Abstract
Single best answer
A 62-year-old man with type 2 diabetes and hypertension attends for his annual review. He is asymptomatic. His medications include metformin 1 g twice daily, ramipril 5 mg once daily and amlodipine 5 mg once daily. His blood pressure is 148/90 mmHg.
Recent results show:
eGFR: 54 mL/min/1.73 m2
Urine albumin-to-creatinine ratio (ACR): 42 mg/mmol, confirmed on repeat early-morning sample
No haematuria
A kidney failure risk equation (KFRE) calculation estimates his 5-year risk of kidney failure at 2%.
A. Arrange urgent nephrology referral
B. Optimise cardiovascular risk factors
C. Reassure and repeat renal function tests in 12 months only
D. Start loop diuretic therapy to reduce albuminuria
E. Stop metformin due to reduced eGFR
Answer DOI: 10.1177/17557380261446499c