Diabetes: nephropathy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Diabetes: nephropathy

Sample item

A 52-year-old man with type 2 diabetes for 10 years and blood pressure 148/92 mmHg has a urine albumin-to-creatinine ratio of 150 mg/g on two of three samples. eGFR is 85 mL/min/1.73 m2. Which drug class is most appropriate to slow progression of his kidney disease?

ASulfonylureaBThiazolidinedioneCDihydropyridine calcium channel blocker aloneDACE inhibitor or angiotensin receptor blocker

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. ACE inhibitor or angiotensin receptor blocker

Persistent albuminuria of 30 to 300 mg/g is moderately increased albuminuria, the earliest clinically detectable sign of diabetic nephropathy. ACE inhibitors or ARBs reduce intraglomerular pressure by dilating the efferent arteriole and slow progression. Good glycaemic and blood pressure control and smoking cessation add benefit.

Option by option

A. Sulfonylurea
Sulfonylureas lower glucose without any kidney protection and carry hypoglycaemia risk.
B. Thiazolidinedione
Thiazolidinediones improve insulin sensitivity but have no renoprotective role and cause fluid retention.
C. Dihydropyridine calcium channel blocker alone
A dihydropyridine calcium channel blocker alone dilates the afferent arteriole and does not reduce albuminuria.
D. ACE inhibitor or angiotensin receptor blocker (correct)
RAAS blockade lowers intraglomerular pressure and proteinuria beyond its blood pressure effect.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, ACE inhibitor or angiotensin receptor blocker. Persistent albuminuria of 30 to 300 mg/g is moderately increased albuminuria, the earliest clinically detectable sign of diabetic nephropathy.

Why is "Sulfonylurea" not the answer?

Sulfonylureas lower glucose without any kidney protection and carry hypoglycaemia risk.

Why is "Thiazolidinedione" not the answer?

Thiazolidinediones improve insulin sensitivity but have no renoprotective role and cause fluid retention.

Why is "Dihydropyridine calcium channel blocker alone" not the answer?

A dihydropyridine calcium channel blocker alone dilates the afferent arteriole and does not reduce albuminuria.

What concept does this question test?

It tests Diabetes: nephropathy in General Medicine. ACE inhibitors or ARBs reduce intraglomerular pressure by dilating the efferent arteriole and slow progression. Good glycaemic and blood pressure control and smoking cessation add benefit.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Diabetes: nephropathy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.