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Acute kidney injury with medicine-associated risk — SCE Acute Medicine MCQ

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ModerateRenal medicineAcute kidney injury with medicine-associated riskSCE Acute Medicine

A 74-year-old man with CKD and heart failure is admitted with AKI after diarrhoea. Creatinine has risen from 110 to 295 micromol/L and potassium is 5.4 mmol/L. He is taking ramipril, spironolactone, furosemide and metformin. BP is 92/50 mmHg and he is clinically volume depleted. What is the most appropriate next step in management?

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Correct answer: B — Hold nephrotoxic and volume-sensitive medicines, assess fluid status and treat hypovolaemia

The immediate priority in AKI is identification and correction of reversible causes, including hypovolaemia and medicines that worsen renal perfusion or accumulation toxicity. ACE inhibitors, spironolactone and metformin should be withheld temporarily in this context, with careful fluid assessment because of heart failure. A creatinine rise alone is not an automatic indication for dialysis.

Reference: NICE NG148