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Diuretic Dilemma in Cardiorenal Syndrome — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareDiuretic Dilemma in Cardiorenal SyndromeSCE Palliative Medicine

A 72‑year‑old man with advanced heart failure and chronic kidney disease stage 4 (eGFR 18 ml/min/1.73 m²) has worsening breathlessness. His cardiologist proposes increasing his furosemide dose, but his renal function continues to decline. What best describes the diuretic dilemma in advanced cardiorenal syndrome?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Increasing diuretics relieves congestion but may worsen renal function by causing pre‑renal AKI — balancing decongestion against renal perfusion is the core challenge

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

Option D correctly characterises the diuretic dilemma: diuretics improve congestion but can impair renal perfusion, risking pre‑renal AKI. NICE NG106 advises using the lowest effective diuretic dose and multidisciplinary discussion, including renal liaison when eGFR is below 30 ml/min/1.73 m² ([nice.org.uk](https://www.nice.org.uk/guidance/ng106/chapter/Recommendations?utm_source=openai)). Distractor A is false: renal function is highly relevant. B is unsupportable: guidelines do not mandate stopping diuretics at eGFR thresholds but rather careful titration and specialist input. C is incorrect: diuretics do not universally benefit renal function. E is wrong: oral diuretics remain effective; route choice depends on clinical context, not a syndrome‑specific rule.

Reference: NICE NG106: Chronic heart failure in adults – Diagnosis and management (2025), Recommendation 1.9.1 and recommendation to liaise with renal physician if eGFR <30 ml/min/1.73 m². https://www.nice.org.uk/guidance/ng106/chapter/Recommendations