes has A1c 6.8%, estimated GFR 38 mL/min/1.73 m2, and urine albumin-creatinine ratio 420 mg/g. She takes metformin and lisinopril. Blood pressure is 124/74 mm Hg. Which of the following is the most appropriate at this time?

Accepted Answer

Add an SGLT2 inhibitor if not contraindicated

Answer

Restrict fluid intake to 500 mL daily

Answer

Stop renin-angiotensin system blockade

Answer

Add glyburide for kidney protection

Answer

Start dialysis planning immediately

Diabetic kidney disease — USMLE Step 3 MCQ

A 58-year-old woman with type 2 diabetes has A1c 6.8%, estimated GFR 38 mL/min/1.73 m2, and urine albumin-creatinine ratio 420 mg/g. She takes metformin and lisinopril. Blood pressure is 124/74 mm Hg. Which of the following is the most appropriate at this time?