Self assessment questions

Dr Peter Topham

Consultant Nephrologist

UHL

GIM teaching 25.4.17

A 74-year-old man presented with acute renal failure. He had a past medical history of hypertension, ischaemic heart

disease and type II diabetes mellitus. He smoked 25 cigarettes a day. He was recently found to be in atrial fibrillation and

anticoagulation with warfarin was commenced. Shortly before presentation he developed lower abdominal pain

associated with watery diarrhoea that had become blood-stained, and a rash on his legs.

On examination, he was afebrile, pulse was 104 beats per minute, irregularly irregular, blood pressure 176/94 mmHg, and

he was euvolaemic. He had abdominal tenderness below the umbilicus without guarding or rebound. No abdominal

masses were palpable. A purpuric rash was noted on his feet, legs and buttocks. His peripheral pulses were absent below

the popliteal pulses bilaterally.

Investigations:

haemoglobin 10.6 g/dL (11.5–16.5)

white cell count 22 × 109/L (4–11)

neutrophil count 18 × 109/L (1.5–7.0)

lymphocyte count 3.1 × 109/L (1.5–4.0)

eosinophil count 0.9 × 109/L (0.04–0.40)

platelet count 164 × 109/L (150–400)

erythrocyte sedimentation rate 75 mm/1st h (<20)

serum potassium 5.9 mmol/L (3.5–4.9)

serum creatinine 305 µmol/L (60–110)

serum bicarbonate 21 mmol/L (20–28)

complement C3 55 mg/dL (65–190)

complement C4 12 mg/dL (15–50)

urinalysis blood 2+ protein 2+

What is the most likely cause of acute renal failure?

A. Acute tubular necrosis.

B. Atheroembolic renal disease (cholesterol emboli).

C. Henoch Schonlein purpura.

D. Acute interstitial nephritis.

E. Aortic dissection

Question 1

A 76-year-old woman was found to have impaired renal function. Over the preceding 6 months she had noticed general malaise,

exertional breathlessness, low back and generalised joint pain, and 6kg weight loss. She had a background of long-standing,

poorly-controlled rheumatoid disease and type II diabetes mellitus. She was taking metformin,, ramipril, codeine /paracetamol.

and infliximab

On examination, she was pale and had a widespread deforming arthropathy with evidence of active synovitis. There were nodules

over her elbows. She had a marked kyphosis. Fundoscopy demonstrated background diabetic retinopathy.

Investigations:

haemoglobin 7.8 g/dL (11.5–16.5)

serum creatinine 185 µmol/L (60–110)

eGFR 24 mls/min (>60)

serum albumin 33 g/L (37–49)

serum total protein 70 g/L (61–76)

serum C-reactive protein 48 mg/L (<10)

urinalysis protein: trace

urinary albumin:creatinine ratio 32 mg/mmol (<2.5)

urinary protein:creatinine ratio 516 mg/mmol (<15)

What is the most likely cause of her renal dysfunction?

A analgesic nephropathy

B diabetic nephropathy

C membranous nephropathy

D myeloma kidney

E secondary amyloidosis

Question 2

A 68-year-old woman with a 12-year history of type II diabetes mellitus presented with increasing leg swelling and was found to have

impaired renal function. Her diabetic control had been poor with Haemoglobin A1c levels of between 8.5 and 9.5% over the

preceding 3 years. She also had hypertension and ischaemic heart disease (stable angina). She had also had infrequent

(less than 1 episode per year) urinary tract infections over the preceding 30 years. She was taking aspirin, simvastatin, bisoprolol, and

gliclazide. She smoked 10 cigarettes per day.

On examination, she had a BMI of 34. Her blood pressure was 184/92mmHg, she had pitting oedema of her legs and sacrum and a

small right sided pleural effusion. Her jugular venous pressure was elevated by 4cm. Fundoscopy revealed no retinopathy and there

was no evidence of peripheral neuropathy.

Investigations:

haemoglobin 13.6 g/dL (11.5–16.5)

serum sodium 143 mmol/L (137–144)

serum potassium 4.4 mmol/L (3.5–4.9)

serum creatinine 223 µmol/L (60–110)

serum albumin 36 g/L (37–49)

eGFR 20 mls/min (>60)

urinalysis protein 2+

blood negative

urinary protein:creatinine ratio 255 mg/mmol (<15)

Ultrasound of renal tract: left kidney 9.5 cm, right kidney 10cm

No hydronephrosis

What is the most likely cause of her renal impairment?

A. Diabetic nephropathy.

B. Hypertensive nephrosclerosis.

C. Membranous nephropathy.

D. Papillary necrosis.

E. Renovascular disease.

Question 3

A 32-year-old black woman presented with several swellings in her mouth. She had end-stage renal disease due to chronic

pyelonephritis and had received a deceased donor renal transplant (0-1-0 mismatch) 5 months earlier. Her post-transplant course

had been uncomplicated. Her treatment included tacrolimus 2mg bd, mycophenolate mofetil 500mg bd, prednisolone 5mg od,

ranitidine 150mg bd

On examination, 3 dark red/purple papules, 1 to 3cm diameter were present on the hard and soft palate. No other mucosal or

skin lesions were identified. Examination was otherwise uninformative.

Investigations:

haemoglobin 12.2g/dL (11.5–16.5)

white cell count 5.3× 109/L (4–11)

neutrophil count 3.2× 109/L (1.5–7.0)

lymphocyte count 1.4× 109/L (1.5–4.0)

platelet count 168× 109/L (150–400)

serum creatinine 123 µmol/L (60–110)

A biopsy of one of the lesions demonstrated bundles of atypical spindle cells with numerous blood filled clefts.

A diagnosis of Kaposi’s sarcoma was made.

What is the most likely cause of these lesions?

A. BK virus

B. Cytomegalovirus

C. Epstein–Barr virus

D. Human herpes virus 8

E. Human immunodeficiency virus 1

Question 4

A 72-year-old man presented with increasing peripheral oedema. He had a background of stage 3 chronic kidney disease and

ischaemic heart disease. Three months earlier an MR renal angiogram had demonstrated a 70% ostial stenosis in the right

renal artery and an occluded left renal artery.

On examination, pulse was 96 beats per minute, blood pressure 172/84 mmHg, and oedema was present to mid-thigh level

and in the sacrum. Bibasal crackles were present in the chest.

Investigations on admission:

haemoglobin 12.2 g/dL (13–18)

serum urea 12.2 mmol/L (2.5–7.0)

serum creatinine 146 µmol/L (60–110)

urinalysis 1+ protein

Renal ultrasound scan: left kidney 9.6 cm bipolar length, reduced cortical thickness,

right kidney 11.2 cm, cortex 1.5 cm.

No hydronephrosis.

Echocardiogram: moderate left ventricular hypertrophy, ejection fraction 35%, normal right heart.

He was treated with increasing doses of intravenous furosemide (up to 250 mg bd). His weight reduced by 4 kg over the first

10 days after admission but he remained very oedematous.

Investigations 10 days after admission:

serum urea 42.1 mmol/L (2.5–7.0)

serum creatinine 354 µmol/L (60–110)

What is the most appropriate next step in management?

A. add oral metolazone

B. angioplasty and stenting of the right renal artery

C. commence renal replacement therapy

D. intravenous dopamine

E. switch furosemide to bumetanide

Question 5

A 41-year-old man presented with persistent nonvisible haematuria. He was otherwise well and had no significant past

medical history. He had no family history of renal disease. He was taking no medication. He had smoked 20 cigarettes

per day for 20 years.

On examination, his blood pressure was 132/80 and no other abnormalities were identified.

Investigations:

serum sodium 143 mmol/L (137–144)

serum potassium 4.4 mmol/L (3.5–4.9)

serum creatinine 85 µmol/L (60–110)

estimated glomerular filtration rate (MDRD) >60 mL/min (>60)

serum corrected calcium 2.78 mmol/L (2.2–2.6)

plasma parathyroid hormone 10.4 pmol/L (0.9–5.4)

urinalysis 3+ blood, negative protein

urine microscopy red blood cells and acanthocytes

What is the most likely cause for the haematuria?

A. hypercalciuria

B. IgA nephropathy

C. renal stone disease

D. thin membrane nephropathy

E. transitional cell carcinoma

Question 6

A 52-year-old man presented with persistent nonvisible haematuria. He was otherwise well and had no significant past

medical history. He had no family history of renal disease. He was taking no medication. He had smoked 15-20 cigarettes

per day for 30 years.

On examination, his blood pressure was 132/80 and no other abnormalities were identified.

Investigations:

serum sodium 143 mmol/L (137–144)

serum potassium 4.4 mmol/L (3.5–4.9)

serum creatinine 85 µmol/L (60–110)

estimated glomerular filtration rate >60 mL/min (>60)

serum corrected calcium 2.78 mmol/L (2.2–2.6)

plasma parathyroid hormone 10.4 pmol/L (0.9–5.4)

urinalysis 3+ blood, trace protein

urine microscopy red blood cells and acanthocytes

renal ultrasound 2 normal, unobstructed kidneys

What is the most appropriate next investigation?

A. 24 hour urinary calcium

B. CT urogram

C. cystoscopy

D. renal biopsy

E. urine cytology

Question 7

A 22-year-old woman had a seizure 18 hours following an elective ovarian cystectomy. Post-operatively she had complained

of considerable abdominal pain and nausea. She had no past medical history and in particular was not known to have

epilepsy. She took no regular medication. Lorazepam (1.2mg IV) had been administered to stop the seizure.

On examination 15 minutes after the seizure, she was drowsy but opened eyes to command, made incomprehensible sounds,

and localised in response to pain. No focal neurological deficit was identified. On fundoscopy the optic discs were swollen.

There was no nuchal rigidity.

Investigations:

serum sodium mmol/L 114 mmol/L (137–144)

serum potassium 3.5 mmol/L (3.5–4.9)

serum creatinine 65 µmol/L (60–110)

plasma osmolality 238 mosmol/kg (278–300)

urinary osmolality 575 mosmol/kg (350–1000)

urinary sodium 46 mmol/L

What is the most appropriate treatment to correct hyponatraemia in this clinical setting?

A. Demeclocycline

B. Fluid restriction

C. Furosemide

D. Hypertonic saline

E. Tolvaptan

Question 8

A 45-year-old woman with sarcoidosis complained of polydipsia and polyuria. Her urine output was > 8 L per day. She had no

other symptoms. She also had type II diabetes mellitus. She was taking prednisolone 10mg once a day and

metformin 1g twice a day.

On examination, her blood pressure was 122 / 68 mmHg lying and 126 / 72 standing, her chest examination was normal and

there were no other abnormal findings.

Investigations:

serum sodium 136 mmol/L (137–144)

serum potassium 4.8 mmol/L (3.5–4.9)

serum creatinine 112 µmol/L (60–110)

estimated glomerular filtration rate 48 mL/min (>60)

fasting plasma glucose 7.2 mmol/L (3–6)

haemoglobin A1c 9.2 % (3.8–6.4)

serum corrected calcium 2.75 mmol/L (2.2–2.6)

plasma osmolality 282 mosmol/kg (278–300)

urinary osmolality 92 mosmol/kg (350–1000)

A chest X-ray demonstrated bilateral hilar enlargement. A supine abdominal X-ray demonstrated nephrocalcinosis.

A water deprivation test was performed. After 8 hours the following results were obtained:

Urine volume 980 ml

urine osmolality 760 mosmol/kg

plasma osmolality 288 mosmol/kg.

What is the most likely cause of the polyuria?

A. Central diabetes insipidus

B. Hypercalcaemia

C. Hyperglycaemia

D. Nephrogenic diabetes insipidus

E. Primary polydipsia

Question 9

A 55-year-old woman with type 2 diabetes mellitus, coronary artery disease and chronic kidney disease was electively

admitted for coronary angiography.

Investigations:

serum sodium 138 mmol/L (137–144)

serum potassium 4.5 mmol/L (3.5–4.9)

serum creatinine 165 μmol/L (60–110)

serum corrected calcium 2.42 mmol/L (2.2–2.6)

serum bicarbonate 24 mmol/L (20–28)

Which treatment will provide the greatest reduction in her risk for contrast-induced nephropathy?

A. N-acetyl cysteine 1.2g 1hr pre- and 3hrs post-procedure

B. 5% dextrose in water at 1mL/kg per hr for 12 hours per and post procedure

C. 0.9% saline at 1mL/kg per hr for 12 hr pre-and post-procedure

D. isotonic sodium bicarbonate at 3 mL/kg per hr for 1 hour pre-procedure and 1mL/kg per hr for 6 hours post-procedure

E. 250 mL of 10% mannitol in 0.45% saline over 2 hours pre-procedure

Question 10

A 74-year-old man presented with acute renal failure. He had a past medical history of hypertension, ischaemic heart

disease and type II diabetes mellitus. He smoked 25 cigarettes a day. He was recently found to be in atrial fibrillation and

anticoagulation with warfarin was commenced. Shortly before presentation he developed lower abdominal pain

associated with watery diarrhoea that had become blood-stained, and a rash on his legs.

On examination, he was afebrile, pulse was 104 beats per minute, irregularly irregular, blood pressure 176/94 mmHg, and

he was euvolaemic. He had abdominal tenderness below the umbilicus without guarding or rebound. No abdominal

masses were palpable. A purpuric rash was noted on his feet, legs and buttocks. His peripheral pulses were absent below

the popliteal pulses bilaterally.

Investigations:

haemoglobin 10.6 g/dL (11.5–16.5)

white cell count 22 × 109/L (4–11)

neutrophil count 18 × 109/L (1.5–7.0)

lymphocyte count 3.1 × 109/L (1.5–4.0)

eosinophil count 0.9 × 109/L (0.04–0.40)

platelet count 164 × 109/L (150–400)

erythrocyte sedimentation rate 75 mm/1st h (<20)

serum potassium 5.9 mmol/L (3.5–4.9)

serum creatinine 305 µmol/L (60–110)

serum bicarbonate 21 mmol/L (20–28)

complement C3 55 mg/dL (65–190)

complement C4 12 mg/dL (15–50)

urinalysis blood 2+ protein 2+

What is the most likely cause of acute renal failure?

A. Acute tubular necrosis.

B. Atheroembolic renal disease (cholesterol emboli).

C. Henoch Schonlein purpura.

D. Acute interstitial nephritis.

E. Aortic dissection

Question 1 - answer

A 76-year-old woman was found to have impaired renal function. Over the preceding 6 months she had noticed general malaise,

exertional breathlessness, low back and generalised joint pain, and 6kg weight loss. She had a background of long-standing,

poorly-controlled rheumatoid disease and type II diabetes mellitus. She was taking metformin, ramipril, codeine /paracetamol.

and infliximab.

On examination, she was pale and had a widespread deforming arthropathy with evidence of active synovitis. There were nodules

over her elbows. She had a marked kyphosis. Fundoscopy demonstrated background diabetic retinopathy.

Investigations:

haemoglobin 7.8 g/dL (11.5–16.5)

serum creatinine 185 µmol/L (60–110)

eGFR 24 mls/min (>60)

serum albumin 33 g/L (37–49)

serum total protein 70 g/L (61–76)

serum C-reactive protein 48 mg/L (<10)

urinalysis protein: trace

urinary albumin:creatinine ratio 32 mg/mmol (<2.5)

urinary protein:creatinine ratio 516 mg/mmol (<15)

What is the most likely cause of her renal dysfunction?

A analgesic nephropathy

B diabetic nephropathy

C membranous nephropathy

D myeloma kidney

E secondary amyloidosis

Question 2 - answer

A 68-year-old woman with a 12-year history of type II diabetes mellitus presented with increasing leg swelling and was found to have

impaired renal function. Her diabetic control had been poor with Haemoglobin A1c levels of between 8.5 and 9.5% over the

preceding 3 years. She also had hypertension and ischaemic heart disease (stable angina). She had also had infrequent

(less than 1 episode per year) urinary tract infections over the preceding 30 years. She was taking aspirin, simvastatin, bisoprolol, and

gliclazide. She smoked 10 cigarettes per day.

On examination, she had a BMI of 34. Her blood pressure was 184/92mmHg, she had pitting oedema of her legs and sacrum and a

small right sided pleural effusion. Her jugular venous pressure was elevated by 4cm. Fundoscopy revealed no retinopathy and there

was no evidence of peripheral neuropathy.

Investigations:

haemoglobin 13.6 g/dL (11.5–16.5)

serum sodium 143 mmol/L (137–144)

serum potassium 4.4 mmol/L (3.5–4.9)

serum creatinine 223 µmol/L (60–110)

serum albumin 36 g/L (37–49)

eGFR 20 mls/min (>60)

urinalysis protein 2+

blood negative

urinary protein:creatinine ratio 255 mg/mmol (<15)

Ultrasound of renal tract: left kidney 9.5 cm, right kidney 10cm

No hydronephrosis

What is the most likely cause of her renal impairment?

A. Diabetic nephropathy.

B. Hypertensive nephrosclerosis.

C. Membranous nephropathy.

D. Papillary necrosis.

E. Renovascular disease.

Question 3 - answer

A 32-year-old black woman presented with several swellings in her mouth. She had end-stage renal disease due to chronic

pyelonephritis and had received a deceased donor renal transplant (0-1-0 mismatch) 5 months earlier. Her post-transplant course

had been uncomplicated. Her treatment included tacrolimus 2mg bd, mycophenolate mofetil 500mg bd, prednisolone 5mg od,

ranitidine 150mg bd

On examination, 3 dark red/purple papules, 1 to 3cm diameter were present on the hard and soft palate. No other mucosal or

skin lesions were identified. Examination was otherwise uninformative.

Investigations:

haemoglobin 12.2g/dL (11.5–16.5)

white cell count 5.3× 109/L (4–11)

neutrophil count 3.2× 109/L (1.5–7.0)

lymphocyte count 1.4× 109/L (1.5–4.0)

platelet count 168× 109/L (150–400)

serum creatinine 123 µmol/L (60–110)

A biopsy of one of the lesions demonstrated bundles of atypical spindle cells with numerous blood filled clefts.

A diagnosis of Kaposi’s sarcoma was made.

What is the most likely cause of these lesions?

A. BK virus

B. Cytomegalovirus

C. Epstein–Barr virus

D. Human herpes virus 8

E. Human immunodeficiency virus 1

Question 4 - answer

A 72-year-old man presented with increasing peripheral oedema. He had a background of stage 3 chronic kidney disease and

ischaemic heart disease. Three months earlier an MR renal angiogram had demonstrated a 70% ostial stenosis in the right

renal artery and an occluded left renal artery.

On examination, pulse was 96 beats per minute, blood pressure 172/84 mmHg, and oedema was present to mid-thigh level

and in the sacrum. Bibasal crackles were present in the chest.

Investigations on admission:

haemoglobin 12.2 g/dL (13–18)

serum urea 12.2 mmol/L (2.5–7.0)

serum creatinine 146 µmol/L (60–110)

urinalysis 1+ protein

Renal ultrasound scan: left kidney 9.6 cm bipolar length, reduced cortical thickness,

right kidney 11.2 cm, cortex 1.5 cm.

No hydronephrosis.

Echocardiogram: moderate left ventricular hypertrophy, ejection fraction 35%, normal right heart.

He was treated with increasing doses of intravenous furosemide (up to 250 mg bd). His weight reduced by 4 kg over the first

10 days after admission but he remained very oedematous.

Investigations 10 days after admission:

serum urea 42.1 mmol/L (2.5–7.0)

serum creatinine 354 µmol/L (60–110)

What is the most appropriate next step in management?

A. add oral metolazone

B. angioplasty and stenting of the right renal artery

C. commence renal replacement therapy

D. intravenous dopamine

E. switch furosemide to bumetanide

Question 5 - answer

A 41-year-old man presented with persistent nonvisible haematuria. He was otherwise well and had no significant past

medical history. He had no family history of renal disease. He was taking no medication. He had smoked 20 cigarettes

per day for 20 years.

On examination, his blood pressure was 132/80 and no other abnormalities were identified.

Investigations:

serum sodium 143 mmol/L (137–144)

serum potassium 4.4 mmol/L (3.5–4.9)

serum creatinine 85 µmol/L (60–110)

estimated glomerular filtration rate (MDRD) >60 mL/min (>60)

serum corrected calcium 2.78 mmol/L (2.2–2.6)

plasma parathyroid hormone 10.4 pmol/L (0.9–5.4)

urinalysis 3+ blood, negative protein

urine microscopy red blood cells and acanthocytes

What is the most likely cause for the haematuria?

A. hypercalciuria

B. IgA nephropathy

C. renal stone disease

D. thin membrane nephropathy

E. transitional cell carcinoma

Question 6 - answer

A 52-year-old man presented with persistent nonvisible haematuria. He was otherwise well and had no significant past

medical history. He had no family history of renal disease. He was taking no medication. He had smoked 15-20 cigarettes

per day for 30 years.

On examination, his blood pressure was 132/80 and no other abnormalities were identified.

Investigations:

serum sodium 143 mmol/L (137–144)

serum potassium 4.4 mmol/L (3.5–4.9)

serum creatinine 85 µmol/L (60–110)

estimated glomerular filtration rate >60 mL/min (>60)

serum corrected calcium 2.78 mmol/L (2.2–2.6)

plasma parathyroid hormone 10.4 pmol/L (0.9–5.4)

urinalysis 3+ blood, trace protein

urine microscopy red blood cells and acanthocytes

renal ultrasound 2 normal, unobstructed kidneys

What is the most appropriate next investigation?

A. 24 hour urinary calcium

B. CT urogram

C. cystoscopy

D. renal biopsy

E. urine cytology

Question 7 - answer

A 22-year-old woman had a seizure 18 hours following an elective ovarian cystectomy. Post-operatively she had complained

of considerable abdominal pain and nausea. She had no past medical history and in particular was not known to have

epilepsy. She took no regular medication. Lorazepam (1.2mg IV) had been administered to stop the seizure.

On examination 15 minutes after the seizure, she was drowsy but opened eyes to command, made incomprehensible sounds,

and localised in response to pain. No focal neurological deficit was identified. On fundoscopy the optic discs were swollen.

There was no nuchal rigidity.

Investigations:

serum sodiummmol/L 114 mmol/L (137–144)

serum potassium 3.5 mmol/L (3.5–4.9)

serum creatinine 65 µmol/L (60–110)

plasma osmolality 238 mosmol/kg (278–300)

urinary osmolality 575 mosmol/kg (350–1000)

urinary sodium 46 mmol/L

What is the most appropriate treatment to correct hyponatraemia in this clinical setting?

A. Demeclocycline

B. Fluid restriction

C. Furosemide

D. Hypertonic saline

E. Tolvaptan

Question 8 - answer

A 45-year-old woman with sarcoidosis complained of polydipsia and polyuria. Her urine output was > 8 L per day. She had no

other symptoms. She also had type II diabetes mellitus. She was taking prednisolone 10mg once a day and

metformin 1g twice a day.

On examination, her blood pressure was 122 / 68 mmHg lying and 126 / 72 standing, her chest examination was normal and

there were no other abnormal findings.

Investigations:

serum sodium 136 mmol/L (137–144)

serum potassium 4.8 mmol/L (3.5–4.9)

serum creatinine 112 µmol/L (60–110)

estimated glomerular filtration rate 48 mL/min (>60)

fasting plasma glucose 7.2 mmol/L (3–6)

haemoglobin A1c 9.2 % (3.8–6.4)

serum corrected calcium 2.75 mmol/L (2.2–2.6)

plasma osmolality 282 mosmol/kg (278–300)

urinary osmolality 92 mosmol/kg (350–1000)

A chest X-ray demonstrated bilateral hilar enlargement. A supine abdominal X-ray demonstrated nephrocalcinosis.

A water deprivation test was performed. After 8 hours the following results were obtained:

Urine volume 980 ml

urine osmolality 760 mosmol/kg

plasma osmolality 288 mosmol/kg.

What is the most likely cause of the polyuria?

A. Central diabetes insipidus

B. Hypercalcaemia

C. Hyperglycaemia

D. Nephrogenic diabetes insipidus

E. Primary polydipsia

Question 9 - answer

A 55-year-old woman with type 2 diabetes mellitus, coronary artery disease and chronic kidney disease was electively

admitted for coronary angiography.

Investigations:

serum sodium 138 mmol/L (137–144)

serum potassium 4.5 mmol/L (3.5–4.9)

serum creatinine 165 μmol/L (60–110)

serum corrected calcium 2.42 mmol/L (2.2–2.6)

serum bicarbonate 24 mmol/L (20–28)

Which treatment will provide the greatest reduction in her risk for contrast-induced nephropathy?

A. N-acetyl cysteine 1.2g 1hr pre- and 3hrs post-procedure

B. 5% dextrose in water at 1mL/kg per hr for 12 hours per and post procedure

C. 0.9% saline at 1mL/kg per hr for 12 hr pre-and post-procedure

D. isotonic sodium bicarbonate at 3 mL/kg per hr for 1 hour pre-procedure and 1mL/kg per hr for 6 hours post-procedure

E. 250 mL of 10% mannitol in 0.45% saline over 2 hours pre-procedure

Question 10- answer