Question 1 [1 mark]

A 78-year-old man is seen on the acute medical unit after 3 days of watery diarrhoea, vomiting and poor oral intake. He takes ramipril, furosemide and regular naproxen for osteoarthritis. His blood pressure is 90/52 mmHg, pulse 108/min, and his mucous membranes are dry. He has passed little urine for 24 hours. A bladder scan shows 60 mL residual volume, and urine dipstick shows no blood, protein or leucocytes. His creatinine was 92 µmol/L three months ago.

Test	Result	Reference range
Sodium	139 mmol/L	137–144
Potassium	5.3 mmol/L	3.5–4.9
Urea	24.6 mmol/L	2.5–7.0
Creatinine	238 µmol/L	60–110
Bicarbonate	19 mmol/L	20–28
Urine sodium (spot)	12 mmol/L	below 20 suggests sodium avidity

What is the most likely cause of his acute kidney injury?

Renal hypoperfusion from volume depletionPost-renal obstruction from prostatic enlargementAcute tubular necrosis from prolonged ischaemiaRapidly progressive glomerulonephritisAcute interstitial nephritis from a drug reaction

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Question 1 [1 mark]

Demo · PLAB 1