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Diabetic kidney disease — SCE Endocrinology MCQ

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ModerateDiabetes complicationsDiabetic kidney diseaseSCE Endocrinology

A 45-year-old man with type 1 diabetes has albumin:creatinine ratio 8 mg/mmol on two early-morning urine samples. Blood pressure is 146/88 mmHg and eGFR is 84 ml/min/1.73 m2. HbA1c is 59 mmol/mol. What is the most appropriate management?

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

Start an ACE inhibitor and optimise blood pressure and glycaemia is best because persistent albuminuria with hypertension in diabetes should prompt renin-angiotensin system blockade and risk-factor optimisation. The alternatives are less appropriate because waiting misses disease-modifying care; loop diuretic alone is not renoprotective; biopsy is not first-line in a typical pattern; SGLT2 therapy cannot replace insulin. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG17; NICE CKD guideline NG203