Sepsis-associated AKI — ESENeph MCQ

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EasyAcute Kidney Injury, Electrolytes and Acid-BaseSepsis-associated AKIESENeph

A 77-year-old man is admitted with pneumonia, hypotension and oliguria. Creatinine has risen from 92 to 198 micromol/L within 48 hours and urine output is 0.3 mL/kg/hour for 8 hours. Potassium is 4.9 mmol/L and bicarbonate is 20 mmol/L; bladder scan shows 60 mL. What is the most appropriate management?

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Correct answer: C — Treat sepsis and restore circulating volume

This is early septic AKI with hypoperfusion and oliguria; prompt sepsis treatment, haemodynamic optimisation and renal monitoring are the correct priorities. Loop diuretics do not treat AKI and should not be used routinely to convert oliguric AKI. Ultrasound is not routine when the cause is clear and obstruction is unlikely. The pearl is that NICE defines AKI by creatinine rise or oliguria, so urine output should be taken seriously even before severe biochemical derangement develops. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG148 Acute Kidney Injury: https://www.nice.org.uk/guidance/ng148/chapter/recommendations