A 65-year-old woman has a long-standing history of T2DM that has been complicated with non-proliferative retinopathy, albuminuria, peripheral neuropathy and ischemic heart disease. Her medications are metformin, gliclazide, irbesartan, atorvastatin, metoprolol, and aspirin. Her investigations reveal a serum creatinine 3mg/dl, urea 75mg/dl, sodium 138mEq/l, and potassium 5mEq/l. The estimated glomerular filtration rate (eGFR) is 28. Which of the following medications should be discontinued immediately given the abnormal renal function?
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الإجابة: C. Metformin
Metformin is contraindicated once eGFR falls below 30 because it is renally excreted and accumulates, risking lactic acidosis. With eGFR 28 it must be stopped. Irbesartan (ARB) is renoprotective in diabetic nephropathy with albuminuria and K+ 5 is acceptable, so it is not the drug to stop; atorvastatin and metoprolol need no renal withdrawal.
ليش كل خيار صح أو غلط
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A
ليش غلط
She has ischaemic heart disease, and a statin is given when ASCVD risk is elevated, so atorvastatin is continued.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 3 -
B
ليش غلط
In diabetic nephropathy with albuminuria an ARB is kept, because ACE inhibitors and ARBs are proven to slow progression.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 12 -
C
ليش صح
Metformin should be avoided when eGFR is below 30; hers is 28.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 6
- المصدر
- RT - DM.pdf · p. 10
Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 6 - المحاضرة
- Diabetes Mellitus · Endocrinology · Module B
- ظهر في
- Endo bank