Lisinopril and high Scr

[Pharmacy Kid]

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I know with ace-i and arbs you monitor Scr because an elevation can mean renal stenosis. However, if a pt has always had a high Scr level which is slighty increasing and is on ace-i or arb, what point do you consider decreasing, stopping, or changing anything at all?

 

[glory4england]

I know with ace-i and arbs you monitor Scr because an elevation can mean renal stenosis. However, if a pt has always had a high Scr level which is slighty increasing and is on ace-i or arb, what point do you consider decreasing, stopping, or changing anything at all?

What I learned in school and rotations: 30% increased in SCr the 1st two months of therapy or serum K > 5.6 mmol, you consider d/c or dose reduction

The KDOQI guidelines suggest dose reduction if GFR decreases by 30-50% and d/c if GFR decreases by more than 50%.

But I'm still a P4 so interested to see what practicing pharmacists have to say.

 

[xiphoid2010]

I know with ace-i and arbs you monitor Scr because an elevation can mean renal stenosis. However, if a pt has always had a high Scr level which is slighty increasing and is on ace-i or arb, what point do you consider decreasing, stopping, or changing anything at all?

A bump of < 0.5 on SrCr is usually acceptable as long as K+ stays normal. Above that, I would eval risk vs. benefits case by case. What if it's a CHF or post MI pt? What about simple hypertension pt?

 

[tungsten87]

A bump of < 0.5 on SrCr is usually acceptable as long as K+ stays normal. Above that, I would eval risk vs. benefits case by case. What if it's a CHF or post MI pt? What about simple hypertension pt?

exactly, if there is a compelling indication and the patient is still maintaining fairly consistent renal function, you'd want to leave them on the drug. diabetes, CHF, post-MI should have an ACE-I/ARB on board for sure and regardless we would expect to see a brief rise in SCr but there is a good chance it will come back to baseline after a few weeks/months.