A 68-year-old woman with chronic kidney disease (eGFR 28 mL/min/1.73m²) and diabetes presents with acute-onset dyspnoea, orthopnoea, and peripheral oedema. Chest X-ray shows bilateral pulmonary oedema. BNP is 850 pg/mL. Echocardiography reveals ejection fraction 28% with global hypokinesis. Serum creatinine has risen from 2.1 to 3.8 mg/dL over 48 hours. Urine sodium is 15 mEq/L. What is the most appropriate immediate next step in management?

See the options, answer & explanation

Sign in free to reveal the answer choices, the correct answer, the detailed explanation, and AI-powered insights for this question.