A 64‑year‑old man with type 2 diabetes attends review. HbA1c is 63 mmol/mol, eGFR 42 mL/min/1.73 m² and urine ACR 42 mg/mmol on repeat testing. Blood

Question

A 64‑year‑old man with type 2 diabetes attends review. HbA1c is 63 mmol/mol, eGFR 42 mL/min/1.73 m² and urine ACR 42 mg/mmol on repeat testing. Blood pressure is 146/86 mmHg despite perindopril 5 mg daily. He has ankle oedema but no dyspnoea. What is the most appropriate management?

Accepted Answer

Optimise ACE inhibitor dose if tolerated, add an SGLT2 inhibitor if appropriate and monitor renal function

Answer

Treat only with tighter dietary sugar restriction

Answer

Refer for dialysis education as the next step

Answer

Stop renin‑angiotensin blockade because albuminuria is present

Answer

Use loop diuretic alone as kidney‑protective therapy

Diabetic kidney disease — RACGP Fellowship MCQ

A 64‑year‑old man with type 2 diabetes attends review. HbA1c is 63 mmol/mol, eGFR 42 mL/min/1.73 m² and urine ACR 42 mg/mmol on repeat testing. Blood pressure is 146/86 mmHg despite perindopril 5 mg daily. He has ankle oedema but no dyspnoea. What is the most appropriate management?