Baseline serum creatinine is 0.8-0.9mg/dl, most recently 0.85mg/dL two weeks prior.

Both kidneys appears normal, without evidence of hydronephrosis or hydroureter. The echogenicity is normal. The left kidney measures 9.5 cm and the right kidney measures 10.1 cm.

(Image courtery of A. Prof Frank Gaillard from Radiopaedia.org Case 35985)

Correct! This patient is oliguric, with many “muddy brown” granular casts on urine sediment. A FENa > 1.0% is also suggestive, though should not be considered in isolation.

With a normal appearing kidney/bladder ultrasound and a foley catheter in place, this patient’s low urine output and AKI are likely due to something else. Try again!

This patient has been volume resuscitated and continues to worsen, suggesting against Pre-renal AKI. He also has significant abnormalities on urine sediment. Try again!

In the absence of red blood cells on urinalysis, it is unlikely for this patient to have glomerulonephritis. Take another look at the urine sediment; what kind of casts are those?

While this patient does have hypotension and evidence of volume overload after aggressive fluid resuscitation, his urine studies and urine sediment suggest a different cause of oliguric AKI. Try again!