13th July 2026

You are reviewing Samir, a 70-year-old gentleman admitted with shortness of breath and low urine output after being discharged on NSAIDs by the orthopaedic department following an ankle fracture.

You are reviewing Samir, a 70-year-old gentleman admitted with shortness of breath and low urine output after being discharged on NSAIDs by the orthopaedic department following an ankle fracture. He has a background of a metallic valve replacement and is on Warfarin 4mg daily. His X-ray shows evidence of pulmonary oedema, and his blood tests show an acute kidney injury with an eGFR of 35 ml/min/1.73 m2. His INR is within therapeutic range. He is not known to have renal impairment. You plan to review his medications to optimise his renal function. 

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