A 61-year-old with type 2 diabetes, coronary disease and CKD has eGFR 48 mL/min/1.73 m2 and UACR 520 mg/g despite maximally tolerated lisinopril. A1C

Question

A 61-year-old with type 2 diabetes, coronary disease and CKD has eGFR 48 mL/min/1.73 m2 and UACR 520 mg/g despite maximally tolerated lisinopril. A1C is 7.8% on metformin. Which addition most directly lowers both kidney-progression and cardiovascular risk?

Accepted Answer

Start an SGLT2 inhibitor with proven kidney and cardiovascular benefit

Answer

Replace lisinopril with short-acting nifedipine to reduce albuminuria

Answer

Add glyburide because reduced filtration prolongs its glucose-lowering effect

Answer

Use sliding-scale insulin alone and stop metformin immediately

Answer

Begin when eGFR falls below 30 before adding kidney-protective therapy

Type 2 diabetes with albuminuric CKD — ABIM Board MCQ

A 61-year-old with type 2 diabetes, coronary disease and CKD has eGFR 48 mL/min/1.73 m2 and UACR 520 mg/g despite maximally tolerated lisinopril. A1C is 7.8% on metformin. Which addition most directly lowers both kidney-progression and cardiovascular risk?