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AKI Case 1

Educational resources for renal medicine

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Case 1

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
Potassium 5.5 (3.6-5.2)  1800hr 22mls  B.P. 100/60
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


Question 1

How would you classify his renal failure?

(a)  Pre-renal

(b)  Renal

(c)  Post-renal

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Question 2

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.

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Page last modified 30.11.2016, 10:04 by Emma Farrell. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.