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NSAID-associated acute kidney injury — SCE Acute Medicine MCQ

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HardRenal medicineNSAID-associated acute kidney injurySCE Acute Medicine

A volume-depleted patient with CKD becomes oliguric after taking ibuprofen. Sediment is bland and ultrasound excludes obstruction. Which mechanism best explains the abrupt fall in filtration?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Give oral magnesium and continuous ECG monitoring

The best answer is “Give oral magnesium and continuous ECG monitoring”. This is correct because renal prostaglandins preserve afferent flow when effective circulating volume is low. NSAID blockade removes that compensation and reduces glomerular pressure. ACE inhibitors dilate rather than constrict the efferent arteriole, while bland urine and normal imaging argue against glomerular, crystal and obstructive alternatives.

Reference: NICE NG148 acute-kidney-injury recommendations: https://www.nice.org.uk/guidance/ng148/chapter/Recommendations