**Question:** A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also reports that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab results reveal a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine? A. Diuretic therapy B. Vasoconstrictor therapy C. Nitrates D. Laxatives **Correct Answer:** **Core Concept:** Cirrhosis is a chronic liver disease characterized by the formation of regenerative nodules and fibrosis leading to impaired liver function. Cirrhosis can cause various complications, including fluid overload, renal insufficiency, and elevated serum creatinine and blood urea nitrogen (BUN) levels. **Why the Correct Answer is Right:** The patient's elevated BUN and creatinine levels indicate impaired renal function due to cirrhosis. In this case, the appropriate treatment focuses on managing renal dysfunction and fluid overload. **Why Options A and B are Incorrect:** A. Diuretic therapy (option A) may worsen renal dysfunction in cirrhosis, as it can lead to worsened fluid overload and worsened renal function. B. Vasoconstrictor therapy (option B) is not relevant to the management of renal dysfunction in this context. **Why Options C and D are Incorrect:** C. Nitrates (option C) are primarily used in the management of angina and hypertension, not renal dysfunction resulting from liver cirrhosis. D. Laxatives (option D) are not relevant to the management of renal dysfunction or fluid overload in liver cirrhosis. **Clinical Pearls:** 1. In patients with liver cirrhosis and renal dysfunction, the focus of treatment should be on addressing fluid overload and improving renal function. 2. Avoidance of diuretic therapy and vasoconstrictor therapy are essential to prevent worsening renal dysfunction in these patients. 3. Nitrates are not indicated in renal dysfunction related to liver cirrhosis, and laxatives are not relevant to treating fluid overload or renal dysfunction in this context. In conclusion, the correct answer is option A (diuretic therapy) which should be avoided due to its potential worsening of renal dysfunction in liver cirrhosis patients.