Starting an ACE inhibitor, ARB or SGLT2 inhibitor usually causes an early, haemodynamic fall in eGFR within the first few weeks. A fall of up to about 30% is generally acceptable and should not prompt stopping a drug that protects the kidney long term. A larger fall warrants checking volume status, interacting drugs such as NSAIDs or diuretics, and, where suspected, renal artery stenosis.
- Recheck creatinine and potassium within about two to four weeks of starting or increasing RAS blockade.
- An eGFR fall of up to about 30% is expected and usually stabilises.
- Investigate a fall greater than 30%: volume depletion, NSAIDs, diuretics, renovascular disease.
- Do not stop SGLT2 inhibitors for an early modest eGFR dip.
Why it matters
Kidney-protective drugs are often stopped for the very dip that signals they are working haemodynamically.
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