A 45-year-old woman is reviewed in general practice for hypertension. She has no diabetes, cardiovascular disease or systemic inflammatory symptoms.

Question

A 45-year-old woman is reviewed in general practice for hypertension. She has no diabetes, cardiovascular disease or systemic inflammatory symptoms. She takes amlodipine 10 mg once daily and has no history of angioedema. Her clinic BP is 148/92 mmHg on repeated measurement. She is clinically euvolaemic. Her eGFR was 67 mL/min/1.73 m² 4 months ago and is now 65 mL/min/1.73 m². Two early-morning urine ACR measurements, taken 3 months apart, are 44 mg/mmol and 47 mg/mmol. Urine dipstick is negative for blood; urine culture is negative. Potassium is 4.5 mmol/L. She is not taking NSAIDs. Her laboratory-reported 5-year Kidney Failure Risk Equation risk is 1.2%. What is the most appropriate management plan now?

Accepted Answer

Start an ACE inhibitor, titrate to the highest tolerated licensed dose, recheck eGFR and potassium after 1–2 weeks, and continue CKD monitoring in primary care with a clinic BP target below 140/90 mmHg

Answer

Start an ACE inhibitor, titrate to the highest tolerated licensed dose, recheck eGFR and potassium after 1–2 weeks, and use a clinic BP target below 130/80 mmHg

Answer

Start an ACE inhibitor, titrate to the highest tolerated licensed dose, and defer repeat eGFR and potassium testing until the next routine CKD review

Answer

Continue amlodipine alone, monitor eGFR and ACR routinely in primary care, and use a clinic BP target below 140/90 mmHg

Answer

Refer for nephrology assessment, start an ACE inhibitor, recheck eGFR and potassium after 1–2 weeks, and use a clinic BP target below 130/80 mmHg

Chronic kidney disease with persistent albuminuria and hypertension — MSRA MCQ