A 54-year-old woman with an 11-year history of type 2 diabetes presents for care. She was first noted to have proteinuria 4 years earlier; her serum creatinine level then was 1.1 mg per deciliter (97 μmol per liter). Her urinary protein excretion has progressively increased to 2.8 g per 24 hours, and her serum creatinine level to 3.1 mg per deciliter (274 μmol per liter). The estimated glomerular filtration rate (GFR) is 26 ml per minute per 1.73 m 2 of body-surface area. Her blood pressure is 155/90 mm Hg, and the glycated hemoglobin level is 7.6 mg per deciliter. The medications she is currently taking include an oral hypoglycemic agent, an angiotensin-converting- enzyme (ACE) inhibitor, a statin, and a thiazide diuretic. How should her case be managed?
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