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 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 -

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntley J, Berkman L, Curb JD, Evans D, Hennekens CH (June 1991). "Smoking and mortality among older men and women in three communities". N. Engl. J. Med. 324 (23): 1619–25. doi:10.1056/NEJM199106063242303. PMID 2030718.
  6. ↑ Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH, Grosse SD (August 2009). "Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP". Pediatrics. 124 (2): 823–36. doi:10.1542/peds.2009-1397. PMID 19581259.
  7. ↑ Ginès P, Schrier RW (September 2009). "Renal failure in cirrhosis". N. Engl. J. Med. 361 (13): 1279–90. doi:10.1056/NEJMra0809139. PMID 19776409.
  8. ↑ Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J (January 1996). "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club". Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.
  9. ↑ Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB (April 2006). "Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention". Circulation. 113 (14): 1807–16. doi:10.1161/CIRCULATIONAHA.106.174287. PMID 16567565.
  10. ↑ Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G (March 2005). "Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology". Eur. Heart J. 26 (5): 516–24. doi:10.1093/eurheartj/ehi108. PMID 15689345.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ Johnson W, Nguyen ML, Patel R (November 2012). "Hypertension crisis in the emergency department". Cardiol Clin. 30 (4): 533–43. doi:10.1016/j.ccl.2012.07.011. PMID 23102030.
  14. ↑ Elliott WJ (2006). "Clinical features in the management of selected hypertensive emergencies". Prog Cardiovasc Dis. 48 (5): 316–25. doi:10.1016/j.pcad.2006.02.004. PMID 16627047.
  15. ↑ Schwarz A, Krause PH, Kunzendorf U, Keller F, Distler A (September 2000). "The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis". Clin. Nephrol. 54 (3): 179–90. PMID 11020015.
  16. ↑ Praga M, González E (June 2010). "Acute interstitial nephritis". Kidney Int. 77 (11): 956–61. doi:10.1038/ki.2010.89. PMID 20336051.
  17. ↑ Khwaja A (2012). "KDIGO clinical practice guidelines for acute kidney injury". Nephron Clin Pract. 120 (4): c179–84. doi:10.1159/000339789. PMID 22890468.
  18. ↑ Lameire N, Van Biesen W, Vanholder R (2005). "Acute renal failure". Lancet. 365 (9457): 417–30. doi:10.1016/S0140-6736(05)17831-3. PMID 15680458.
  19. ↑ Gudbjartsson T, Thoroddsen A, Petursdottir V, Hardarson S, Magnusson J, Einarsson GV (December 2005). "Effect of incidental detection for survival of patients with renal cell carcinoma: results of population-based study of 701 patients". Urology. 66 (6): 1186–91. doi:10.1016/j.urology.2005.07.009. PMID 16360438.
  20. ↑ Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF (November 1971). "Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases". Cancer. 28 (5): 1165–77. PMID 5125665.
  21. ↑ Queisser-Luft A, Stolz G, Wiesel A, Schlaefer K, Spranger J (July 2002). "Malformations in newborn: results based on 30,940 infants and fetuses from the Mainz congenital birth defect monitoring system (1990-1998)". Arch. Gynecol. Obstet. 266 (3): 163–7. PMID 12197558.
  22. ↑ Sanna-Cherchi S, Ravani P, Corbani V, Parodi S, Haupt R, Piaggio G, Innocenti ML, Somenzi D, Trivelli A, Caridi G, Izzi C, Scolari F, Mattioli G, Allegri L, Ghiggeri GM (September 2009). "Renal outcome in patients with congenital anomalies of the kidney and urinary tract". Kidney Int. 76 (5): 528–33. doi:10.1038/ki.2009.220. PMID 19536081.
  23. ↑ Glassberg KI (June 2002). "Normal and abnormal development of the kidney: a clinician's interpretation of current knowledge". J. Urol. 167 (6): 2339–50, discussion 2350–1. PMID 11992035.
  24. ↑ Abboud H, Henrich WL (January 2010). "Clinical practice. Stage IV chronic kidney disease". N. Engl. J. Med. 362 (1): 56–65. doi:10.1056/NEJMcp0906797. PMID 20054047.
  25. ↑ Denic A, Mathew J, Lerman LO, Lieske JC, Larson JJ, Alexander MP, Poggio E, Glassock RJ, Rule AD (June 2017). "Single-Nephron Glomerular Filtration Rate in Healthy Adults". N. Engl. J. Med. 376 (24): 2349–2357. doi:10.1056/NEJMoa1614329. PMC 5664219. PMID 28614683.
  26. ↑ Borowitz MJ, Craig FE, Digiuseppe JA, Illingworth AJ, Rosse W, Sutherland DR, Wittwer CT, Richards SJ (July 2010). "Guidelines for the diagnosis and monitoring of paroxysmal nocturnal hemoglobinuria and related disorders by flow cytometry". Cytometry B Clin Cytom. 78 (4): 211–30. doi:10.1002/cyto.b.20525. PMID 20533382.
  27. ↑ Knochel JP (1982). "Rhabdomyolysis and myoglobinuria". Annu. Rev. Med. 33: 435–43. doi:10.1146/annurev.me.33.020182.002251. PMID 6282181.
  28. ↑ Giannoglou GD, Chatzizisis YS, Misirli G (March 2007). "The syndrome of rhabdomyolysis: Pathophysiology and diagnosis". Eur. J. Intern. Med. 18 (2): 90–100. doi:10.1016/j.ejim.2006.09.020. PMID 17338959.
  29. ↑ Coe FL (September 1983). "Uric acid and calcium oxalate nephrolithiasis". Kidney Int. 24 (3): 392–403. PMID 6645213.
  30. ↑ Maalouf NM, Cameron MA, Moe OW, Sakhaee K (March 2004). "Novel insights into the pathogenesis of uric acid nephrolithiasis". Curr. Opin. Nephrol. Hypertens. 13 (2): 181–9. PMID 15202612.
  31. ↑ Ellis EN, Mauer SM, Sutherland DE, Steffes MW (February 1989). "Glomerular capillary morphology in normal humans". Lab. Invest. 60 (2): 231–6. PMID 2915517.
  32. ↑ Dickinson BL (August 2016). "Unraveling the immunopathogenesis of glomerular disease". Clin. Immunol. 169: 89–97. doi:10.1016/j.clim.2016.06.011. PMID 27373970.
  33. ↑ Trachtman H, Bergwerk A, Gauthier B (August 1994). "Isolated proteinuria in children. Natural history and indications for renal biopsy". Clin Pediatr (Phila). 33 (8): 468–72. doi:10.1177/000992289403300804. PMID 7955787.
  34. ↑ Pusey CD (October 2003). "Anti-glomerular basement membrane disease". Kidney Int. 64 (4): 1535–50. doi:10.1046/j.1523-1755.2003.00241.x. PMID 12969182.
  35. ↑ Bolton WK (November 1996). "Goodpasture's syndrome". Kidney Int. 50 (5): 1753–66. PMID 8914046.
  36. ↑ Kalluri R, Wilson CB, Weber M, Gunwar S, Chonko AM, Neilson EG, Hudson BG (October 1995). "Identification of the alpha 3 chain of type IV collagen as the common autoantigen in antibasement membrane disease and Goodpasture syndrome". J. Am. Soc. Nephrol. 6 (4): 1178–85. PMID 8589284.
  37. ↑ Noris M, Remuzzi G (April 2005). "Hemolytic uremic syndrome". J. Am. Soc. Nephrol. 16 (4): 1035–50. doi:10.1681/ASN.2004100861. PMID 15728781.
  38. ↑ Goodship TH, Cook HT, Fakhouri F, Fervenza FC, Frémeaux-Bacchi V, Kavanagh D, Nester CM, Noris M, Pickering MC, Rodríguez de Córdoba S, Roumenina LT, Sethi S, Smith RJ (March 2017). "Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference". Kidney Int. 91 (3): 539–551. doi:10.1016/j.kint.2016.10.005. PMID 27989322.
  39. ↑ Loirat C, Fakhouri F, Ariceta G, Besbas N, Bitzan M, Bjerre A, Coppo R, Emma F, Johnson S, Karpman D, Landau D, Langman CB, Lapeyraque AL, Licht C, Nester C, Pecoraro C, Riedl M, van de Kar NC, Van de Walle J, Vivarelli M, Frémeaux-Bacchi V (January 2016). "An international consensus approach to the management of atypical hemolytic uremic syndrome in children". Pediatr. Nephrol. 31 (1): 15–39. doi:10.1007/s00467-015-3076-8. PMID 25859752.
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