A 58-year-old man with type 2 diabetes on metformin and sitagliptin develops nephrotic-range proteinuria. eGFR is 38 mL/min/1.73 m². HbA1c is 8.2%. Per the 2024 ADA guidelines, which drug addition provides BOTH cardiorenal protection AND is specifically recommended at this eGFR threshold?
- A Empagliflozin
- B Finerenone ✓
- C Liraglutide
- D Dapagliflozin
Explanation
Finerenone (a non-steroidal mineralocorticoid receptor antagonist) is indicated in CKD with T2DM down to eGFR ≥25 mL/min/1.73 m² with elevated UACR, based on FIDELIO-DKD and FIGARO-DKD trials showing reduction in CKD progression and CV events. SGLT2 inhibitors (empagliflozin, dapagliflozin) require eGFR ≥20–25 for cardiorenal benefit but their glucose-lowering efficacy falls significantly below eGFR 45; finerenone uniquely adds on top of SGLT2i or RASi at this stage. GLP-1 RAs like liraglutide provide CV benefit but do not have specific renal endpoint data at this eGFR. The 2024 ADA Standards of Medical Care specifically recommend finerenone for CKD stages G3–G4 with albuminuria despite RASi.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.