Discussion on the best options for management of hypertension, T2 diabetes mellitus in the context of macroalbuminuria is sought to get an insight into the matter.
1. First step will be RAAS blockade using ACE-I or ARB (provided there is no hyperkalemia). Gradually increase the dose to the maximum tolerable and monitor proteinuria. Addition of ACE-I and ARB, has not been proved to enhance the efficacy, rather it increases the side effect profile.
2. IF significant proteinuria persist despite maximum dosages of ACE-I or ARB, start on a SGLT-1 inhibitors (EMPA REG, CANVAS, CREDENCE).