Ask the Experts

 Subscribe via email
Recent
Categories
Tags
Add a reply View Replies (3)

Resolved proteinuria VS rising creatinine level when using ACEI

  1. khaled
    khaled
  2. General Nephrology Questions
  3. Sunday, 13 May 2012
  4.  Subscribe via email
Dear exprts , I have a female patient , 63 years old , with longstanding DM type 2 for more than 20 years .the patient is coming presented by proteinuria 13 gm / day .  the patient was treated before from recurrent renal calculi and UTI . 4 months ago the patient creatinine was 1.5 mg/dl , and it gradually rises to 1.7 , 1.9 , 2.37 with one month interval between every reading . her medication described for her from another hospital  is as follows : ezapril 20 mg  3 tab/12 hr irbesartan 150 mg once / day iron supplement hypolipidemic drug regular insulin  metformin 500 mg once / day  my question is about the dose of ACEI IF IT SHOULD BE DECREASED OR NOT ? what about metformin ?    
Responses (3)
Jordan Weinstein
Jordan Weinstein
Verified UKidney Expert
Accepted Answer Pending Moderation
Statistically, this is very likely to be diabetes, particularly if glycemia was not well managed. In general, it would be reasonable to biopsy a patient with very high-grade protein (>5 g / day) and diabetes in order to ensure another disease such as Membranous Nephropathy is not coexisting, as obviously this would have important treatment implications. As mentioned, I prefer aldactone and ACE or ARB rather than ACE/ARB together, potassium permitting. Metformin may be used with caution down to eGFR of 33 cc/min.

Jordan
  1. more than a month ago
  2. General Nephrology Questions
  3. # 1
khaledalibahgat
khaledalibahgat
Accepted Answer Pending Moderation
Dear Dr.Jordan
no biopsy was taken for the patient . also her BP is about 130 / 90 .
so you will decrease the dose of ACEI , for her creatinine rise or not?
do you prefer doing a biopsy for the patient despite this long standing diabetes suggesting diabetic nephropathy ?
metformin is ok with her?
  1. more than a month ago
  2. General Nephrology Questions
  3. # 2
Jordan Weinstein
Jordan Weinstein
Verified UKidney Expert
Accepted Answer Pending Moderation
Regardless of your course of action here, unless the patient is very hypertensive to explain such extreme proteinuria, it will be difficult to achieve major improvements in proteinuria in my opinion. I have been quite impressed with combining aldactone and ACE OR ARB, potassium permitting. I feel aldactone-based combinations are more effective that ACE+ARB or either added to DRI. One question I would have is whether this patient has ever been biopsied?
  1. more than a month ago
  2. General Nephrology Questions
  3. # 3
  • Page :
  • 1


There are no replies made for this post yet.
Be one of the first to reply to this post!
khaledalibahgat
Submit Your Response
Upload files or images for this discussion by clicking on the upload button below. Supports gif,jpg,png,zip,rar,pdf,jpeg,doc,docx,xls,xlsx
• Insert • Remove Upload Files (Maximum File Size: 10 MB) - NB: PLEASE REMOVE ALL IDENTIFYING DATA
Cite your Sources with a URL link to help readers verify facts or find more details.
Add Another Link
ukidneyisup