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Chronic kidney disease with albuminuria — CCFP MCQ

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HardChronic disease managementChronic kidney disease with albuminuriaCCFP

A patient with diabetic kidney disease starts an ACE inhibitor. Two weeks later creatinine has risen 38% and potassium is 5.8 mmol/L; blood pressure is stable and there is no volume overload. What should be done?

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

Reveal the answer and explanation

Correct answer: C — Hold the ACE inhibitor and investigate the renal decline and hyperkalemia

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

A is correct. A creatinine rise above roughly 30% with significant hyperkalemia exceeds the expected hemodynamic change and requires withholding therapy while reversible contributors and important renal disease are assessed. B uses an unsafe threshold. C worsens potassium. D intensifies the suspected problem. E abandons essential biochemical safety monitoring. Renin-angiotensin protection may be cautiously reintroduced only after the cause is corrected and values permit.

Reference: Diabetes Canada: Chronic kidney disease in diabetes: https://guidelines.diabetes.ca/cpg/chapter29