American Board of Internal Medicine (ABIM) Certification Practice Exam

Which complication is of concern with an increase in serum creatinine of more than 30% after starting ACE inhibitor treatment?

1. End-stage kidney disease

2. Severe anemia

3. Acute bacterial infection

4. Urinary incontinence

The correct answer is: End-stage kidney disease

An increase in serum creatinine of more than 30% after the initiation of an ACE inhibitor raises concern primarily about potential acute kidney injury, which can progress to end-stage kidney disease if not managed appropriately. ACE inhibitors can affect renal function, particularly in patients with certain underlying conditions such as bilateral renal artery stenosis, dehydration, or pre-existing renal impairment, as they alter the hemodynamics of the kidneys by inhibiting angiotensin II formation. This can lead to a further decline in renal perfusion and function. When serum creatinine rises significantly, it signals that the kidneys may be under stress and not filtering waste products effectively, increasing the risk for acute renal failure and potentially necessitating dialysis or transplantation in severe cases. Monitoring renal function after starting ACE inhibitors is crucial to prevent serious complications and to ensure that the benefits of blood pressure control and heart failure management provided by these medications outweigh the risks. The other options do not directly correlate as immediate concerns related to the increase in serum creatinine after commencing ACE inhibitor therapy. While severe anemia, acute bacterial infections, and urinary incontinence are important medical issues, they are not typically associated with the direct effects or complications of ACE inhibitors on kidney function.