RASi Uptitration eGFR Dip Acceptable — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChronic Kidney DiseaseRASi Uptitration eGFR Dip AcceptableESENeph

A 45-year-old man with CKD G4 and diabetes has eGFR 22. His Ramipril is uptitrated from 5 to 10 mg. eGFR drops from 22 to 18 (18% decline). Potassium 5.0. Should the dose be maintained?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Continue ramipril and repeat monitoring

KDIGO 2024 states >30% decline post-RASi exceeds variability. 18% is expected haemodynamic effect reflecting therapeutic reduction in intraglomerular pressure. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2024 – CKD (Practice Point 3.6): https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf