A 65-year-old male with history of type 2 diabetes for 15 years came to the clinic for follow up. His hemoglobin A1C is 6.7%. His pulse is 70/minute and blood pressure 145/90 mmHg. Physical exam did not show symptoms of neuropathy. Laboratory evaluation revealed microalbuminuria (level between 30-300 mg per 24 hours). What is the best next step in managing this patient?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Start him on Enalapril
Moderately increased albuminuria (30-300 mg/day) in a diabetic, here also with BP above 130/80, is an indication to start an ACE inhibitor (or ARB), which slows progression of nephropathy. Renal biopsy is not needed for typical diabetic nephropathy, and simply repeating the urinalysis delays treatment.
ليش كل خيار صح أو غلط
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A
ليش غلط
Renal biopsy is only for select cases to find a specific cause; ACE inhibitors used early slow the progression of proteinuria and reduce the risk of progression to ESRD.
✓ Step Up To Medicine 6th, 2024 (CKD).pdf · p. 4 -
B
ليش غلط
A low-protein diet (0.7-0.8 g/kg/day) only may slow CKD progression; ACE inhibitors used early slow the progression of proteinuria and reduce the risk of progression to ESRD.
✓ Step Up To Medicine 6th, 2024 (CKD).pdf · p. 4 -
C
ليش غلط
Annual urine ACR is screening for diabetics with no evidence of nephropathy; his urine is already positive, so treatment (ACE inhibitor/ARB) is due now, not a repeat in a year.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 3 -
D
ليش صح
He already has increased albuminuria and BP above 130/80; the notes say to give an ACE inhibitor or ARB in both situations (enalapril is an ACE inhibitor).
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 3
- المصدر
- Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 3
RT - DM.pdf · p. 14 - المحاضرة
- Diabetes Mellitus · Endocrinology · Module B
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- Endo bank