Acute kidney injury case study with questions and answers
Single best answer question based on renal clinical case:
Single best answer question 1.
- A 50 year old alcoholic male presents with sepsis secondary to klebsiella pneumonia. His background includes IHD, previous pneumonia, hypercholesterolaemia and hypertension. Medications include: furosemide, enalapril, aspirin, clopidogrel, co-amoxiclav (current) and simvastatin
- He is treated with IV antibiotics and is managed on an ITU setting for 1 week
- On step down to a medical ward routine bloods reveal:
- Sodium 132
- Potassium 5.0
- Urea 24 (from 8)
- Creatinine 390 (from 60)
- Clinically he is mildly dry, with a BP 135/83, HR 90, he is catheterised with a U/O 35ml/hr
Which one of the following is the best management option?
- Switch to high dose IV furosemide, stop enalapril, give IV fluids to maintain urine output, daily bloods
- Stop furosemide, stop enalapril, add in dopamine and maintain adequate hydration to maintain urine output, daily bloods
- Stop furosemide, stop enalapril, adequate fluids to maintain urine output, daily bloods
- Continue furosemide, stop enalapril, high dose corticosteroids and continue adequate fluids to maintain urine output, daily bloods
- None of the above
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- Answer: 3 (stop furosemide, stop enalapril, adequate fluids to maintain urine output, daily bloods)
- This man has risk factors for AKI (hypertension and dehydration) and is on various renotoxic medications including aspirin, enalapril (ACE-I) and furosemide (loop diuretic).
- The key is to maintain hydration to keep urine output reasonable (>0.5ml/kg/hr) while stopping as many renotoxic medications as possible.
- Fluids should be given and frusemide and enalapril stopped. He has a history of ischaemic heart disease so stopping aspirin is not ideal. Daily bloods to monitor response is advised.
- There is no evidence for dopamine (mentioned in option 2) or hydrocortisone (mentioned in option 4).