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Obstructive AKI — ESENeph MCQ

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ModerateAcute Kidney InjuryObstructive AKIESENeph

A 55-year-old man presents with a creatinine of 800 umol/L, bilateral hydronephrosis on ultrasound, and a palpable bladder. Post-void residual is 1200 mL. After catheterisation, a large diuresis occurs. What complication should be monitored for?

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Correct answer: A — Post-obstructive diuresis causing hyponatraemia, hypokalaemia, and volume depletion

Post-obstructive diuresis is a physiological (and sometimes pathological) increase in urine output following relief of urinary obstruction. It can cause significant fluid and electrolyte losses including sodium, potassium, and water, leading to hyponatraemia, hypokalaemia, and intravascular volume depletion. Close monitoring of fluid balance, electrolytes (at least 6-hourly initially), and judicious IV fluid replacement is essential. Most post-obstructive diuresis is self-limiting.

Reference: NICE AKI Pathway 2019; EAU 2024 – Urological Emergencies