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RASi eGFR Dip Threshold — ESENeph MCQ

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ModerateChronic Kidney DiseaseRASi eGFR Dip ThresholdESENeph

A 60-year-old man with CKD G3b is on Enalapril 20 mg for proteinuric CKD. After initiating Enalapril 3 weeks ago, his eGFR dropped from 38 to 30 mL/min/1.73m2 (21% decline). He is asymptomatic. According to KDIGO 2024, what eGFR decline warrants investigation?

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Correct answer: D — A decline >30% from baseline warrants evaluation when starting haemodynamically active therapy

KDIGO 2024 CKD guideline states that an eGFR change >20% on a subsequent test exceeds expected variability. However, when haemodynamically active therapy (RASi or SGLT2i) is initiated, a threshold of >30% is suggested to exceed expected variability and warrant further evaluation. This patient's 21% decline is within the expected haemodynamic range and does not mandate stopping Enalapril. Continue therapy and recheck in 2-4 weeks.

Reference: KDIGO 2024 – CKD Guideline