RAS blockers, SGLT2 inhibitors, finerenone and aldosterone synthase inhibitors all lower intraglomerular pressure, and eGFR commonly falls in the first weeks. This is haemodynamic, not injury, and stopping the drug for it removes long-term protection.
- Check creatinine and potassium one to four weeks after starting or increasing these drugs
- Accept an eGFR fall of up to about 30% if potassium is safe
- Look for volume depletion, NSAIDs or renal artery stenosis if the fall is larger
- Do not stop an SGLT2 inhibitor for an early, stable dip
Why it matters
Unnecessary withdrawal after an expected dip is one of the commonest reasons patients lose kidney protection.
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