ACE/ARB & Creatinine
A creatinine bump after ACEi/ARB is not an automatic stop sign.
The Hemodynamic Effect Is Intentional
ACE inhibitors and ARBs reduce efferent arteriolar constriction, lowering intraglomerular pressure.
An early eGFR dip is not the same as structural nephrotoxicity.
Trend Creatinine AND Potassium
Know the baseline and recheck after initiation or dose escalation.
Quantify the change rather than reacting to the absolute creatinine alone.
When the Rise Is Bigger Than Expected
Look for volume depletion, overdiuresis, NSAIDs, hypotension, AKI or renovascular disease before labeling the drug itself as nephrotoxic.
Reversible contributors should be identified and addressed first.
Preserve Beneficial Therapy When Safe
Hyperkalemia or a modest creatinine rise does not automatically mean permanent discontinuation.
Reversible contributors and the original renal/cardiovascular indication matter.
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