Drugs that lower intraglomerular pressure, including ACE inhibitors, ARBs, SGLT2 inhibitors and MRAs, commonly produce an early fall in eGFR within the first weeks. This reflects haemodynamic change and is associated with long-term kidney protection, not injury.
KDIGO advises continuing ACE inhibitors or ARBs unless creatinine rises by more than 30% within 4 weeks. Recheck creatinine and potassium at 1 to 4 weeks after starting or increasing the dose. A larger rise should prompt a look for volume depletion, NSAIDs or renal artery stenosis before stopping the drug.
- Check creatinine and potassium 1 to 4 weeks after starting or up-titrating
- A rise of up to 30% is expected; continue the drug
- More than 30%: review volume status, diuretics and NSAIDs
- Consider renal artery stenosis if eGFR falls sharply
Why it matters
Stopping kidney-protective drugs for an expected early dip removes the long-term benefit.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for nephrology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free