Oliguria differential diagnosis

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


An expert algorithm to assist in the diagnosis of oliguria can be found here

Overview

There are several life-threatening causes of oliguria which need to be evaluated for first, 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.

Differential Diagnosis

Life Threatening Causes

Life threatening diseases to exclude immediately include:[1][2]

Common Causes

Differential Diagnosis of Oliguria

The following table outlines the major differential diagnoses of Oliguria.

Abbreviations: ABG = Arterial blood gases, CBC = Complete blood count, KFT = Kidney function test, MRI = Magnetic resonance imaging, CT = Computed tomography,

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 Ultrasound X-ray CT MRI
Prerenal Alcohol poisoning[3][4][5][6]
Aspergillosis[7][8][9]
Cholera[10][11][11][12]
Congestive heart failure[13][14][15][16][17][18]
Dehydration[19][20][21][22]

- Burns

-Cutaneous loss e.g. sweating

- Inadequate water intake

- Salt-wasting nephropathy

Diabetes insipidus[23][24][25][26]
Diabetes mellitus[27][28][29]
Diarrhea and/or vomiting[30][31][32][33]
Drugs/toxins[34][35][36][37]

- ACE inhibitor

- Aminoglycosides

- Amphotericin B

- Contrast material

- Cyclosporin

- Diuretics

- Digitalis

- Heavy metals

- Indomethacin

- Tacrolimus

- NSAIDs

Esophageal varices bleeding[38][39]
Heart disease

-Congenital

-Acquired

Hemorrhage
Hemolysis
Hepatorenal syndrome
Ischemic cardiomyopathy
Liver cirrhosis[40][41][42]
Malignant hypertension
Myocarditis
Peritonitis
Perinatal asphyxia
Polycythemia
Respiratory distress syndrome
Shock

- Anaphylactic

- Cardiogenic

- Hypotensive

- Septic

- Toxic

Third space losses

- Capillary leak

- Surgery

- Trauma

Toxic megacolon
Intrinsic renal Acute interstitial nephritis
Acute tubular necrosis
Cancer

- Renal cell carcinoma

- Metastatic cancer

Chronic kidney failure
Congenital kidney disease

- Agenesis

- Dysplasia

- Hypoplasia

- Polycystic

End stage renal disease
Endogenous toxins

- Hemoglobin

- Myoglobin

- Uric acid

Glomerulonephritis
Goodpasture syndrome
Hemolytic uremic syndrome
Nephrolithiasis
Nephrotic syndrome
Thrombosis

- Renal vein

- Renal artery

Transplant rejection
Transient dysfunction of the newborn
Postrenal Bladder outlet obstruction
Benign prostatic hyperplasia
Catheter-related
Chronic prostatitis
Obstructive uropathy
Neurogenic bladder

References

  1. ↑ Anderson RJ, Linas SL, Berns AS, Henrich WL, Miller TR, Gabow PA, Schrier RW (May 1977). "Nonoliguric acute renal failure". N. Engl. J. Med. 296 (20): 1134–8. doi:10.1056/NEJM197705192962002. PMID 854045.
  2. ↑ Dixon BS, Anderson RJ (August 1985). "Nonoliguric acute renal failure". Am. J. Kidney Dis. 6 (2): 71–80. PMID 3895901.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Yost DA (December 2002). "Acute care for alcohol intoxication. Be prepared to consider clinical dilemmas". Postgrad Med. 112 (6): 14–6, 21–2, 25–6. PMID 12510444.
  6. ↑ Boba A (July 1999). "Management of acute alcoholic intoxication". Am J Emerg Med. 17 (4): 431. PMID 10452451.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Horger M, Hebart H, Einsele H, Lengerke C, Claussen CD, Vonthein R, Pfannenberg C (September 2005). "Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome?". Eur J Radiol. 55 (3): 437–44. doi:10.1016/j.ejrad.2005.01.001. PMID 16129254.
  10. ↑ 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.
  11. ↑ 11.0 11.1 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ Kittleson M, Hurwitz S, Shah MR, Nohria A, Lewis E, Givertz M, Fang J, Jarcho J, Mudge G, Stevenson LW (June 2003). "Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality". J. Am. Coll. Cardiol. 41 (11): 2029–35. PMID 12798577.
  16. ↑ Filippatos G, Rossi J, Lloyd-Jones DM, Stough WG, Ouyang J, Shin DD, O'connor C, Adams KF, Orlandi C, Gheorghiade M (June 2007). "Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study". J. Card. Fail. 13 (5): 360–4. doi:10.1016/j.cardfail.2007.02.005. PMID 17602982.
  17. ↑ Zamora E, Lupón J, Vila J, Urrutia A, de Antonio M, Sanz H, Grau M, Ara J, Bayés-Genís A (May 2012). "Estimated glomerular filtration rate and prognosis in heart failure: value of the Modification of Diet in Renal Disease Study-4, chronic kidney disease epidemiology collaboration, and cockroft-gault formulas". J. Am. Coll. Cardiol. 59 (19): 1709–15. doi:10.1016/j.jacc.2011.11.066. PMID 22554602.
  18. ↑ McAlister FA, Ezekowitz J, Tarantini L, Squire I, Komajda M, Bayes-Genis A, Gotsman I, Whalley G, Earle N, Poppe KK, Doughty RN (May 2012). "Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula". Circ Heart Fail. 5 (3): 309–14. doi:10.1161/CIRCHEARTFAILURE.111.966242. PMID 22441773.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ Dossetor JB (December 1966). "Creatininemia versus uremia. The relative significance of blood urea nitrogen and serum creatinine concentrations in azotemia". Ann. Intern. Med. 65 (6): 1287–99. PMID 5928490.
  22. ↑ Baskett PJ (June 1990). "ABC of major trauma. Management of hypovolaemic shock". BMJ. 300 (6737): 1453–7. PMC 1663124. PMID 2198971.
  23. ↑ Christensen JH, Rittig S (May 2006). "Familial neurohypophyseal diabetes insipidus--an update". Semin. Nephrol. 26 (3): 209–23. doi:10.1016/j.semnephrol.2006.03.003. PMID 16713494.
  24. ↑ Crowley RK, Sherlock M, Agha A, Smith D, Thompson CJ (April 2007). "Clinical insights into adipsic diabetes insipidus: a large case series". Clin. Endocrinol. (Oxf). 66 (4): 475–82. doi:10.1111/j.1365-2265.2007.02754.x. PMID 17371462.
  25. ↑ McIver B, Connacher A, Whittle I, Baylis P, Thompson C (December 1991). "Adipsic hypothalamic diabetes insipidus after clipping of anterior communicating artery aneurysm". BMJ. 303 (6815): 1465–7. PMC 1671669. PMID 1773159.
  26. ↑ Zerbe RL, Robertson GL (December 1981). "A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria". N. Engl. J. Med. 305 (26): 1539–46. doi:10.1056/NEJM198112243052601. PMID 7311993.
  27. ↑ "3. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2018". Diabetes Care. 41 (Suppl 1): S28–S37. January 2018. doi:10.2337/dc18-S003. PMID 29222374.
  28. ↑ Mogensen CE, Vestbo E, Poulsen PL, Christiansen C, Damsgaard EM, Eiskjaer H, Frøland A, Hansen KW, Nielsen S, Pedersen MM (April 1995). "Microalbuminuria and potential confounders. A review and some observations on variability of urinary albumin excretion". Diabetes Care. 18 (4): 572–81. PMID 7497874.
  29. ↑ Harris MI, Klein R, Welborn TA, Knuiman MW (July 1992). "Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis". Diabetes Care. 15 (7): 815–9. PMID 1516497.
  30. ↑ Carpenter DO (February 1990). "Neural mechanisms of emesis". Can. J. Physiol. Pharmacol. 68 (2): 230–6. PMID 2178747.
  31. ↑ 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.
  32. ↑ Hall AJ, Rosenthal M, Gregoricus N, Greene SA, Ferguson J, Henao OL, Vinjé J, Lopman BA, Parashar UD, Widdowson MA (August 2011). "Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005". Emerging Infect. Dis. 17 (8): 1381–8. doi:10.3201/eid1708.101533. PMC 3381564. PMID 21801613.
  33. ↑ Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK (November 2017). "2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea". Clin. Infect. Dis. 65 (12): e45–e80. doi:10.1093/cid/cix669. PMID 29053792.
  34. ↑ Toto RD, Mitchell HC, Lee HC, Milam C, Pettinger WA (October 1991). "Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis". Ann. Intern. Med. 115 (7): 513–9. PMID 1883120.
  35. ↑ Bismuth C, Gaultier M, Conso F, Efthymiou ML (1973). "Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications". Clin. Toxicol. 6 (2): 153–62. doi:10.3109/15563657308990513. PMID 4715199.
  36. ↑ Sawaya BP, Briggs JP, Schnermann J (August 1995). "Amphotericin B nephrotoxicity: the adverse consequences of altered membrane properties". J. Am. Soc. Nephrol. 6 (2): 154–64. PMID 7579079.
  37. ↑ Whelton A (May 1999). "Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications". Am. J. Med. 106 (5B): 13S–24S. PMID 10390124.
  38. ↑ Graham DY, Smith JL (April 1981). "The course of patients after variceal hemorrhage". Gastroenterology. 80 (4): 800–9. PMID 6970703.
  39. ↑ de Franchis R (October 2010). "Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension". J. Hepatol. 53 (4): 762–8. doi:10.1016/j.jhep.2010.06.004. PMID 20638742.
  40. ↑ Ge PS, Runyon BA (March 2014). "The changing role of beta-blocker therapy in patients with cirrhosis". J. Hepatol. 60 (3): 643–53. doi:10.1016/j.jhep.2013.09.016. PMID 24076364.
  41. ↑ Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.
  42. ↑ Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G (November 1986). "Cirrhosis: value of caudate to right lobe ratio in diagnosis with US". Radiology. 161 (2): 443–5. doi:10.1148/radiology.161.2.3532188. PMID 3532188.


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