Oliguria with edema

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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
Aspergillosis[3][4] +/- - - - - - - +/- - Not applicable Not applicable Not applicable Not applicable Not applicable Allergy test, ↑IgE (>1000 IU/dl), Direct visualization of fungal hyphae Not applicable 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 Not applicable - Polymerase chain reaction (PCR)
Cholera[5][6][6][7] +/- + - - - +/- + - - Leukocytosis, ↑HCT ↑BUN, ↑Cr ↓Na, ↑Ca, ↑Mg Not applicable ↑Lactate, ↓HCO3 Stool PCR, Stool culture, Serotyping Not applicable Not applicable Not applicable Not applicable - -
Congestive heart failure (CHF)[8][9] + - - - - - + - + 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 -
Dehydration[10][11] + + - +/- - +/- +/- - - 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[12][13] +/- +/- - - - + + - - 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[14][15] +/- +/- +/- +/- +/- +/- +/- +/- +/- 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 - -
Esophageal varices bleeding[16][17] +/- - - - +/- - - - - Normocytic normochromic anemia ↑BUN, ↑Cr Not applicable Not applicable Not applicable Not applicable 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 -
Heart disease[18][19] +/- - - - - - - +/- +/- ↑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 -
Hemorrhage[20][21] - - - - - - - - - Normocytic normochromic anemia, ↑PT, ↑PTT ↑BUN, ↑Cr ↑Na, ↑Cl, ↓Ca Not applicable Metabolic acidosis Not applicable Peritoneal cavity fluid in FAST Bilateral opacities in the lung field, Hemothorax, Hemoperitoneum, Ruptured abdominal aortic aneurysm Intrathoracic, intra-abdominal, and retroperitoneal bleeding Not applicable Source of bleeding in the upper GI in EGD, Angiography -
Hemolysis[22][23] +/- - - - - - - - - Thrombocytopenia, Microcytic hypochromic anemia, ↑RDW, ↑Retic count Not applicable Not applicable Not applicable Not applicable ↑LDH, ↓Haptoglobin, ↑Unconjugated bilirubin Hepatomegaly,Splenomegaly Not applicable Not applicable Not applicable - -
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 < 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[26][27] +/- - - - - - - +/- +/- 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[28][29] +/- - +/- +/- +/- - - - +/- 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[30][31] +/- - + - - +/- - +/- +/- 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 -
Myocarditis[32] +/- - - - +/- - - +/- - Leukocytosis (eosinophilia),↑ESR and CRP Not applicable Not applicable Not applicable Not applicable Cardiac enzymes, Viral antibodies Not applicable Not applicable Not applicable Inflammatory edema, Degree of scarring Endomyocardial biopsy, Echocardiography, Scintigraphy Not applicable
Peritonitis[33][34] +/- - +/- - +/- +/- +/- - - Leukocytosis Not applicable Not applicable Not applicable Not applicable Ascitic fluid neutrophil count > 500 cells/µL Not applicable Not applicable Not applicable Not applicable - -
Polycythemia[35][36] +/- - - - - - - +/- - ↑RBC, ↑HCT, ↑HGB, Thrombocytosis, Leukocytosis, ↑PT and aPTT ↓Erythropoietin Not applicable Not applicable Not applicable Hyperuricemia Splenomegaly Not applicable Not applicable Not applicable - Phlebotomy is the usual treatment
Respiratory distress syndrome[37] + - +/- - - - - + - Not applicable Not applicable Not applicable Not applicable Metabolic and respiratory acidosis Pulse oximetry Not applicable Bilateral, diffuse, reticular granular or ground-glass appearance +/- Cardiomegaly Not applicable Not applicable Patent ductus arteriosus in echocardiography -
Shock[38] +/- +/- +/- +/- +/- +/- - +/- - ↑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[39] +/- +/- +/- - + + +/- - - 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[40][41] +/- - +/- - +/- +/- +/- +/- +/- 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[42][43] +/- - - - - +/- - - +/- 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[44][45] + - - - +/- +/- - - +/- 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[46][47][48]

- 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[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 Renal masses, stones, and cysts Renal vein thrombosis, Renal artery stenosis in magnetic resonance angiography Percutaneous renal biopsy -
Endogenous toxins[51][52][53][54][55]

- 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[56][57][58] +/- - - - - - - - + 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[59][60][61] +/- - - - - - - +/- +/- 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[62][63][64] +/- - +/- +/- +/- + + - +/- 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[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 Not applicable Intravenous pyelography (IVP), Renal tomography, Nuclear renal scan -

References

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