Intrinsic AKI Furosemide Unresponsive — FRCA Final MCQ

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ModerateIntensive Care MedicineIntrinsic AKI Furosemide UnresponsiveFRCA Final

A 65-year-old man on ICU has acute kidney injury with oliguria. His bladder scan shows 50 mL residual volume. His CVP is 14 mmHg. Furosemide 80 mg IV has not increased urine output. This patient has:

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Correct answer: A — Normal renal function

Low bladder residual excludes post-renal obstruction. CVP 14 suggests adequate (or elevated) preload, making pure hypovolaemia unlikely. Failure to respond to furosemide in the presence of adequate intravascular volume suggests intrinsic renal injury (ATN, cortical necrosis, interstitial nephritis). Furosemide should not be used to treat AKI (NICE NG148) – it does not improve outcomes but may be used for volume management. The patient requires investigation: urine microscopy, renal ultrasound, and renal team review.

Reference: NICE – 2019 – NG148 AKI; KDIGO – 2012 – AKI guidelines