Is it Always Safe to Administer RAS Inhibitors to Patients Who Underwent Unilateral Radical Nephrectomy?

Compensatory increases in single-kidney glomerular filtration rate (GFR) are usually observed after unilateral radical nephrectomy. However, the influence of hemodynamically active therapies on early functional compensation remains uncertain. We describe a 65-year-old man with latent autoimmune diabetes of adulthood, nonproteinuric chronic kidney disease consistent with atherosclerotic nephropathy, and mildly reduced baseline renal function who underwent right radical nephrectomy with caval thrombus removal for clear cell renal cell carcinoma. Based on preoperative split renal function, a postnephrectomy GFR above 45 mL/min was anticipated. Despite continued treatment with ramipril and dapagliflozin, GFR at 3 months remained close to the immediate postoperative value. After discontinuation of both agents, GFR increased above the expected threshold and remained stable, without albuminuria. This observation is hypothesis-generating and suggests that combined ACE and SGLT2 inhibition may transiently attenuate early functional compensation through hemodynamic mechanisms, particularly in patients with atherosclerotic nephropathy, supporting individualized perioperative management and close renal function monitoring.