Oliguria with somatic pain

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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
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 - -
Esophageal varices bleeding[5][6] +/- - - - +/- - - - - 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 -
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 -
Liver cirrhosis[9][10] +/- - +/- +/- +/- - - - +/- 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
Myocarditis[11] +/- - - - +/- - - +/- - 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[12][13] +/- - +/- - +/- +/- +/- - - Leukocytosis Not applicable Not applicable Not applicable Not applicable Ascitic fluid neutrophil count > 500 cells/µL Not applicable Not applicable Not applicable Not applicable - -
Shock[14] +/- +/- +/- +/- +/- +/- - +/- - ↑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[15] +/- +/- +/- - + + +/- - - 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[16][17] +/- - +/- - +/- +/- +/- +/- +/- 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
Cancer[18][19] + - - - +/- +/- - - +/- 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[20][21][22]

- 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[23][24] + - - - +/- - - - + 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 -
Hemolytic uremic syndrome[25][26][27] +/- - +/- +/- +/- + + - +/- 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[28][29][30] - - - - +/- +/- - - - 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

  1. ↑ 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.
  2. ↑ 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.
  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. ↑ Graham DY, Smith JL (April 1981). "The course of patients after variceal hemorrhage". Gastroenterology. 80 (4): 800–9. PMID 6970703.
  6. ↑ 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.
  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. ↑ 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.
  10. ↑ 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.
  11. ↑ Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA (April 1985). "Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome". N. Engl. J. Med. 312 (14): 885–90. doi:10.1056/NEJM198504043121404. PMID 3974674.
  12. ↑ Such J, Runyon BA (October 1998). "Spontaneous bacterial peritonitis". Clin. Infect. Dis. 27 (4): 669–74, quiz 675–6. PMID 9798013.
  13. ↑ Runyon BA (October 1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis". Hepatology. 12 (4 Pt 1): 710–5. PMID 2210672.
  14. ↑ Vincent JL, De Backer D (October 2013). "Circulatory shock". N. Engl. J. Med. 369 (18): 1726–34. doi:10.1056/NEJMra1208943. PMID 24171518.
  15. ↑ Jalan KN, Sircus W, Card WI, Falconer CW, Bruce CB, Crean GP, McManus JP, Small WP, Smith AN (July 1969). "An experience of ulcerative colitis. I. Toxic dilation in 55 cases". Gastroenterology. 57 (1): 68–82. PMID 5305933.
  16. ↑ 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.
  17. ↑ Praga M, González E (June 2010). "Acute interstitial nephritis". Kidney Int. 77 (11): 956–61. doi:10.1038/ki.2010.89. PMID 20336051.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ Noris M, Remuzzi G (April 2005). "Hemolytic uremic syndrome". J. Am. Soc. Nephrol. 16 (4): 1035–50. doi:10.1681/ASN.2004100861. PMID 15728781.
  26. ↑ 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.
  27. ↑ 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.
  28. ↑ Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z (March 2013). "Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States". Kidney Int. 83 (3): 479–86. doi:10.1038/ki.2012.419. PMC 3587650. PMID 23283137.
  29. ↑ Singh P, Enders FT, Vaughan LE, Bergstralh EJ, Knoedler JJ, Krambeck AE, Lieske JC, Rule AD (October 2015). "Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community". Mayo Clin. Proc. 90 (10): 1356–65. doi:10.1016/j.mayocp.2015.07.016. PMC 4593754. PMID 26349951.
  30. ↑ Teichman JM (February 2004). "Clinical practice. Acute renal colic from ureteral calculus". N. Engl. J. Med. 350 (7): 684–93. doi:10.1056/NEJMcp030813. PMID 14960744.
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