試題詳解

62. 一位40歲男性，輕度高血壓(sBP 148 mmHg)，serum creatinine 1.0 mg/dL, urine protein 0.6 g/24-Hr urine, renal biopsy為 IgA nephropathy, without advanced tubulointerstitial fibrosis, nor crescent formation. 醫師先給予 RAAS blocker, 持續追蹤6個月，再檢測實驗室數值為: serum creatinine 1.4 mg/dL, urine protein 1.3 g/24-Hr urine, sBP 120 mmHg. 請問: 以下處置，何者最適宜?
(A) intravenous methylprednisolone (500-1000 mg/day, for 3 days) followed by oral azathioprine for declining renal function。
(B) add on oral steroid 0.4 mg/kg/day。
(C) add on fish oil。
(D) arrange tonsillectomy + add on fish oil。
(E) hold RAAS blocker, shift to SGLT2i (sodium glucose cotransporter 2 inhibitor)。