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ACE inhibitor creatinine rise — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentACE inhibitor creatinine riseGPhC CRA

Two weeks after ramipril was increased for hypertension, creatinine has risen from 100 to 136 micromol/L and potassium is 5.5 mmol/L. The patient is euvolaemic and has been taking ibuprofen daily. What is the best initial response?

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Correct answer: B — Stop ibuprofen, investigate and repeat bloods; reduce or stop ramipril if abnormalities persist

The creatinine rise is 36%, exceeding the 30% action threshold. In hypertension, potassium 5.0–5.9 mmol/L requires investigation and removal or reduction of potassium-raising or nephrotoxic medicines such as NSAIDs; persistent abnormality then requires ACE-inhibitor dose reduction and early recheck. Continuing unchanged, adding a potassium-sparing agent, giving potassium or switching directly to an ARB fails to address the renal and hyperkalaemia signal.

Reference: NHS SPS ACE inhibitor monitoring: https://www.sps.nhs.uk/monitorings/ace-inhibitors-and-angiotensin-ii-receptor-blockers-monitoring/