skip to main content

Cardiorenal Syndrome — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHeart FailureCardiorenal SyndromeEECC

A 70-year-old man with acute decompensated HFrEF (LVEF 20%) develops oliguria (urine output 15 mL/hr) despite intravenous furosemide 80 mg bolus followed by a continuous infusion at 20 mg/hr. His creatinine has risen from 130 to 210 micromol/L. Central venous pressure is 22 cmH2O. What is the most appropriate next step?

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

Reveal the answer and explanation

Correct answer: C — Add metolazone 2.5 mg orally to overcome diuretic resistance

This patient has diuretic resistance with cardiorenal syndrome. The ESC HF Guidelines recommend a sequential nephron blockade strategy: adding a thiazide-type diuretic (metolazone or bendroflumethiazide) to loop diuretics to overcome resistance at the distal convoluted tubule (Class IIa). This combination can produce profound diuresis and requires close monitoring of electrolytes and renal function. Ultrafiltration/CVVH is reserved for refractory fluid overload unresponsive to pharmacological diuretic escalation. Simply increasing the furosemide dose further has diminishing returns due to the ceiling effect.

Reference: ESC (2023): Focused Update on Heart Failure