Oliguria with vomiting

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

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 Not applicable HCO3 LFT Not applicable Not applicable Not applicable Not applicable - Thiamine must be given to prevent Wernicke's encephalopathy
Cholera[3][4][4][5] +/- + - - - +/- + - - Leukocytosis, ↑HCT BUN, ↑Cr Na, ↑Ca, ↑Mg Not applicable Lactate, ↓HCO3 Stool PCR, Stool culture, Serotyping Not applicable Not applicable Not applicable Not applicable - -
Dehydration[6][7] + + - +/- - +/- +/- - - Not applicable BUN, ↑Cr Na, ↑K, ↓Cl Ketones and glucose, ↑Urine specific gravity Lactate, ↓HCO3 Hypoglycemia Not applicable Not applicable Not applicable Not applicable - -
Diarrhea and/or vomiting[8][9] +/- +/- - - - + + - - Leukocytosis with predominant neutrophilia, ↑ ESR Not applicable Not applicable Ketones, Organic acids, Porphobilinogen, Aminolevulinic acid Not applicable Stool anion gap, Stool pH < 5.5, Stool culture, Serotyping, Enzyme immunoassay (rotavirus or adenovirus), LFT, Amylase, Lipase Normal Not applicable Not applicable Not applicable - -
Drugs/toxins[10][11] +/- +/- +/- +/- +/- +/- +/- +/- +/- Not applicable BUN, ↑Cr, ↑CK K, ↓Mg, ↓Ca, ↓P Ingested drug, Glucose, Aminoacid, Phosphate, Ketone, Hyaline cast, RBC Lactate, Metabolic acidosis Toxicology, Rapid immunoassay Nephropathy Radioopaque substances, Ingested drug packets Not applicable Not applicable - -
Hepatorenal syndrome[12][13] +/- - - - +/- +/- - - +/- Leukocytosis, ↑PT GFR, ↑BUN, ↑Cr Na Proteinuria, Na < 10 mEq/L, Urine osmolality > plasma osmolality Not applicable Alpha feto-protein, Cryoglobulinemia Exclude hydronephrosis and intrinsic renal disease Not applicable Not applicable Not applicable Right ventricular preload, ventricular filling pressures, and cardiac function in echocardiography -
Malignant hypertension[14][15] +/- - + - - +/- - +/- +/- Microangiopathic hemolytic anemia BUN, ↑Cr Na, ↑K, ↑P Proteinuria, Microscopic hematuria Acidosis Cardiac enzymes, Urinary catecholamines, TSH, ↑Renin Not applicable Cardiomegaly, Pulmonary edema, Rib notching, Aortic coarctation, Mediastinal widening, Aortic dissection Not applicable Not applicable Left atrial enlargement and left ventricular hypertrophy in echocardiography -
Peritonitis[16][17] +/- - +/- - +/- +/- +/- - - Leukocytosis Not applicable Not applicable Not applicable Not applicable Ascitic fluid neutrophil count > 500 cells/µL Not applicable Not applicable Not applicable Not applicable - -
Shock[18] +/- +/- +/- +/- +/- +/- - +/- - HCT, ↑PT and aPTT, Eosinophilia, Leukocytosis GFR, ↑BUN, ↑Cr Not applicable Not applicable 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, Pneumothorax, Ruptured aneurysm, Aortic dissection, Pulmonary embolism Not applicable - -
Toxic megacolon[19] +/- +/- +/- - + + +/- - - Leukocytosis, Anemia, ↑ESR and CRP BUN, ↑Cr Na Not applicable Not applicable Loss of haustra, Hypoechoic and thick bowel walls, Dilated colon > 6cm, Dilatation of ileal loops Dilated colon, Free intraperitoneal air Bowel perforation, Abscess Not applicable Not applicable 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[20][21] +/- - +/- - +/- +/- +/- +/- +/- Eosinophilia BUN, ↑Cr, ↑FENa Not applicable Eosinophiluria, Sterile pyuria, Microscopic hematuria, Proteinuria Not applicable ↑Total IgG, ↑IgG4 Normal-sized kidneys Not applicable Not applicable Not applicable - History of long term analgesic use
Acute tubular necrosis[22][23] +/- - - - - +/- - - +/- Anemia BUN, ↑Cr, ↑FENa Na, ↑K, ↑Mg, ↑P, ↓Ca Pigmented, muddy brown, granular casts Not applicable Not applicable Obstructive uropathy, Renal size, Cortical thickness, Hydronephrosis Nephrolithiasis Nephrolithiasis, Area of obstruction Nephrolithiasis, Area of obstruction Loss of tubular cells or the denuded tubules, Swollen tubular cells, Loss of the cell brush border in renal biopsy Furosemide stress testing for staging
Cancer[24][25] + - - - +/- +/- - - +/- Normocytic or microcytic anemia, Leukocytosis or lymphocytosis, ↑Reticulocytes, Thrombocytopenia GFR, ↑BUN, ↑Cr, ↓Erythropoietin Na, ↑K, ↓Mg, ↑P, ↓Ca Gross hematuria Not applicable 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[26][27][28]

- Agenesis

- Dysplasia

- Hypoplasia

- Polycystic

+/- - - - +/- +/- - - +/- HCT GFR P, ↓Ca Microalbuminuria, Uricosuria Not applicable Genetic testing forADPKD2 Visualization of kidney cysts Small kidney cysts (0.5 cm) Kidney size, Intracranial aneurysms Not applicable - -
Endogenous toxins[29][30][31][32][33]

- Hemoglobin

- Myoglobin

- Uric acid

+/- - +/- + - +/- - - +/- Anemia, Thrombocytopenia GFR, ↑BUN, ↑Cr K, ↑Urate, ↓Ca Uricosuria, Hematuria, Myoglobinuria, Casts Not applicable Creatine kinase > 1000 U/L Malignant or cystic lesions, Hydronephrosis, Nephrocalcinosis, Urolithiasis Not applicable Urolithiasis, Wilms tumor, Polycystic kidney disease Not applicable Ureter or bladder abnormality in voiding cystourethrography -
Hemolytic uremic syndrome[34][35][36] +/- - +/- +/- +/- + + - +/- Severe anemia, Thrombocytopenia, ↑ aPTT BUN, ↑Cr Not applicable Mild proteinuria, Red blood cells, Red blood cell casts Not applicable Schistocytes, ↑FDP and D-dimer, ↑ Bilirubin, ↑LDH, ↓Haptoglobin, Stool culture (for E coli 0157:H7 or shigella), ↓ADAMTS-13 activity Ruling out obstruction Not applicable Not applicable Not applicable Diffuse thickening of the glomerular capillary wall, Swelling of endothelial cells, Fibrin thrombi in renal biopsy -
Nephrolithiasis[37][38][39] - - - - +/- +/- - - - 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 Not applicable Intravenous pyelography (IVP), Renal tomography, Nuclear renal scan -

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