15th July 2024

Management

A persistent reduction in eGFR (<60 for 90 days or more) or elevation in ACR (>3 for 90 days or more) should prompt pharmacological management. An angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) should be offered to those with an ACR of >3 mg/mmol and titrated to the highest dose tolerated. All anti-hypertensives have a role but ACEIs and ARBs are most effective in reducing intraglomerular pressure and albuminuria.

Hyperglycaemia and hypertension should be addressed as per NICE targets and those with stage III disease or more should be offered atorvastatin 20mg.  Patients should be advised to stop smoking and encouraged to lose excess body weight.