Do you recommend using doses of ACEi or ARBs that is above the usual dosing with the goal of reducing a patient's proteinuria further?
1 Answer
Mednet MemberInvited Expert
Nephrology · UAB Medicine
Answered on
No, doses above the therapeutic maximum typically result in more side effects without additional benefit. For example, the VA NEPHRON D study showed increased rates of hyperkalemia and AKI with dual RAAS blockade. We now have more medication options to reduce proteinuria including SGLT2-INHs and finerenone. These medications + a low salt diet and BP control are typically sufficient to control proteinuria. If UPCR remains > 1 g/g despite maximal medical management, I would consider a kidney biopsy, especially if the diagnosis of diabetes mellitus is < 10 years.