Which statement about ACE inhibitors and ARBs in CKD with albuminuria is correct?

• A. Initiation does not affect proteinuria.
• B. ACE inhibitors/ARBs slow CKD progression by reducing intraglomerular pressure and proteinuria; monitor creatinine and potassium after initiation.
• C. They are contraindicated in all patients with albuminuria.
• D. They should be started without any laboratory monitoring.

Answer: (B)

In CKD with albuminuria, the goal is to reduce pressure inside the glomeruli that drives protein leakage and nephron loss. ACE inhibitors and ARBs achieve this by dilating the efferent arteriole, which lowers intraglomerular pressure and decreases proteinuria. That reduction in protein leakage translates into slower progression of kidney disease and better long-term renal outcomes.

After starting therapy, it’s important to monitor kidney function and electrolytes because the hemodynamic changes can cause a rise in creatinine and an increase in potassium. Checking serum creatinine and potassium within 1–2 weeks (and then periodically) helps ensure safety and guide adjustments if needed.

These agents are not contraindicated in all patients with albuminuria; they are protective and recommended for many individuals with proteinuric CKD precisely because of their antiproteinuric and renoprotective effects. They should not be started without laboratory monitoring.