renal

Question 1

What is the main reason for ACE / ARB in CKD?

What is the dilemma that ACE / ARB causes from its MOA?

Answer 1

Reduce BP and proteinuria, slow progression of CKD

MOA of ACE / ARB: cause vasodilation of efferent arteriole, reducing hydrostatic pressure and hence lesser protein is filtered out, helping with albuminuria.

However. less Creatinine is filtered into the tubules, more Creatinine stays in the blood and causing SCr to rise. Hence we expect SCr to rise and it seems like kidney function is “worsening”

(but as long as SCr doesnt rise > 30% within 4 weeks from initiating or increase in dose, if not need to STOP)

Question 2

What is the approach to dose ACE / ARB?

Answer 2

Highest tolerated dose possible

Question 3

What agent can be added for patients with CKD and DM? (assuming patient is on ACE/ARB and SGLT2i already_

Answer 3

Finerenone