Perioperative AKI Prevention — RACP Adult Medicine MCQ
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Correct answer: C — Use goal-directed haemodynamic care to maintain perfusion and euvolaemia, minimise nephrotoxins and monitor postoperative creatinine and urine output
Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E
D is correct. Cardiac-surgery AKI prevention is a bundle: assess risk, avoid nephrotoxins, maintain renal perfusion and use individualised haemodynamic and fluid management to achieve euvolaemia. In HFrEF, both under-resuscitation and a fixed excess crystalloid load can cause harm. E ignores congestion and measured response. A lacks a routine protective indication. B exposes the patient to invasive treatment without a dialysis indication. C makes renal ischaemia more likely. Decisions about ACE inhibitor interruption, diuretic dosing, glycaemic management and postoperative monitoring are individualised; no single fluid volume or mean arterial pressure is safe for every high-risk cardiac-surgery patient.
Reference: Medical Journal of Australia: Selecting and optimising patients for total knee arthroplasty: https://www.mja.com.au/system/files/issues/210_03/mja212109.pdf Australian RACP: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination