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Acute Kidney Injury — RACP Adult Medicine MCQ

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EasyNephrologyAcute Kidney InjuryRACP Adult Medicine

A 70-year-old woman is admitted with acute kidney injury (creatinine rising from 90 to 380 µmol/L over 3 days). She has been taking ibuprofen and ramipril. Urine output is 200 mL in 12 hours. Renal ultrasound shows no obstruction. Urinalysis shows no blood or protein. What is the most likely cause?

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Correct answer: E — Pre-renal AKI

The combination of NSAIDs (afferent arteriolar vasoconstriction via prostaglandin inhibition) and ACE inhibitors (efferent arteriolar vasodilation) causes a haemodynamic reduction in GFR (pre-renal AKI). The bland urinalysis (no blood/protein) supports this. Management involves ceasing both nephrotoxic agents and IV fluid resuscitation. If this were ATN, muddy brown casts would typically be present.

Reference: KHA-CARI – 2020 – AKI Guidelines; KDIGO – 2012 – AKI Guidelines