Oliguria with fatigue and tachypnea

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  | Aspergillosis[1][2] | +/-  | \-  | \-  | \-  | \-  | \-  | \-  | +/-  | \-  | 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)
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 | \-
Ischemic cardiomyopathy[7][8] | +/-  | \-  | \-  | \-  | \-  | \-  | \-  | +/-  | +/-  | 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  | \-
Malignant hypertension[9][10] | +/-  | \-  | \+  | \-  | \-  | +/-  | \-  | +/-  | +/-  | 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[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
Polycythemia[12][13] | +/-  | \-  | \-  | \-  | \-  | \-  | \-  | +/-  | \-  | ↑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[14] | \+  | \-  | +/-  | \-  | \-  | \-  | \-  | \+  | \-  | 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[15] | +/-  | +/-  | +/-  | +/-  | +/-  | +/-  | \-  | +/-  | \-  | ↑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  | \-  | \-
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
Goodpasture syndrome[18][19][20] | +/-  | \-  | \-  | \-  | \-  | \-  | \-  | +/-  | +/-  | 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 | \-

## References[edit | edit source]

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7. ↑ 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.
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9. ↑ 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.
10. ↑ 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.
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. ↑ Gregg XT, Prchal JT (January 1997). "Erythropoietin receptor mutations and human disease". Semin. Hematol. 34 (1): 70–6. PMID 9025165.
13. ↑ Kralovics R, Indrak K, Stopka T, Berman BW, Prchal JF, Prchal JT (September 1997). "Two new EPO receptor mutations: truncated EPO receptors are most frequently associated with primary familial and congenital polycythemias". Blood. 90 (5): 2057–61. PMID 9292543.
14. ↑ Hooper SB, Te Pas AB, Kitchen MJ (May 2016). "Respiratory transition in the newborn: a three-phase process". Arch. Dis. Child. Fetal Neonatal Ed. 101 (3): F266–71. doi:10.1136/archdischild-2013-305704. PMID 26542877.
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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. ↑ 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.
19. ↑ Bolton WK (November 1996). "Goodpasture's syndrome". Kidney Int. 50 (5): 1753–66. PMID 8914046.
20. ↑ 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.