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Diabetic CKD — RCPSC IM MCQ

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ModerateNephrologyDiabetic CKDRCPSC IM

A 63-year-old man with type 2 diabetes has eGFR 48 mL/min/1.73 m2 and urine albumin-creatinine ratio 68 mg/mmol despite maximally tolerated ACE inhibitor. A1C is 7.2 percent, potassium is 4.5 mmol/L, blood pressure is 126/74 mm Hg, and he has no recurrent genital infections. What is the most appropriate management?

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

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Correct answer: C — Add an SGLT2 inhibitor for kidney and cardiovascular protection

Albuminuric diabetic CKD despite RAAS blockade is an indication for SGLT2 inhibitor therapy if eGFR and tolerability permit, for kidney and cardiovascular protection beyond glycemic lowering.

Reference: Diabetes Canada CKD in diabetes 2025 update; KDIGO 2024 CKD guideline