After initiation of an ACE inhibitor or an ARB with renoprotective effects, the creatinine level may rise by up to what percentage?

After initiation of an ACE inhibitor or an ARB with renoprotective effects, the creatinine level may rise by up to what percentage?

• A. 30%
• B. 5%
• C. 10%
• D. 50%

Answer: (A)

Starting an ACE inhibitor or ARB can cause a small, temporary rise in creatinine because these drugs lower intraglomerular pressure by dilating the efferent arteriole. This hemodynamic change typically leads to a modest drop in GFR, reflected as a creatinine increase. Up to about 30% is expected and generally acceptable, especially if the patient is monitored closely. If the rise stays within this range, continue treatment and recheck creatinine (and potassium) after 1–2 weeks. A rise greater than about 30% or a rapid decline in kidney function should prompt reassessment for factors like dehydration, NSAID use, or bilateral renal artery stenosis, and may require adjusting or stopping the therapy. Despite the initial creatinine bump, these agents offer long-term kidney protection by reducing intraglomerular pressure and proteinuria.

Starting an ACE inhibitor or ARB can cause a small, temporary rise in creatinine because these drugs lower intraglomerular pressure by dilating the efferent arteriole. This hemodynamic change typically leads to a modest drop in GFR, reflected as a creatinine increase. Up to about 30% is expected and generally acceptable, especially if the patient is monitored closely. If the rise stays within this range, continue treatment and recheck creatinine (and potassium) after 1–2 weeks. A rise greater than about 30% or a rapid decline in kidney function should prompt reassessment for factors like dehydration, NSAID use, or bilateral renal artery stenosis, and may require adjusting or stopping the therapy. Despite the initial creatinine bump, these agents offer long-term kidney protection by reducing intraglomerular pressure and proteinuria.