A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 45-year-old male with poorly controlled diabetes presents with increasing proteinuria and hypertension. His blood pressure is 160/95 mmHg. Laboratory tests reveal an ACR of 1200 mg/g. Renal biopsy shows nodular glomerulosclerosis. Which of the following treatment strategies would most effectively slow the progression of his kidney disease?
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A
Sodium-glucose cotransporter-2 inhibitorsIncorrect. SGLT2 inhibitors slow progression but ACE inhibitors remain the cornerstone for proteinuric diabetic CKD per established guidelines.
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B
Diuretic therapyIncorrect. Diuretics control volume and BP but do not reduce intraglomerular pressure or slow nephropathy progression specifically.
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C
Angiotensin-converting enzyme inhibitorsCorrect. ACE inhibitors dilate efferent arterioles, lowering intraglomerular pressure, reducing proteinuria, and slowing diabetic nephropathy progression.
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D
Calcium channel blocker therapyIncorrect. Calcium channel blockers (non-dihydropyridine) reduce BP but do not selectively dilate efferent arterioles like ACEi.
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E
Statin therapyIncorrect. Statins manage cardiovascular risk in CKD but do not slow renal disease progression directly.
↑ Tap an answer to reveal the reasoning
Answer: C. The patient's presentation is consistent with diabetic nephropathy, characterized by nodular glomerulosclerosis and significant proteinuria. ACE inhibitors are effective in reducing intraglomerular pressure and proteinuria, thereby slowing disease progression. Calcium channel blockers primarily manage blood pressure but do not address intraglomerular pressure, ruling out choice A.