skip to main content

Diabetes CKD — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateInternal Medicine (chronic management)Diabetes CKDUSMLE Step 3

A 58-year-old woman with type 2 diabetes has A1c 7.3%, eGFR 48 mL/min/1.73 m2, and urine albumin-creatinine ratio 420 mg/g despite lisinopril. She has no recurrent genital infections or ketoacidosis history. Blood pressure is 128/74 mm Hg. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: A — Add an SGLT2 inhibitor

SGLT2 inhibitors slow CKD progression and reduce cardiovascular events in diabetes with albuminuric CKD when eGFR permits use.

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