skip to main content

SGLT2i eGFR Dip — RACP Adult Medicine MCQ

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

ModerateNephrologySGLT2i eGFR DipRACP Adult Medicine

A 65-year-old man with known CKD stage 4 on ramipril has a stable creatinine of 250 µmol/L. His potassium is 5.0 mmol/L. He is commenced on dapagliflozin. Four weeks later, his creatinine rises to 290 µmol/L but potassium has fallen to 4.5 mmol/L. What is the correct interpretation?

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

Reveal the answer and explanation

Correct answer: B — SGLT2 inhibitor-induced AKI – cease dapagliflozin

When commencing SGLT2 inhibitors, an initial 'eGFR dip' of up to 10–15% is expected and reflects a haemodynamic effect (reduced intraglomerular pressure through afferent arteriolar vasoconstriction). This is analogous to the ACEi/ARB dip and is NOT nephrotoxic. The dip stabilises within 2–4 weeks and is followed by a slower rate of long-term GFR decline (net benefit). Dapagliflozin should be continued. A drop in potassium is also expected (SGLT2i promote mild natriuresis and kaliuresis). The initial eGFR dip should not prompt drug cessation.

Reference: KDIGO – 2024 – CKD Guidelines; DAPA-CKD Trial