Approach to acute kidney injury Quiz: Ace Your Exams
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A 72-year-old man presents to the emergency department with acute-onset lower abdominal pain, difficulty urinating, and a weak urinary stream for one day. He has no fever, chills, dysuria, or hematuria. He has not had any changes in medication, travel, or trauma. Past medical history includes benign prostatic hyperplasia (BPH), for which he takes tamsulosin. Temperature is 37°C (98.6°F), blood pressure is 155/90 mmHg, heart rate is 102 beats per minute, respiratory rate is 14 breaths per minute, and oxygen saturation is 98% on room air. The abdomen is distended, and there is suprapubic tenderness with palpation. A digital rectal examination reveals an enlarged, smooth, non-tender prostate without nodules. There is no costovertebral angle tenderness. Renal ultrasound shows bilateral hydronephrosis and a distended bladder without evidence of renal parenchymal abnormalities. Laboratory results are shown below. Post-void residual bladder volume is 450 mL. Which of the following is the best next step in management?
| Laboratory test | Result |
| Sodium | 138 mEq/L |
| Potassium | 5.3 mEq/L |
| Serum creatinine | 4.4 mg/dL (baseline 1.1 mg/dL) |
| Blood urea nitrogen (BUN) | 45 mg/dL |
| Urinalysis | Bland sediment |
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