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Is the juice worth the squeeze?

I have a long-time patient who came in yesterday and we were reviewing their labs together and noted a tremendous success. The patient’s albuminuria has fallen 90% since 2018. This is due to adding and then maximizing losartan, adding dapagliflozin, and most recently starting finerenone.

Here is the albuminuria over time:

Over that time their eGFR looks like this:

How should we square the recent drop in eGFR with the reduction proteinuria? We typically switch to a risk based model, here are their Tangri KFRE scores over time:

I was quite surprised to see the KFRE rise over time despite the 90% reduction in albuminuria. I am not changing therapy. The eGFR is nearly intact and I am not going to tiny changes in creatinine (the most recent jump was less than 0.2 mg/dL) guide therapy decisions. I am going to continue to ride these medications which have repeatedly been shown to protect kidneys (and hearts).