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Obstructive acute kidney injury — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesObstructive acute kidney injurySCE Acute Medicine

A 76-year-old man with prostate cancer presents with nausea, reduced urine output and bilateral loin discomfort. Creatinine is 620 micromol/L, potassium 6.1 mmol/L and ultrasound shows bilateral hydronephrosis. ECG is normal. What is the most appropriate next step in management?

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Correct answer: A — Urgent urinary tract decompression with urology involvement

Bilateral hydronephrosis with severe AKI indicates post-renal obstruction requiring urgent decompression, such as catheterisation, stenting or nephrostomy depending on level. Diuretics do not relieve obstruction. Biopsy is inappropriate before addressing a clear reversible cause. The pearl is that obstruction is one of the most time-sensitive and reversible causes of AKI.

Reference: NICE CG169 AKI; UK Kidney Association