A 50-year-old male with 2 diabetes mellitus is found to have 24-hour urinary albumin of 250 mg. Which of the following drugs may be used to retard the progression of the renal disease –
**Core Concept**
The question is testing the understanding of the management of diabetic nephropathy, specifically the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow the progression of renal disease.
**Why the Correct Answer is Right**
Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, is a first-line treatment for patients with diabetic nephropathy. By inhibiting the conversion of angiotensin I to angiotensin II, enalapril reduces intraglomerular pressure, decreases proteinuria, and slows the progression of renal disease. This is particularly beneficial in patients with diabetic nephropathy, as they are at high risk of developing end-stage renal disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Hydrochlorothiazide is a diuretic that may actually worsen proteinuria and renal function in patients with diabetic nephropathy by increasing intraglomerular pressure.
**Option C:** Amiloride is a potassium-sparing diuretic that may be beneficial in patients with hypertension, but it does not have the same renoprotective effects as ACE inhibitors in patients with diabetic nephropathy.
**Option D:** Aspirin has anti-inflammatory properties and may be beneficial in patients with cardiovascular disease, but it does not have a role in the management of diabetic nephropathy.
**Clinical Pearl / High-Yield Fact**
ACE inhibitors, such as enalapril, should be considered as first-line treatment for patients with diabetic nephropathy, as they have been shown to slow the progression of renal disease and reduce the risk of cardiovascular events.
**✓ Correct Answer: B. Enalapril**