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* Nuclear renal scan can determine renal function
* Nuclear renal scan can determine renal function
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|[[Nephrotic syndrome]]<ref name="pmid1996578">{{cite journal |vauthors=Praga M, Borstein B, Andres A, Arenas J, Oliet A, Montoyo C, Ruilope LM, Rodicio JL |title=Nephrotic proteinuria without hypoalbuminemia: clinical characteristics and response to angiotensin-converting enzyme inhibition |journal=Am. J. Kidney Dis. |volume=17 |issue=3 |pages=330–8 |date=March 1991 |pmid=1996578 |doi= |url=}}</ref><ref name="pmid9370176">{{cite journal |vauthors=Haas M, Meehan SM, Karrison TG, Spargo BH |title=Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997 |journal=Am. J. Kidney Dis. |volume=30 |issue=5 |pages=621–31 |date=November 1997 |pmid=9370176 |doi= |url=}}</ref><ref name="pmid16968733">{{cite journal |vauthors=Malafronte P, Mastroianni-Kirsztajn G, Betônico GN, Romão JE, Alves MA, Carvalho MF, Viera Neto OM, Cadaval RA, Bérgamo RR, Woronik V, Sens YA, Marrocos MS, Barros RT |title=Paulista Registry of glomerulonephritis: 5-year data report |journal=Nephrol. Dial. Transplant. |volume=21 |issue=11 |pages=3098–105 |date=November 2006 |pmid=16968733 |doi=10.1093/ndt/gfl237 |url=}}</ref><ref name="pmid20947631">{{cite journal |vauthors=Hausmann R, Kuppe C, Egger H, Schweda F, Knecht V, Elger M, Menzel S, Somers D, Braun G, Fuss A, Uhlig S, Kriz W, Tanner G, Floege J, Moeller MJ |title=Electrical forces determine glomerular permeability |journal=J. Am. Soc. Nephrol. |volume=21 |issue=12 |pages=2053–8 |date=December 2010 |pmid=20947631 |pmc=3014018 |doi=10.1681/ASN.2010030303 |url=}}</ref><ref name="pmid15146236">{{cite journal |vauthors=Reiser J, von Gersdorff G, Loos M, Oh J, Asanuma K, Giardino L, Rastaldi MP, Calvaresi N, Watanabe H, Schwarz K, Faul C, Kretzler M, Davidson A, Sugimoto H, Kalluri R, Sharpe AH, Kreidberg JA, Mundel P |title=Induction of B7-1 in podocytes is associated with nephrotic syndrome |journal=J. Clin. Invest. |volume=113 |issue=10 |pages=1390–7 |date=May 2004 |pmid=15146236 |pmc=406528 |doi=10.1172/JCI20402 |url=}}</ref><ref name="pmid21110043">{{cite journal |vauthors=Gbadegesin R, Lavin P, Foreman J, Winn M |title=Pathogenesis and therapy of focal segmental glomerulosclerosis: an update |journal=Pediatr. Nephrol. |volume=26 |issue=7 |pages=1001–15 |date=July 2011 |pmid=21110043 |pmc=3624015 |doi=10.1007/s00467-010-1692-x |url=}}</ref>
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* Serum [[creatinine]] is normal in uncomplicated [[nephrotic syndrome]]
* Serum [[albumin]] is decreased
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* [[Proteinuria]] > 3.5g/day
* The following may or may not be present
** [[Waxy casts]]
** [[Oval fat bodies]]
** [[Fatty casts]]
** Granular casts
** [[Microhematuria]]
** Dysmorphic RBCs
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* Genetic screening for NPHS1 and NPHS2 mutations
* Renal [[biopsy]] aids diagnosis
* Other useful tests:
** [[Hepatitis B]] and C
** [[HIV]]
** [[Syphilis]]
** [[Antinuclear antibody]]
** Anti–double stranded DNA antibodies
** Complement
* Absence of phospholipase A2 receptor may indicate secondary [[nephrotic syndrome]]
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* Ultrasound scanning may demonstrate focal glomerulosclerosis
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Revision as of 17:33, 3 May 2018


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

Differential Oliguria

Classification by etiology 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 Haematuria/Proteinuria Edema Blood tests Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other
Prerenal Myocarditis[1][2][3][4] +/- - - - +/- - - +/- - - - - - - - - -
  • Endomyocardial biopsy is the gold standard for the diagnosis of myocarditis
  • Echocardiography is useful for the following:
    • Exclusion of amyloidosis, congenital and/or valvular diseases
    • Assessment of cardiac dysfunction
    • Detection of inflammatory origin, wall motion abnormalities, wall thickening, and pericardial effusion
    • Distinction between fulminant and acute myocarditis
  • Scintigraphy is useful for detecting myocardial inflammation
  • ECG is non-specific but may detect the following:
Peritonitis[5][6] +/- - +/- - +/- +/- +/- - - - - - - - -
  • Peritoneal fluid analysis is the most important component of diagnosis and demonstrates the following:
- - - - -
Perinatal asphyxia[7][8][9] +/- - +/- - - +/- - +/- - - - -
  • Elevated cardiac troponin T and I levels are specific for cardiac dysfunction
  • Neutrophil gelatinase-associated lipocalin is under investigation as a biomarker for acute kidney injury
  • Fetal umbilical artery pH <7.0
  • Elevated liver transaminases
  • Coagulation profile should be carried out
- -
  • Acute brain injury may be seen on MRI
  • ECG may demonstrate ischemia with changes in the ST segment
  • Echocardiography may demonstrate the following:
Polycythemia[10][11][12][13][14] +/- - - - - - - +/- - - -
  • Oxygen saturation ≥ 92%
- - - -
Respiratory distress syndrome[15][16][17][18] + - +/- - - - - + - - - - - -
  • Pulse oximetry is useful in diagnosis
-
  • Demonstrates the following:
    • Bilateral, diffuse, reticular granular or ground-glass appearance
    • Poor lung expansion
    • Cardiomegaly may or may not be present
    • Streaky opacities may indicate pneumonia
- -
Shock[19][20][21][22]

- Anaphylactic

- Cardiogenic

- Hypotensive

- Septic

- Toxic

+/- +/- +/- +/- +/- +/- - +/- +/- - - - -
Third space losses[23][24][25]

- Capillary leak

- Surgery

- Trauma

+/- +/- +/- +/- +/- +/- - +/- +/- -
  • May visualize fluid collections
  • More accurately visualize the following:
    • Margins of trauma
    • Fluid collection
  • Useful for diagnosis of soft tissue injury
- - -
Toxic megacolon[26][27][28][29] +/- +/- +/- - + + +/- - - - -
  • Ultrasound may demonstrate the following:
    • Loss of haustra
    • Hypoechoic and thick bowel walls
    • Dilated colon > 6cm
    • Dilatation of ileal loops
    • Presence of intraluminal gas and fluid
  • The following is noted with x-ray:
  • Dilated colon
  • Loss of haustra
  • Soft tissue masses
  • Segmental parietal thinning
  • Free intraperitoneal air
  • May demonstrate the following:
- -
Classification by etiology 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 Haematuria/Proteinuria Edema CBC KFT Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other
Intrinsic renal Acute interstitial nephritis[30][31][32][33] +/- - +/- - +/- +/- +/- +/- +/- +/- - -
  • Patients with immunoglobulin G4 - related disease may have elevated serum total IgG and/or IgG4 levels
- - - -
Acute tubular necrosis[34][35][36][37][38] +/- - - - - +/- - - +/- +/-
  • Pigmented, muddy brown, granular casts
- -
  • May be useful in cases with nephrolithiasis
  • May also determine area of obstruction
  • May also determine area of obstruction
  • Renal biopsy may demonstrate the following:
    • Loss of tubular cells or the denuded tubules
    • Swollen tubular cells
    • Loss of the cell brush border
  • Useful kidney function biomarkers:
    • Neutrophil gelatinase-associated lipocalin
    • Interleukin-18
    • Kidney injury molecule 1
    • Cystatin C
    • Sodium/hydrogen exchanger isoform 3
Cancer[39][40][41][42][43]

- Renal cell carcinoma

- Metastatic cancer

+ - - - +/- +/- - - + +/- -
  • Ultrasound can detect fluid collection and morphologic change
  • Flank mass
  • May determine soft tissue invasion and staging
  • Percutaneous cyst puncture may aid diagnosis of malignant cystic lesions
  • Histology can determine type of cancer
  • Renal cell carcinoma can be divided into the following types:
    • Clear cell (75%)
    • Chromophilic (15%)
    • Chromophobic (5%)
    • Oncocytoma (3%)
    • Collecting duct (2%)
Chronic kidney failure[44][45][46][47][48][49] + - - - +/- - - - + +
  • May demonstrate nephrolithiasis
  • Retrograde pyelogram may determine obstruction
  • May determine renal masses, stones, and cysts
  • Percutaneous renal biopsy is also useful in diagnosis
Congenital kidney disease[50][51][52][53][54]

- Agenesis

- Dysplasia

- Hypoplasia

- Polycystic

+/- - - - +/- +/- - - +/- +/-
  • Decreased GFR
-
  • Genetic testing for ADPKD1 and ADPKD2
  • Ultrasound is the gold standard for visualization of cysts
  • More sensitive than ultrasound and can detect small cysts (0.5 cm)
  • Useful for determining kidney size and progression
  • Magnetic resonance angiography may determine intracranial aneurysms
- -
End stage renal disease[44][45][46][47][48][49] + - - - +/- - - - + +
  • May demonstrate nephrolithiasis
  • Retrograde pyelogram may determine obstruction
  • May determine renal masses, stones, and cysts
  • Useful in those who are contraindicated for intravenous contrast
  • May determine renal vein thrombosis
  • Magnetic resonance angiography can diagnose [[[renal artery stenosis]]
  • Percutaneous renal biopsy is also useful in diagnosis
Endogenous toxins[55][56][57][58][59]

- Hemoglobin

- Myoglobin

- Uric acid

+/- - +/- + - +/- - - +/- +/- - - -
  • Voiding cystourethrograms may detect ureter or bladder abnormalities
  • Radionuclide studies may visualize calculi
Glomerulonephritis[60][61][62][63][64][65][66] +/- - - - - - - - + + - - -
  • May determine the following:
    • Kidney size
    • Echogenicity of the renal cortex
    • Obstruction
    • Degree of fibrosis
-
  • Renal biopsy may aid diagnosis
  • Light and electron microscopy may have specific findings and determine pathology
  • Immunofluorescence may also exhibit diagnostic findings
Goodpasture syndrome[67][68][69][70][71][72] +/- - - - - - - +/- +/- +/- - - -
  • Bilateral, basal, patchy parenchymal consolidations
- -
Hemolytic uremic syndrome[73][74][75][76] +/- - +/- +/- +/- + + - +/- +/- - -
  • Helpful in ruling out obstruction
- - -
  • Renal biopsy may demonstrate the following:
    • Diffuse thickening of the glomerular capillary wall
    • Swelling of endothelial cells
    • Fibrin thrombi
Nephrolithiasis[77][78][79][80][81][82] - - - - +/- +/- - - - -
  • Calcium - containing stones are radio-opaque
  • Uric acid or cystine stones are radiolucent
  • Plain or KUB (kidney-ureter-bladder) radiograph may determine stone characteristics such as:
    • Size
    • Shape
    • Composition
    • Location
    • Differentiate between a phlebolith and an obstructing calcific stone
  • Stone movement may also be monitored
-
  • Intravenous pyelography (IVP) visualizes entire urinary system and is gold standard for the diagnosis of ureterolithiasis
  • Renal tomography can determine similar findings as CT, however has been largely replaced by CT
  • Nuclear renal scan can determine renal function

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