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Accelerated CKD progression — ESENeph MCQ

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HardChronic Kidney DiseaseAccelerated CKD progressionESENeph

A 72-year-old man with CKD G3b has eGFR values of 43, 34 and 29 mL/min/1.73 m² over 7 months. Urine ACR is 12 mg/mmol, blood pressure is 132/76 mmHg and renal ultrasound shows no obstruction. He has recently started over-the-counter ibuprofen for osteoarthritis. What is the most appropriate management?

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

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Correct answer: D — Stop NSAID and investigate accelerated CKD progression

A sustained eGFR decline of this magnitude is clinically significant even with modest albuminuria and should prompt medication review and investigation for reversible causes. NSAIDs can reduce renal perfusion and accelerate kidney injury, especially in CKD. Steroids are not indicated without evidence of immune renal disease. The pearl is that CKD progression assessment requires trends, not a single eGFR value.

Reference: NICE NG203; KDIGO 2024 CKD Guideline; BNF