Oliguria with fatigue and edema: Difference between revisions

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[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]

Latest revision as of 22:59, 29 July 2020


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 Congestive heart failure (CHF)[1][2] + - - - - - + - + Anemia, Leukocytosis BUN, ↑Cr Na, ↑K Not applicable Lactate, ↓HCO3, BNP, ↑Troponin Cardiomegaly, Pulmonary hypertension, Pleural effusions Pulmonary edema Not applicable Valvular heart disease Decreased ejection fraction in echocardiography, Heart function and damage in nuclear imaging -
Drugs/toxins[3][4] +/- +/- +/- +/- +/- +/- +/- +/- +/- 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 - -
Heart disease[5][6] +/- - - - - - - +/- +/- ESR and CRP BUN, ↑Cr Not applicable Not applicable Not applicable Throat culture, Rapid streptococcal antigen test, Hyperoxia test, Pulse oximetry Not applicable Cardiomegaly, Dextrocardia Not applicable Not applicable Ventricular dysfunction, Left and right ventricular hypertrophy, Valvular disease in echocardiography -
Hepatorenal syndrome[7][8] +/- - - - +/- +/- - - +/- 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 -
Ischemic cardiomyopathy[9][10] +/- - - - - - - +/- +/- Anemia Cr Na, ↓K, ↓Mg Not applicable Not applicable Troponin, Creatine kinase, Creatine kinase - MB, BNP Not applicable 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[11][12] +/- - +/- +/- +/- - - - +/- Not applicable Not applicable Not applicable Not applicable Not applicable LFT, Aspartate aminotransferase to platelet ratio, FibroTest/FibroSure, Hepascore, FibroSpectatio 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[13][14] +/- - + - - +/- - +/- +/- 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 -
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[15][16] +/- - +/- - +/- +/- +/- +/- +/- 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[17][18] +/- - - - - +/- - - +/- 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[19][20] + - - - +/- +/- - - +/- 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[21][22][23]

- 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 - -
End stage renal disease[24][25] + - - - +/- - - - + Anemia GFR, ↑BUN, ↑Cr K Hypoalbuminuria HCO3 Phosphate, 25-hydroxy vitamin D, Alkaline phosphatase, Parathyroid hormone Hydronephrosis, Retroperitoneal fibrosis, Enlarged or shrunken kidneys Renal masses, stones, and cysts Renal vein thrombosis, Renal artery stenosis in magnetic resonance angiography Percutaneous renal biopsy -
Endogenous toxins[26][27][28][29][30]

- 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 -
Glomerulonephritis[31][32][33] +/- - - - - - - - + Pleocytosis, Anemia, Leukocytosis, ↑ESR BUN, ↑Cr Not applicable Specific gravity > 1.020, Proteinuria, Hematuria, Red blood cell casts, White blood cell casts, Cellular casts, Oval fat bodies Not applicable Not applicable 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[34][35][36] +/- - - - - - - +/- +/- Anemia, Leukocytosis, ↑ESR BUN, ↑Cr Not applicable Low-grade proteinuria, Gross or microscopic hematuria, RBC casts Not applicable Anti– glomerular basement membrane antibody Antineutrophilic cytoplasmic antibody Not applicable Bilateral, basal, patchy parenchymal consolidations Not applicable Not applicable Diffuse alveolar hemorrhage in pulmonary biopsy -
Hemolytic uremic syndrome[37][38][39] +/- - +/- +/- +/- + + - +/- 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 -

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