A 26-year-old woman with type 1 diabetes for 13 years has blood pressure of 134/82 mmHg and eGFR of 96 mL/min/1.73 m². Urine albumin-to-creatinine ratio is 85 mg/g on two separate first morning samples three months apart. Retinal screening shows moderate background retinopathy. The single most appropriate pharmacological addition is:

• A Insulin dose reduction
• B Amlodipine
• C Furosemide
• D An ACE inhibitor ✓

Explanation

Persistent albuminuria defined as an albumin-to-creatinine ratio of 30 mg/g or more on two of three samples over three to six months establishes early diabetic kidney disease, here in the moderately increased category (30 to 300 mg/g). An ACE inhibitor reduces intraglomerular pressure and slows progression even when baseline blood pressure is near normal, and is standard of care in albuminuric diabetic kidney disease. Amlodipine controls pressure but does not reduce intraglomerular hypertension comparably.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.