Question

A 70-year-old man with stage 3b chronic kidney disease (eGFR 38 mL/min/1.73 m²) is seen in clinic. His urine albumin:creatinine ratio (ACR) is 45 mg/mmol. What is the most appropriate management regarding renin–angiotensin system blockade?

Accepted Answer

Offer an ACE inhibitor or ARB, titrated to maximum tolerated dose

Answer

Avoid ACE inhibitors or ARBs because of reduced eGFR

Answer

Start a beta-blocker instead of ACE inhibitor or ARB

Answer

No treatment is needed; repeat kidney function in 5 years

Answer

Start high-dose loop diuretics instead of ACE inhibitor or ARB

Practice question

A 70-year-old man with stage 3b chronic kidney disease (eGFR 38 mL/min/1.73 m²) is seen in clinic. His urine albumin:creatinine ratio (ACR) is 45 mg/mmol. What is the most appropriate management regarding renin–angiotensin system blockade?