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Acute kidney injury requiring renal replacement therapy — SCE Acute Medicine MCQ

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HardRenal medicineAcute kidney injury requiring renal replacement therapySCE Acute Medicine

A 63-year-old woman with septic shock develops oliguric AKI despite resuscitation. Potassium is 6.6 mmol/L after insulin-glucose, pH is 7.08, bicarbonate is 8 mmol/L and she has pulmonary oedema requiring high oxygen. Creatinine is 410 micromol/L. What is the most appropriate next step in management?

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Correct answer: C — Urgent renal replacement therapy discussion with critical care and nephrology

Refractory hyperkalaemia, severe metabolic acidosis, pulmonary oedema and oliguria are indications for urgent renal replacement therapy consideration. The decision is based on complications, not a specific creatinine threshold. Further fluids may worsen pulmonary oedema when volume overloaded.

Reference: NICE NG148 acute kidney injury; UK Kidney Association AKI guidance