MRCP2-1333

MRCP2-1333

A 20-year-old female presents with recurrent episodes of cystitis despite treatment with trimethoprim. She has a history of diabetes mellitus since the age of 12 and is currently on twice daily mixed insulin. Additionally, she has been taking oral contraceptives for the past two years and smokes 10 cigarettes per day. Her two elder brothers are healthy. On examination, she appears thin but well with a BMI of 21.5 kg/m2, a blood pressure of 108/76 mmHg, and normal cardiovascular, respiratory, and abdominal findings.

Laboratory investigations reveal serum sodium of 140 mmol/L (137-144), serum potassium of 4.5 mmol/L (3.5-4.9), serum urea of 5.6 mmol/L (2.5-7.5), serum creatinine of 95 µmol/L (60-110), fasting plasma glucose of 10.2 mmol/L (3.0-6.0), and HbA1c of 87 mmol/mol (20-42) or 10.1% (3.8-6.4). An ultrasound of the abdomen suggests reflux nephropathy.

What is the optimal treatment plan to preserve her renal function?