oliguria

oliguria

1. haematuria + red cell casts, oliguria, proteinuria, hypertension - nephritic syndrome

   • IgA nephropathy (Beurger's disease) (renal biopsy)
   • Goodpasture's disease (anti-GBM)
   • SLE (ANA or anti-ds-DNA)

2. oliguria / raised creatinine - AKI (or uraemia, hyperkalaemia, oedema if late)

   • oliguria < 0.5 ml/kg/hr for six hours /  50% rise in creatinine over seven days /  26 micromol rise in creatinine over 48 hours
   • normal MSU - pre-renal (75%)
     • shock (hypotension, increased lactate, increased CRT, oliguria, confusion)
     • renovascular (renal bruits, Hx of AF)
   • haematuria, proteinuria - renal
     • acute tubular necrosis (ATN) (85%) (--> reduced Na+/H2O retention)
       • drugs: aminoglycoside antibiotics, cephalosporin antibiotics, NSAIDs, radiological contrast
       • heavy metal poisoning
       • dark urine, myalgia, generalised weakness - rhabdomyolysis (CK > 10,000)
       • thrombocytopenia, purpura, haemolysis and ATN - haemolytic urinary syndrome (HUS) after E. coli 0147
         • HUS --> thrombocytopenia, purpura, haemolysis and ATN
       • hypoperfusion --> ischaemia --> acute tubular necrosis
     • interstitial nephritis (10%)
       • drugs: antibiotics, diuretics, etc.
     • red cell casts - glomerulonephritis (5%) (biopsy)
       • (NSAID HSP) Neoplasm, SLE, Amyloid, Infection, Diabetes, Henoch-Schonlein Purpora
   • post-renal (obstruction) (USS ?hydronephrosis)