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Oliguria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

To view a comprehensive algorithm of common findings of urine composition and urine output, click here

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Oliguria and anuria are the decreased or absent production of urine, respectively.

Oliguria is defined as a urine output that is less than 1 mL/kg/h in infants,[1] less than 0.5 mL/kg/h in children,[1] and less than 400 mL[1] or 500 mL[2] per 24h in adults – this equals 17 or 21 mL/hour. For example, in an adult weighing 70 kg it equals 0.24 or 0.3 ml/hour/kg. Alternatively, however, the value of 0.5 mL/kg/h is commonly used to define oliguria in adults as well.[2]

Olig- (or oligo-) is a Greek prefix meaning small or few.[3]

Anuria is defined as less than 50mL urine output per day.

References

  1. ↑ 1.0 1.1 1.2 Klahr S, Miller S (1998). “Acute oliguria”. N Engl J Med. 338 (10): 671–5. doi:10.1056/NEJM199803053381007. PMID 9486997. Free Full Text.
  2. ↑ 2.0 2.1 Merck manuals > Oliguria Last full review/revision March 2009 by Soumitra R. Eachempati
  3. ↑ http://biology.about.com/od/prefixesandsuffixeso/g/blo3.htm

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Historical Perspective

Historical Perspective

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Classification

Classification

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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Oliguria is usually as a result of acute renal insult rather than chronic failure and more commonly due to tubular damage caused by renal hypoperfusion or nephrotoxins, where reabsorption of glomerular filtrate is impaired.

Pathophysiology

The mechanisms causing oliguria can be divided into several categories:

Prerenal

In response to hypoperfusion of the kidney (e.g. as a result of dehydration by poor oral intake, diarrhea, massive bleeding or sepsis)

Renal

Due to kidney damage (severe hypoperfusion, rhabdomyolysis, medication)

Postrenal

As a consequence of obstruction of the urine flow (e.g. enlarged prostate, tumor compression urinary outflow, expanding hematoma or fluid collection)

The decreased production of urine may be a sign of dehydration, renal failure or urinary obstruction/urinary retention.

Postoperative Oliguria

Patients usually have a decrease in urine output after a major operation that may be a normal physiological response to:

Oliguria in Infants

Oliguria, when defined as less than 1 mL/kg/h, in infants is not considered to be a reliable sign of renal failure.[1]

References

  1. ↑ Arant B (1987). “Postnatal development of renal function during the first year of life”. Pediatr Nephrol. 1 (3): 308–13. PMID 3153294.

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Overview

Oliguria is the low output of urine below 300-500ml/day. The decreased output of urine may be causes by dehydration, renal failure, hypovolemic shock, hyperosmolar nonketotic coma, urinary retention, DKA, preeclampsia, and urinary tract infections among other conditions.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Accelerated hypertension, acute systemic inflammation after myocardial infarction, aneurysmal rupture, aortic valve ring and critical aortic stenosis, atheroemboli, bleeding, bradyarrhythmias , capillary leak, cardiogenic shock, cholesterol embolism, complete heart block, congenital heart disease, dilated cardiomyopathies, heart failure, heat stroke, hypovolemic shock, malignant hypertension, myocardial stunning, cardiac tamponade, pre-eclampsia, renal artery stenosis, severe constrictive pericarditis, superior mesenteric artery occlusion, vasculitis
Chemical/Poisoning Camphor, carbon monoxide
Dental No underlying causes
Dermatologic Anaphylaxis and anaphylactoid reactions, erythroderma, sweating
Drug Side Effect ACE inhibitors, Aldesleukin, amatoxins, aminoglycosides, amphotericin B, analgesic nephropathy, anthracyclines, arsenic trioxide, bacitracin, bendamustine, bleomycin, capecitabine, capreomycin, carbon tetrachloride, carboplatin, carmustine, cidofovir, cisplatin, cyclophosphamide, cyclosporine, cytarabine, deferasirox, etoposide, exenatide, fluconazole, fludarabine, cladribine, gallium, gemcitabine, gyromitrin, hetastarch, hydroxyurea, ifosfamide, immune globulin intravenous injection, irinotecan, lenalidomide, Lincomycin Hydrochloride, lomustine, malignant hyperpyrexia following anesthesia, mannitol, melphalan, methotrexate, micafungin, mithramycin, Nabilone, nitrosourea compounds, NSAIDs , orellanine, oxaliplatin, para-amino salicylic acid, pemetrexed, pentamidine, pentostatin, pramipexole, polymyxin B, rifampicin, sertraline, Streptozocin, Sulfasalazine, sulfinpyrazone, sulphonamide crystalluria Cacluli, synthetic cannabinoids, tacrolimus, taxanes, telavancin, temozolomide, tenofovir, topotecan, valacyclovir, vancomycin, vinca alkaloids
Ear Nose Throat No underlying causes
Endocrine Acute pancreatitis, addisonian crisis, diabetic nephropathy, hypercalciuria, hyperosmolar non-ketotic diabetic coma, hypoaldosteronism, myxedema coma, SIADH
Environmental Burns, heat stroke, insect bites, snake bite (Viperidae)
Gastroenterologic Bowel strangulation, colorectal cancer, hepatic vein thrombosis, hepatorenal syndrome, intestinal obstruction, intususception of intestine, acute pancreatitis, retroperitoneal fibrosis, third space losses, upper or lower gastrointestinal bleeding
Genetic Prune belly syndrome, thrombotic thrombocytopenic purpura, transient renal dysfunction of the newborn
Hematologic Disseminated intravascular coagulation, expanding hematoma, mismatched blood transfusion, myelomatosis, myoglobinuria, polycythemia, porphyria, renal artery thrombosis, renal vein thrombosis, thrombotic thrombocytopenic purpura, transfusion reactions
Iatrogenic Diarrhea, external drainage, malignant hyperpyrexia following anesthesia, mismatched blood transfusion, multiple organ dysfunction syndrome, radiotherapy, sweating, systemic inflammatory response syndrome , vomiting
Infectious Disease Diphtheria, endometriosis, endotoxic shock, enteritis, epidemic dropsy, hantavirus, human monocytotropic ehrlichiosis, lassa fever, leptospirosis, malignant malaria, mycobacterium tuberculosis, neisseria gonorrhoea, post-streptococcal glomerulonephritis, schistosoma haematobium, septic shock, systemic inflammatory response syndrome, toxic shock syndrome
Musculoskeletal/Orthopedic Rhabdomyolysis, cervical spine injury, spinal cord compression, crush syndrome, fractures, massive bleeding, polytrauma
Neurologic Eclampsia, intraventricular hemorrhage, neurogenic bladder, neurogenic shock after central nervous system or spinal cord injury, prolonged convulsions, spinal cord compression
Nutritional/Metabolic Adenine phosphoribosyltransferase deficiency, bulimia, cholesterol embolism
Obstetric/Gynecologic Cervical cancer, endometriosis, hydrometrocolpos, hyperemesis gravidarum, ovarian hyperstimulation syndrome, perinatal asphyxia, postpartum bleeding, pre-eclampsia, pregnancy toxemia, puerperal shock, twin-to-twin transfusion syndrome
Oncologic Benign prostatic hyperplasia, bladder cancer, leukaemia, myelomatosis, pelvic tumour, prostate cancer, tumor lysis syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity Crush syndrome, drug overdose, heavy metal poisoning , heme pigments, myoglobinuria, porphyria, radiocontrast media, rhabdomyolysis, tumor lysis syndrome.
Psychiatric Bulimia
Pulmonary Alport syndrome, massive pulmonary embolism, respiratory distress syndrome, respiratory losses , severe pulmonary hypertension, tension pneumothorax
Renal/Electrolyte Acute cortical necrosis, acute interstitial nephritis, acute on chronic renal failure , acute pyelonephritis, acute renal failure, acute tubular necrosis, addisonian crisis, alport syndrome, analgesic nephropathy, burns, chronic renal failure, end stage kidney disease, glomerulonephritis, hepatic vein thrombosis, hepatorenal syndrome, hydronephrosis, hypoaldosteronism, nephritic syndrome, nephrocalcinosis, nephrolithiasis, nephrotic syndrome, Post-streptococcal glomerulonephritis, renal papillary necrosis, renal vein thrombosis, salt-wasting nephropathies, sulphonamide crystalluria, thrombotic thrombocytopenic purpura
Rheumatology/Immunology/Allergy Anaphylaxis and anaphylactoid reactions, antiphospholipid Antibody Syndrome, disseminated intravascular coagulation, lichen sclerosus et atrophicus, mismatched blood transfusion, multiple organ dysfunction syndrome, systemic lupus erythematosis, systemic inflammatory response syndrome , transfusion reactions, transplant rejection, vasculitis
Sexual Benign prostatic hyperplasia, hydrometrocolpos
Trauma Acute blood loss, crush syndrome, fractures, multiple traumatic injuries, neurogenic bladder, neurogenic shock after central nervous system or spinal cord injury, ruptured hematoma, shock, upper or lower gastrointestinal bleeding
Urologic Benign prostatic hyperplasia, bladder cancer, bladder outlet obstruction, hydronephrosis, kidney stone, nephrotic syndrome, obstruction of the urinary tract, pelvic tumor, prostate cancer, schistosoma haematobium, sulphonamide crystalluria, ureterocele, urethral catheterization, urethral stricture, urethral trauma
Miscellaneous Marathon running, post-resustication syndrome, puerperal shock, radiotherapy, surgery complication

Causes in Alphabetical Order

References

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Differentiating Oliguria from other Diseases

Differentiating Oliguria from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2], Eiman Ghaffarpasand, M.D. [3], Anmol Pitliya, M.B.B.S. M.D.[4]

Overview

There are several life-threatening causes of oliguria which is needed to be evaluated, which include sepsis, urethral stricture, dehydration, and shock. The other possible causes of oliguria can be evaluated by carefully assessing the nature of the symptoms, and obtaining a thorough patient history.

Oliguria Differential Diagnosis

The following table outlines the major differential diagnoses of oliguria:

To review the differential diagnosis of oliguria with thirst, click here.

To review the differential diagnosis of oliguria with muscle weakness, click here.

To review the differential diagnosis of oliguria with somatic pain, click here.

To review the differential diagnosis of oliguria with vomiting, click here.

To review the differential diagnosis of oliguria with diarrhea, click here.

To review the differential diagnosis of oliguria with tachypnea, click here.

To review the differential diagnosis of oliguria with edema, click here.

To review the differential diagnosis of oliguria with fatigue and thirst, click here.

To review the differential diagnosis of oliguria with fatigue and tachypnea, click here.

To review the differential diagnosis of oliguria with fatigue and edema, click here.

To review the differential diagnosis of oliguria with fatigue, vomiting, and diarrhea, click here.

To review the differential diagnosis of oliguria with fatigue, somatic pain, vomiting, and diarrhea, click here.

To review the differential diagnosis of oliguria with fatigue, somatic pain, vomiting, diarrhea, and edema click here.


Abbreviations: ABG = Arterial blood gases, BUN = Blood urea nitrogen, CBC = Complete blood count, CT = Computed tomography, CRP = C – reactive protein, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, IVP = Intravenous pyelography, KFT = Kidney function test, GI = Gastrointestinal, GFR = Glomerular filtration rate, MRI = Magnetic resonance imaging, PT = Prothrombin time

Etiology Clinical manifestations Paraclinical findings Comments
Symptoms and signs Lab findings Imaging
Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other
Prerenal causes Alcohol poisoning[1][2] + – +/- – +/- + +/- – – ↑PT ↑BUN, ↑Cr (isopropyl alcohol) ↓Na NA ↓HCO3 LFT NA NA NA NA – Administer thiamine to prevent Wernicke’s encephalopathy
Aspergillosis[3][4] +/- – – – – – – +/- – NA NA NA NA NA Allergy test, ↑IgE (>1000 IU/dl), direct visualization of fungal hyphae NA Pulmonary infiltrates, mucus plug, mass in the upper lobe surrounded by a crescent of air, solitary or multiple cavities Halo sign, wedge-shaped pulmonary infarction, granuloma NA – Polymerase chain reaction (PCR) confirms the diagnosis
Cholera[5][6][6][7] +/- + +/-

Depends on severity

– – +/- + – – Leukocytosis, ↑HCT ↑BUN, ↑Cr ↓Na, ↑Ca, ↑Mg NA ↑Lactate, ↓HCO3 Stool PCR, stool culture, serotyping NA NA NA NA – –
Congestive heart failure (CHF)[8][9] + – – – – – + – + Anemia, leukocytosis ↑BUN, ↑Cr ↓Na, ↑K NA ↑Lactate, ↓HCO3, ↑BNP, ↑troponin Cardiomegaly, pulmonary hypertension, pleural effusion Pulmonary edema NA Valvular heart disease Decreased ejection fraction in echocardiography, decreased heart function and damage in nuclear imaging –
Dehydration[10][11] + + +/-

Depends on the severity

+/- – +/- +/- – – NA ↑BUN, ↑Cr ↓Na, ↑K, ↓Cl ↑ Urine ketones and glucose, ↑urine specific gravity ↑Lactate, ↓HCO3 Hypoglycemia NA NA NA NA – –
Diarrhea and/or vomiting[12][13] +/- +/- – – – + + – – Leukocytosis with predominant neutrophilia, ↑ESR NA NA ↑ Urine ketones, organic acids, porphobilinogen, aminolevulinic acid NA Stool anion gap, stool pH < 5.5, stool culture, serotyping, enzyme immunoassay (rotavirus or adenovirus), abnormal LFT, amylase, lipase Normal NA NA NA – –
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments
Drugs/toxins[14][15] +/- +/- +/- +/- +/- +/- +/- +/- +/- NA ↑BUN, ↑Cr, ↑CK ↑K, ↓Mg, ↓Ca, ↓P Ingested drug, glucose, aminoacid, phosphate, ketone, hyaline cast, and RBC ↑Lactate, metabolic acidosis Toxicology, rapid immunoassay Nephropathy Radioopaque substances, ingested drug packets NA NA – –
Esophageal varices bleeding[16][17] +/- – – – +/- – – – – Normocytic normochromic anemia ↑BUN, ↑Cr NA NA NA NA Velocity and direction of portal flow Abnormal opacities outside ofesophageal wall, posterior mediastinal or intraparenchymal mass, dilated azygous vein Entire portal venous system Portrays esophageal varices as flow voids Portal hypertension and esophageal varices in positron emission tomography, flexible endoscope, barium swallow of snake-like filling defects –
Congenital heart disease[18][19] +/- – – – – – – +/- +/- ↑ESR and CRP ↑BUN, ↑Cr NA NA NA Throat culture, rapid streptococcal antigen test, hyperoxia test, pulse oximetry NA Cardiomegaly, dextrocardia NA NA Ventricular dysfunction, left and right ventricular hypertrophy, valvular disease in echocardiography –
Hemorrhage[20][21] – + +/-

Depends on the severity

– – – – +/- – Normocytic normochromic anemia, ↑PT, ↑PTT ↑BUN, ↑Cr ↑Na, ↑Cl, ↓Ca NA Metabolic acidosis NA Peritoneal cavity fluid in FAST Bilateral opacities in the lung field, hemothorax, hemoperitoneum, ruptured abdominal aortic aneurysm Intrathoracic, intra-abdominal, and retroperitoneal bleeding NA Source of bleeding in the upper GI in EGD, angiography –
Hemolysis[22][23] +/- – – – – – – +/- – Thrombocytopenia, microcytic hypochromic anemia, ↑RDW, ↑retic count NA NA NA NA ↑LDH, ↓haptoglobin, ↑unconjugated bilirubin Hepatomegaly, splenomegaly NA NA NA – –
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments
Hepatorenal syndrome[24][25] +/- – – – +/- +/- – – +/- Leukocytosis, ↑PT ↓GFR, ↑BUN, ↑Cr ↓Na Proteinuria, Na <10mEq/L, urine osmolality > plasma osmolality NA Alpha feto-protein, cryoglobulinemia Exclude hydronephrosis and intrinsic renal disease NA NA NA Right ventricular preload, ventricular filling pressures, and cardiac function in echocardiography –
Ischemic cardiomyopathy[26][27] +/- – – – – – – +/- +/- Anemia ↑Cr ↓Na, ↓K, ↓Mg NA NA Troponin, creatine kinase, Creatine kinase-MB, BNP NA Abnormal cardiac silhouette Biventricular volume, wall motion abnormality, myocardial perfusion, hypertrophic cardiomyopathy Mid-wall fibrosis in MRI Ejection fraction ≤35%, pulmonary embolism, right ventricular dilation or pericardial effusion with tamponade in echocardiography –
Liver cirrhosis[28][29] +/- – +/- +/- +/- – – – +/- NA NA NA NA NA Abnormal LFT, aspartate aminotransferase to platelet ratio, FibroTest/FibroSure, Hepascore Portal blood flow velocity, hepatic artery enlargement, multifocal lesions or masses, hepatic contour, ascites, splenomegaly Bowel perforation, gynecomastia, azygos vein enlargement, pleural effusion Morphologic changes in the liver, collaterals and shunts, hyperattenuating nodule of hepatocellular carcinoma, portal vein thrombosis Vacular patency, tumor invasion, portal vein thrombosis, steatosis Hepatic function and portal hypertension in nuclear imaging, hepatic perfusion and the development of shunts and tumors in angiography Irreversible and a transplant is usually needed
Malignant hypertension[30][31] +/- – + – – +/- – +/- +/- Microangiopathic hemolytic anemia ↑BUN, ↑Cr ↑Na, ↑K, ↑P Proteinuria, microscopic hematuria Acidosis Cardiac enzymes, urinary catecholamines, TSH, ↑Renin NA Cardiomegaly, pulmonary edema, rib notching, aortic coarctation, mediastinal widening, aortic dissection NA NA Left atrial enlargement and left ventricular hypertrophy in echocardiography –
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments
Myocarditis[32] +/- – – – +/- – – +/- – Leukocytosis (eosinophilia),↑ESR and ↑CRP NA NA NA NA Cardiac enzymes, viral antibodies NA NA NA Inflammatory edema, degree of scarring Endomyocardial biopsy, echocardiography, scintigraphy NA
Peritonitis[33][34] +/- – +/- – +/- +/- +/- – – Leukocytosis NA NA NA NA Ascitic fluid neutrophil count > 500 cells/µL NA NA NA NA – –
Polycythemia[35][36] +/- – – – – – – +/- – ↑RBC, ↑HCT, ↑HGB, thrombocytosis, leukocytosis, ↑PT, and ↑aPTT ↓Erythropoietin NA NA NA Hyperuricemia Splenomegaly NA NA NA – Phlebotomy is the usual treatment
Respiratory distress syndrome[37] + – +/- – – – – + – NA NA NA NA Metabolic and respiratory acidosis Pulse oximetry NA Bilateral, diffuse, reticular granular or ground-glass appearance +/- cardiomegaly NA NA Patent ductus arteriosus in echocardiography –
Shock[38] +/- +/- +/- +/- +/- +/- – +/- – ↑HCT, ↑PT and aPTT, Eosinophilia, Leukocytosis ↓GFR, ↑BUN, ↑Cr NA NA ↑Lactate LFT, ↑BNP, ↑troponin, D-dimer, fibrinogen Pulmonary embolism, pericardial effusion, cardiac tamponade, pneumothorax, thoracic or abdominal aortic aneurysm in RUSH (Rapid Ultrasound for Shock and Hypotension) Pneumonia, pneumothorax, pulmonary edema, widened mediastinum, free air under the diaphragm Traumatic brain injury, stroke, spinal injury, pneumonia, pPneumothorax, ruptured aneurysm, aortic dissection, pulmonary embolism NA – –
Toxic megacolon[39] +/- +/- +/- – + + +/- – – Leukocytosis, anemia, ↑ESR and ↑CRP ↑BUN, ↑Cr ↓Na NA NA Loss of haustra, hypoechoic and thick bowel walls, dilated colon > 6cm, dilatation of ileal loops Dilated colon, free intraperitoneal air Bowel perforation, abscess NA NA Endoscopy and colonoscopy –
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments
Renal causes Acute interstitial nephritis[40][41] +/- – +/- – +/- +/- +/- +/- +/- Eosinophilia ↑BUN, ↑Cr, ↑FENa NA Eosinophiluria, sterile pyuria, mMicroscopic hematuria, proteinuria NA ↑Total IgG, ↑IgG4 Normal-sized kidneys NA NA NA – History of long term analgesic use
Acute tubular necrosis[42][43] +/- – – – – +/- – – +/- Anemia ↑BUN, ↑Cr, ↑FENa ↓Na, ↑K, ↑Mg, ↑P, ↓Ca Pigmented, muddy brown, granular casts NA NA Obstructive uropathy, cortical thickness, hydronephrosis Nephrolithiasis Nephrolithiasis, area of obstruction Nephrolithiasis, area of obstruction Loss of tubular cells or the denuded tubules, swollen tubular cells, lLoss of the cell brush border in renal biopsy Furosemide stress testing for staging
Cancer[44][45] + – – – +/- +/- – – +/- Normocytic or microcytic anemia, leukocytosis or lymphocytosis, ↑reticulocytes, thrombocytopenia ↓GFR, ↑BUN, ↑Cr, ↓Erythropoietin ↓Na, ↑K, ↓Mg, ↑P, ↓Ca Gross hematuria NA LFT Fluid collection and morphological change, flank mass Calcification and widened mediastinum, filling defects in barium contrast Metastasis and staging, cystic and solid masses, lymph node, renal vein, and inferior vena cava involvement Soft tissue invasion and staging Malignant cystic lesions percutaneous cyst puncture Renal cell carcinoma types: Clear cell (75%), chromophilic (15%), chromophobic (5%), oncocytoma (3%), collecting duct (2%)
Congenital kidney disease[46][47][48]

– Agenesis

– Dysplasia

– Hypoplasia

– Polycystic

+/- – – – +/- +/- – – +/- ↑HCT ↓GFR ↓P, ↓Ca Microalbuminuria, uricosuria NA Genetic testing forADPKD2 Visualization of kidney cysts Small kidney cysts (0.5 cm) Kidney size, intracranial aneurysms NA – –
End stage renal disease[49][50] + – – – +/- – – – + Anemia ↓GFR, ↑BUN, ↑Cr ↑K Hypoalbuminuria ↓HCO3 Phosphate, 25-hydroxy vitamin D, alkaline phosphatase, parathyroid hormone Hydronephrosis, retroperitoneal fibrosis, enlarged or shrunken kidneys Obstruction in retrograde pyelogram Renal masses, stones, and cysts Renal vein thrombosis, renal artery stenosis in magnetic resonance angiography Percutaneous renal biopsy –
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments
Endogenous toxins[51][52][53][54][55]

– Hemoglobin

– Myoglobin

– Uric acid

+/- – +/- + – +/- – – +/- Anemia, thrombocytopenia ↓GFR, ↑BUN, ↑Cr ↑K, ↑urate, ↓Ca Uricosuria, hematuria, myoglobinuria, casts NA Creatine kinase > 1000 U/L Malignant or cystic lesions, hydronephrosis, nephrocalcinosis, urolithiasis NA Urolithiasis, wilms tumor, polycystic kidney disease NA Ureter or bladder abnormality in voiding cystourethrography –
Glomerulonephritis[56][57][58] +/- – – – – – – – + Pleocytosis, anemia, leukocytosis, ↑ESR ↑BUN, ↑Cr NA Specific gravity > 1.020, proteinuria, hematuria, red blood cell casts, white blood cell casts, cellular casts, oval fat bodies NA NA ↑C3, ↑C4, ↑CH50, blood and tissue culture, antinuclear antibodies, cryoglobulins, hepatitis B and C serologies, antineutrophil cytoplasmic antibody (ANCA) Kidney size, echogenicity of the renal cortex, obstruction, degree of fibrosis Pulmonary congestion Visceral abscesses – Renal biopsy, light and electron microscopy, immunofluorescence aid diagnosis
Goodpasture syndrome[59][60][61] +/- – – – – – – +/- +/- Anemia, leukocytosis, ↑ESR ↑BUN, ↑Cr NA Low-grade proteinuria, gross or microscopic hematuria, RBC casts NA Anti– glomerular basement membrane antibody, antineutrophilic cytoplasmic antibody NA Bilateral, basal, patchy parenchymal consolidations NA NA Diffuse alveolar hemorrhage in pulmonary biopsy –
Hemolytic uremic syndrome[62][63][64] +/- – +/- +/- +/- + + – +/- Severe anemia, thrombocytopenia, ↑aPTT ↑BUN, ↑Cr NA Mild proteinuria, Red blood cells, Red blood cell casts NA Schistocytes, ↑FDP and D-dimer, ↑bilirubin, ↑LDH, ↓haptoglobin, stool culture (for E coli 0157:H7 or shigella), ↓ADAMTS-13 activity Ruling out obstruction NA NA NA Diffuse thickening of the glomerular capillary wall, swelling of endothelial cells, fibrin thrombi in renal biopsy –
Nephrolithiasis[65][66][67] – – – – +/- +/- – – – Mild leukocytosis, ↑CRP ↑BUN, ↑Cr ↑Na, ↑K, ↑P, ↑Ca, ↑urate Gross or microscopic hematuria, Red blood cells, urinary crystals of calcium oxalate, uric acid, or cystine, hypercalciuria, urinary pH > 7 in struvite stones (Proteus, Pseudomonas, Klebsiella), urinary pH < 5 in uric acid stones ↓HCO3, renal tubular acidosis – All types of stones are visible, hydronephrosis, abdominal aortic aneurysm, cholelithiasis Calcium – containing stones, uric acid or cystine stones, stone movement Stone density, size and composition, hydronephrosis, nephromegaly, perinephric fat streaking NA Intravenous pyelography (IVP), renal tomography, nuclear renal scan –
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments

References

  1. ↑ Pletcher MJ, Maselli J, Gonzales R (December 2004). “Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey”. Am. J. Med. 117 (11): 863–7. doi:10.1016/j.amjmed.2004.07.042. PMID 15589492.
  2. ↑ Cherpitel CJ (March 1989). “Breath analysis and self-reports as measures of alcohol-related emergency room admissions”. J. Stud. Alcohol. 50 (2): 155–61. PMID 2927129.
  3. ↑ Marr KA, Carter RA, Crippa F, Wald A, Corey L (April 2002). “Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients”. Clin. Infect. Dis. 34 (7): 909–17. doi:10.1086/339202. PMID 11880955.
  4. ↑ Cornillet A, Camus C, Nimubona S, Gandemer V, Tattevin P, Belleguic C, Chevrier S, Meunier C, Lebert C, Aupée M, Caulet-Maugendre S, Faucheux M, Lelong B, Leray E, Guiguen C, Gangneux JP (September 2006). “Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey”. Clin. Infect. Dis. 43 (5): 577–84. doi:10.1086/505870. PMID 16886149.
  5. ↑ Weil AA, Khan AI, Chowdhury F, Larocque RC, Faruque AS, Ryan ET, Calderwood SB, Qadri F, Harris JB (November 2009). “Clinical outcomes in household contacts of patients with cholera in Bangladesh”. Clin. Infect. Dis. 49 (10): 1473–9. doi:10.1086/644779. PMC 2783773. PMID 19842974.
  6. ↑ 6.0 6.1 Cash RA, Music SI, Libonati JP, Snyder MJ, Wenzel RP, Hornick RB (January 1974). “Response of man to infection with Vibrio cholerae. I. Clinical, serologic, and bacteriologic responses to a known inoculum”. J. Infect. Dis. 129 (1): 45–52. PMID 4809112.
  7. ↑ Harris JB, Ivers LC, Ferraro MJ (June 2011). “Case records of the Massachusetts General Hospital. Case 19-2011. A 4-year-old Haitian boy with vomiting and diarrhea”. N. Engl. J. Med. 364 (25): 2452–61. doi:10.1056/NEJMcpc1100927. PMID 21696312.
  8. ↑ Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA (September 2007). “Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure”. Circulation. 116 (13): 1482–7. doi:10.1161/CIRCULATIONAHA.107.696906. PMID 17724259.
  9. ↑ Fonarow GC, Adams KF, Abraham WT, Yancy CW, Boscardin WJ (February 2005). “Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis”. JAMA. 293 (5): 572–80. doi:10.1001/jama.293.5.572. PMID 15687312.
  10. ↑ Steiner MJ, DeWalt DA, Byerley JS (June 2004). “Is this child dehydrated?”. JAMA. 291 (22): 2746–54. doi:10.1001/jama.291.22.2746. PMID 15187057.
  11. ↑ Vega RM, Avner JR (June 1997). “A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children”. Pediatr Emerg Care. 13 (3): 179–82. PMID 9220501.
  12. ↑ Carpenter DO (February 1990). “Neural mechanisms of emesis”. Can. J. Physiol. Pharmacol. 68 (2): 230–6. PMID 2178747.
  13. ↑ Bresee JS, Marcus R, Venezia RA, Keene WE, Morse D, Thanassi M, Brunett P, Bulens S, Beard RS, Dauphin LA, Slutsker L, Bopp C, Eberhard M, Hall A, Vinje J, Monroe SS, Glass RI (May 2012). “The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States”. J. Infect. Dis. 205 (9): 1374–81. doi:10.1093/infdis/jis206. PMID 22454468.
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