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CKD with albuminuria — ESENeph MCQ

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ModerateChronic Kidney DiseaseCKD with albuminuriaESENeph

A 54-year-old man with hypertension has repeat blood tests 4 months apart. eGFR is 52 then 50 mL/min/1.73 m² and urine ACR is 46 mg/mmol on two early morning samples. He has no haematuria, normal renal ultrasound and blood pressure 146/86 mmHg. What is the most appropriate management?

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Correct answer: C — Optimise blood pressure and renin-angiotensin system blockade

Persistent eGFR below 60 for more than 90 days with A3 albuminuria meets CKD criteria and needs cardiovascular and renal risk reduction. RAAS blockade and blood pressure optimisation are appropriate when albuminuria is significant and potassium allows. Dialysis planning is premature at this eGFR without rapid progression or symptoms. The pearl is that albuminuria powerfully modifies CKD risk and should be measured, not inferred from dipstick testing.

Reference: NICE NG203 Chronic Kidney Disease; KDIGO 2024 CKD Guideline