Cardiovascular drugs: ACE inhibitors and renal artery stenosis: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular drugs: ACE inhibitors and renal artery stenosis

Sample item

A 66-year-old smoker with peripheral arterial disease and heart failure is started on ramipril. One week later creatinine has risen from 1.2 to 2.8 mg/dL and potassium is 5.9 mmol/L. Ultrasound shows no hydronephrosis. Which underlying lesion best explains this response?

AAcute interstitial nephritis from ramiprilBDiabetic nephropathy with proteinuriaCRenal vein thrombosisDBilateral renal artery stenosis

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Bilateral renal artery stenosis

When renal perfusion pressure is low because of stenosis, glomerular filtration is maintained by angiotensin II constricting the efferent arteriole. An ACE inhibitor or ARB removes this tone and GFR falls abruptly, with hyperkalaemia. Atherosclerosis elsewhere suggests renovascular disease; the drug is stopped and the lesion is confirmed by duplex or CT angiography.

Option by option

A. Acute interstitial nephritis from ramipril
Interstitial nephritis presents with fever, rash, eosinophilia and pyuria after weeks and does not fit a rapid onset within days.
B. Diabetic nephropathy with proteinuria
Diabetic nephropathy is not suggested, and ACE inhibitors slow rather than rapidly worsen it.
C. Renal vein thrombosis
Renal vein thrombosis causes enlarged kidneys with flank pain and haematuria, not a response to a drug.
D. Bilateral renal artery stenosis (correct)
Correct. Loss of efferent constriction collapses filtration pressure in stenotic kidneys.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Bilateral renal artery stenosis. When renal perfusion pressure is low because of stenosis, glomerular filtration is maintained by angiotensin II constricting the efferent arteriole.

Why is "Acute interstitial nephritis from ramipril" not the answer?

Interstitial nephritis presents with fever, rash, eosinophilia and pyuria after weeks and does not fit a rapid onset within days.

Why is "Diabetic nephropathy with proteinuria" not the answer?

Diabetic nephropathy is not suggested, and ACE inhibitors slow rather than rapidly worsen it.

Why is "Renal vein thrombosis" not the answer?

Renal vein thrombosis causes enlarged kidneys with flank pain and haematuria, not a response to a drug.

What concept does this question test?

It tests Cardiovascular drugs: ACE inhibitors and renal artery stenosis in Pharmacology. An ACE inhibitor or ARB removes this tone and GFR falls abruptly, with hyperkalaemia. Atherosclerosis elsewhere suggests renovascular disease; the drug is stopped and the lesion is confirmed by duplex or CT angiography.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular drugs: ACE inhibitors and renal artery stenosis?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.