A 68-year-old man with a 10-year history of type 2 diabetes mellitus and hypertension presents for routine follow-up. His baseline serum creatinine is 1.8 mg/dL (eGFR 38 mL/min/1.73m²), and urinalysis shows 2+ proteinuria. He is started on lisinopril 10 mg daily for diabetic nephropathy. Two weeks later, he reports mild fatigue and dyspnea on exertion. Laboratory studies show: serum creatinine 2.6 mg/dL, BUN 48 mg/dL, potassium 5.8 mEq/L, bicarbonate 20 mEq/L, and urine sodium 15 mEq/L. Urinalysis remains unchanged with no hematuria or casts. Blood pressure is 138/82 mmHg. Which of the following is the most appropriate next step in management?
- A)Continue lisinopril and initiate loop diuretic therapy to improve renal perfusion
- B)Obtain urgent renal artery duplex ultrasound to evaluate for renal artery stenosis
- C)Discontinue lisinopril, initiate hemodialysis, and administer insulin for hyperglycemia
- D)Discontinue lisinopril, check serum creatinine in 1-2 weeks, and address hyperkalemiaGABARITO
- E)Increase lisinopril dose to 20 mg daily and add amlodipine for improved blood pressure control
Explicação
This patient presents with hyperkalemia (5.8 mEq/L), worsening renal function (creatinine 1.8→2.6 mg/dL), and metabolic acidosis (HCO3 20) occurring 2 weeks after ACE inhibitor initiation. These findings are consistent with ACE inhibitor-induced acute kidney i... Ver explicação completa e trilha adaptativa →