A 64-year-old with type 2 diabetes has eGFR 44 mL/min/1.73 m2 and UACR 780 mg/g despite maximized lisinopril. Potassium is 4.7 mEq/L and A1C is 7.3%.

Question

A 64-year-old with type 2 diabetes has eGFR 44 mL/min/1.73 m2 and UACR 780 mg/g despite maximized lisinopril. Potassium is 4.7 mEq/L and A1C is 7.3%. Which intervention most directly slows CKD progression?

Accepted Answer

Add an SGLT2 inhibitor while continuing ACE inhibition

Answer

Stop lisinopril because reduced eGFR proves ACE-inhibitor nephrotoxicity

Answer

Use hydrochlorothiazide as the sole kidney-protective medication

Answer

Start a high-protein diet to preserve filtration

Answer

Add combined ACE inhibitor and ARB treatment to lower albuminuria further

Diabetic kidney disease with albuminuria — ABIM Board MCQ

A 64-year-old with type 2 diabetes has eGFR 44 mL/min/1.73 m2 and UACR 780 mg/g despite maximized lisinopril. Potassium is 4.7 mEq/L and A1C is 7.3%. Which intervention most directly slows CKD progression?