ARB for ACEi cough – CKD — RACP Paediatrics MCQ

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ModerateNephrologyARB for ACEi cough – CKDRACP Paediatrics

The child on an ACE inhibitor develops a persistent dry cough. Renal function and potassium are stable. What is the most appropriate alternative antihypertensive that retains renoprotective properties?

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Correct answer: B — ARB

ARBs (losartan, irbesartan) are the standard alternative to ACE inhibitors for persistent ACE inhibitor cough. They provide equivalent renoprotection (reduced proteinuria, slowed CKD progression) via blockade of the renin-angiotensin system at the AT1 receptor. ACE inhibitors and ARBs should NOT be used concurrently (dual RAAS blockade increases adverse effects without additional benefit).

Reference: RCH Melbourne – 2023 – CKD CPG; KDIGO – 2024