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Diabetic kidney disease — SCE Endocrinology MCQ

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EasyDiabetesDiabetic kidney diseaseSCE Endocrinology

A 60-year-old man with type 2 diabetes has urine ACR 45 mg/mmol on two early-morning samples and eGFR 58 ml/min/1.73 m2. Blood pressure is 146/84 mmHg. He takes metformin and atorvastatin. What is the most appropriate management?

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

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Correct answer: C — Start an ACE inhibitor and optimise blood pressure

Persistent albuminuria in diabetes should prompt renin-angiotensin system blockade and blood pressure optimisation unless contraindicated. Renal biopsy is not first-line when the pattern fits diabetic kidney disease and there are no atypical features. The clinical pearl is to confirm ACR persistence before labelling albuminuria.

Reference: NICE NG203; NICE NG28