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
metformin 500 mg once / day
my question is about the dose of ACEI IF IT SHOULD BE DECREASED OR NOT ?
what about metformin ?