A 65-year-old diabetic woman with CKD G3b (eGFR 36) has persistent albuminuria 680 mg/g on ACE inhibitor and optimal blood pressure control. Which additional agent has been shown in recent trials to reduce CKD progression independent of glycaemic control?
- A Spironolactone
- B Losartan added to ACE inhibitor (dual RAS blockade)
- C Pentoxifylline
- D Finerenone ✓
Explanation
Finerenone, a non-steroidal selective mineralocorticoid receptor antagonist (MRA), demonstrated significant reductions in CKD progression (sustained ≥40% eGFR decline, kidney failure) and cardiovascular outcomes in patients with diabetic CKD in the FIDELIO-DKD and FIGARO-DKD trials. It is approved as add-on to RAS inhibition in diabetic CKD. Spironolactone (steroidal MRA) reduces proteinuria but has greater hyperkalaemia risk and lacks outcomes data in this indication. Dual RAS blockade (ONTARGET trial) worsened renal outcomes and is contraindicated. Pentoxifylline has modest antiproteinuric effects but no outcomes data.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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