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CKD albuminuria monitoring — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)CKD albuminuria monitoringUSMLE Step 3

A 62-year-old man with type 2 diabetes and albuminuric CKD takes maximally tolerated lisinopril and empagliflozin. With eGFR 42 mL/min/1.73 m2 and potassium 4.7 mEq/L, finerenone 10 mg daily was started. Four weeks later, potassium is 4.9 mEq/L and eGFR is 37 mL/min/1.73 m2. What is the best finerenone plan?

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Correct answer: B — Maintain finerenone 10 mg daily and continue periodic potassium and eGFR monitoring

The best answer is “Maintain finerenone 10 mg daily and continue periodic potassium and eGFR monitoring”. At the 4-week assessment, potassium is in the greater-than-4.8 through 5.5 mEq/L band, for which the 10-mg dose is maintained. The modest eGFR decrease does not require discontinuation; escalation to 20 mg is reserved for potassium at or below 4.8 mEq/L when the renal-function criterion is also satisfied. For CKD associated with type 2 diabetes, finerenone is maintained at 10 mg once daily when the 4-week potassium concentration is greater than 4.8 through 5.5 mEq/L; potassium and eGFR are reassessed after dose changes and periodically thereafter.

Reference: FDA: Kerendia Prescribing Information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215341Orig1s009lbl.pdf