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Diabetic kidney disease — SCE Endocrinology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateDiabetesDiabetic kidney diseaseSCE Endocrinology

A 59-year-old man with type 2 diabetes has urine ACR 38 mg/mmol on two early-morning samples. Blood pressure is 128/74 mmHg and eGFR is 69 ml/min/1.73 m². He has no postural symptoms and potassium is 4.4 mmol/L. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: B — Start an ACE inhibitor with renal function and potassium monitoring

Persistent albuminuria in diabetes warrants renin-angiotensin system blockade even when clinic blood pressure is not frankly elevated, provided monitoring is safe. Renal biopsy is not first-line in typical diabetic kidney disease without atypical features. The pearl is that albuminuria is a treatment target, not just a risk marker.

Reference: NICE NG28, NICE CKD guideline NG203