A 65-year-old man has eGFR of 28 mL/min and urine ACR of 80 mg/mmol, and he does not have diabetes. Which action is in line with NICE guidance on chronic kidney disease?
Answer and explanation
Correct answer: A. Offer an ACE inhibitor or ARB titrated to the maximum tolerated dose
- Step 1: Proteinuric CKD benefits from renin-angiotensin blockade.
- Step 2: NICE NG203 recommends an ACEi or ARB, titrated to the highest tolerated dose, for CKD without diabetes when ACR is 70 mg/mmol or more, with nephrology assessment.
Answer
Offer an ACE inhibitor or ARB titrated to the maximum tolerated dose.
Why not the others: Withhold all antihypertensive drugs: Blood pressure treatment slows progression. Start regular ibuprofen for his joint pain, with fluids encouraged: NSAIDs are nephrotoxic. Advise a high-protein diet to replace the protein lost in the urine: High protein worsens kidney strain.
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