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Acute urinary retention causing AKI — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesAcute urinary retention causing AKISCE Acute Medicine

A 82-year-old man is assessed on the acute medical unit. He has suprapubic discomfort, anuria and creatinine 340 micromol/L. Bladder scan shows 950 mL residual volume. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Insert a urinary catheter and monitor post-obstructive diuresis

Insert a urinary catheter and monitor post-obstructive diuresis is the best answer because obstructive AKI from urinary retention requires prompt catheterisation and monitoring after drainage. Give broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Post-obstructive diuresis can cause dehydration and electrolyte disturbance.

Reference: NICE CKS urinary retention; NICE NG148