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Diabetic kidney disease — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Diabetic kidney diseaseUSMLE Step 3

A 58-year-old man with type 2 diabetes has A1c 7.2% on metformin and empagliflozin. Blood pressure is 138/82 mm Hg. Urine albumin-creatinine ratio is 180 mg/g on two samples. Estimated GFR is 64 mL/min/1.73 m2 and potassium is normal. Which of the following is the most appropriate next step in management?

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

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Correct answer: D — Start an ACE inhibitor or angiotensin receptor blocker

Diabetes with hypertension and albuminuria should be treated with ACE inhibitor or ARB kidney-protective therapy if tolerated.

Reference: American Diabetes Association Standards of Care in Diabetes—2026: https://professional.diabetes.org/standards-of-care