American Board of Internal Medicine (ABIM) Certification Practice Exam

An increase in serum creatinine of greater than what percentage from baseline after beginning therapy with an ACE inhibitor or angiotensin receptor blocker may indicate increased health risks?

1. 20%

2. 30%

3. 40%

4. 50%

The correct answer is: 30%

An increase in serum creatinine of greater than 30% from baseline after initiating therapy with an ACE inhibitor or angiotensin receptor blocker may indicate potential health risks, particularly concerning renal function. This threshold is significant because it serves as a warning sign that the patient's kidneys may not be tolerating the medication well, which could lead to acute kidney injury or exacerbate existing renal issues. Monitoring renal function is crucial when starting these classes of medications, as they can lead to changes in renal hemodynamics. A rise in creatinine beyond this 30% mark should prompt further evaluation and consideration of adjustments in therapy, as it may indicate that the patient is at increased risk of complications. This level of increase is more than what's typically expected and ignored could lead to detrimental effects on kidney health and overall patient outcomes. While smaller increases in creatinine can occur when initiating treatment, especially in patients with renal artery stenosis or other renal impairments, a more significant increase suggests that more serious intervention may be necessary. Thus, understanding the implications of a greater than 30% increase in serum creatinine can guide medical professionals in managing their patients effectively to prevent adverse outcomes.