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Acute tubular necrosis — RACP Written MCQ

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ModerateNephrologyAcute tubular necrosisRACP Written

A 79-year-old man is admitted with sepsis and hypotension. Creatinine rises from 92 to 230 micromol/L. Urine microscopy shows muddy brown granular casts and fractional excretion of sodium is elevated after fluids. What is the most likely diagnosis?

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Correct answer: B — Acute tubular necrosis

Sepsis and hypotension followed by granular casts and impaired tubular sodium handling are typical of acute tubular necrosis.

Reference: Therapeutic Guidelines: Kidney and Urinary; Kidney Health Australia principles