MSFinals-2299

MSFinals-2299

A 55-year-old male with type 2 diabetes presents for his annual check-up. He has a history of angina after a previous heart attack and still smokes 10 cigarettes daily. His blood pressure is 145/88 mmHg, and he is in sinus rhythm. Evidence of neuropathy is present in his feet, but no ulcers are visible. He has background diabetic retinopathy and scars from previous photocoagulation therapy. His urine albumin/creatinine ratio is 20 mg/mmol, and his estimated glomerular filtration rate is 50 ml/min/1.73m2. His HbA1c is 51 mmol/mol (20-46).

What is the best intervention to preserve this patient’s kidney structure and function?