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Diabetic CKD — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareDiabetic CKDUSMLE Step 3

A 59-year-old man with type 2 diabetes has eGFR 52 mL/min/1.73 m2 and urine albumin-to-creatinine ratio 420 mg/g on two samples. Blood pressure is controlled on lisinopril. A1c is 7.1%, potassium is 4.6 mEq/L, and he has no recurrent genital infections. Which of the following would you recommend at the follow-up visit?

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

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Correct answer: D — Add an SGLT2 inhibitor

SGLT2 inhibitors reduce kidney and cardiovascular events in diabetic CKD with albuminuria when eGFR is adequate.

Reference: ADA Standards of Care in Diabetes 2026, https://professional.diabetes.org/standards-of-care