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Pre-Renal AKI — RACP Adult Medicine MCQ

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EasyNephrologyPre-Renal AKIRACP Adult Medicine

A 70-year-old man with heart failure presents with oliguria after receiving IV furosemide. His creatinine has risen from 90 to 155 μmol/L over 48 hours. Urine Na⁺ is 8 mmol/L. FeNa is 0.5%. Urine microscopy shows hyaline casts only. Renal ultrasound is normal. What is the most likely type of AKI?

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Correct answer: A — Pre-renal AKI

Low urine sodium (<20 mmol/L), low FeNa (<1%), bland urine sediment (hyaline casts only), and normal renal ultrasound in a patient with heart failure and diuretic use is pre-renal AKI. The kidney is functioning normally — avid sodium reabsorption reflects reduced renal perfusion. Treatment: address the cause (optimise volume status, reduce diuretic dose if over-diuresed). Pre-renal AKI is reversible with restoration of renal perfusion.

Reference: KDIGO – 2024 – AKI Guidelines; eTG Nephrology 2024