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Pre-Renal AKI — RACP Adult Medicine MCQ

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EasyNephrologyPre-Renal AKIRACP Adult Medicine

A 65-year-old man admitted with heart failure develops oliguric AKI. Creatinine rises from 90 to 210 μmol/L. Urine Na⁺ 5 mmol/L. FeNa 0.3%. Urine osmolality 650 mOsm/kg. Bland urine sediment. USS shows no obstruction. What is the AKI type?

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Correct answer: D — Pre-renal AKI

Low urine Na⁺ (<20), low FeNa (<1%), concentrated urine, and bland sediment = pre-renal. The kidney is working normally — avid sodium reabsorption reflects reduced perfusion from heart failure. Treatment: optimise cardiac output, diurese carefully. Pre-renal AKI is reversible with restoration of renal perfusion.

Reference: KDIGO – 2024 – AKI