You are called to review a 75-year-old man on the surgical high dependency ward at 10 p.m. The nurses note that his urine output has fallen over the last few hours.
|History:||Right hemi-colectomy 4 hours ago. (Indication: Caecal Tumour)|
|Prior history:||Hypertension, Type 2 Diabetes Mellitus, and Gout|
|Medications:||Lisinopril 20mg OD||(received this morning)|
|Diclofenic acid 75mg PRN||(nil in last 24 hours)|
|Allopurinol 100mg OD||(received this morning)|
|Spironolactone 25mg OD||(received this morning)|
|Pre-operative bloods||Urine output from catheter||On examination|
|Sodium||135 (125-145)||1700hr||35mls||Heart rate||110 regular|
|Total CO2||25 (24-30)||1900hr||18mls||Weight||60 kilograms|
|Urea||9.5 (2.5-7.5)||2000hr||15mls||Lungs clear|
|Creatinine||146 (50-120)||2100hr||8mls||Abdominal wound - no ooze/swelling|
|eGFR||43mls/min||No oedema, neck veins not visible lying flat|
|Urine dipstick - nil abnormal|
How would you classify his renal failure?
Which of the following would you do immediately? (choose one)
(a) Obtain an urgent ultrasound. After recent abdominal surgery damage to his ureters may have occurred. In addition his bladder may be obstructed.
(b) Administer furosemide 40mg intravenously to improve his urine output and correct his renal impairment.
(c) Administer a fluid challenge of 500mls Normal (0.9%) Saline over 1 hour to see if his urine output and blood pressure improve.
(d) Send off an urgent sample for Anti-GBM, ANCA, ANA, anti-Double stranded DNA.