Chronic Kidney Disease Management Practice Test

A 55-year-old man has CKD stage 3b for 4 years due to diabetes and hypertension; he exercises and limits sodium. Medications include metformin 1,000 mg twice daily, glyburide 5 mg daily, lisinopril 20 mg daily, and atorvastatin 40 mg nightly. He has no hypoglycemia awareness issues but reports two recent episodes of lightheadedness before lunch. BP is 124/70 mm Hg. Labs: creatinine 2.0 mg/dL, eGFR 32 mL/min/1.73 m², K 4.5 mEq/L. Which medication adjustment is most appropriate for this patient?

A 44-year-old man received a living-donor kidney transplant 3 years ago; he has stable function and takes tacrolimus, mycophenolate, and prednisone 5 mg daily. He also takes lisinopril for proteinuria and atorvastatin. He reports no symptoms. BP is 128/76 mm Hg. Labs: creatinine 1.6 mg/dL (baseline 1.6), eGFR 48 mL/min/1.73 m², K 5.8 mEq/L, HCO3 23 mEq/L, tacrolimus trough 7 ng/mL. Urinalysis shows trace protein. Ultrasound shows no obstruction. Which medication adjustment is most appropriate for this patient?