Approach to Oliguria/Proteinuria (Selby) Flashcards
Anuria
UOP < 50-100mL
Oliguria
UOP <400-500mL
Polyuria
UOP >3000mL
Azotemia
elevated blood urea nitrogen (BUN) without symptoms
Uremia
elevated BUN with symptoms
DDx for oliguria/proteinuria in cardiorenal syndrome
systolic Heart failure (decreased EF)
diastolic heart failure (preserved EF)
DDx for oliguria/proteinuria in cor pulmonale
pulmonary HTN causing RHF
DDx for oliguria/proteinuria in valvular abnormalities
aortic regurgitation aortic stenosis mitral regurgitation tricuspid regurgitation tricuspid stenosis
DDx for oliguria/proteinuria in pericarditis
both pericarditis and tamponade (effusion)
DDx for oliguria/proteinuria in hepatorenal syndrome
cirrhosis
DDx for oliguria/proteinuria in prerenal azotemia
hypovolemic shock (dehydration/GI based)
cardiogenic shock
neurogenic shock
septic shock
….look… it’s shock okay?
DDx for oliguria/proteinuria in AKI
prerenal azotemia
intrinsic dysfunction
postrenal azotemia
DDx for oliguria/proteinuria in intrinsic dysfunction (AKI)
ATN
interstitial nephritis
glomerulonephritis (nephrotic and nephritic)
DDx for oliguria/proteinuria in CKD
HTN
Diabetes
AKI etc
Important exam findings in volume status
JVD oral mucosa Cap Refill Skin tenting (use forehead for old people) crackles (non-specific) ascites LE pitting edema sacral edema (non-mobile and elderly)
Important exam findings in HEENT
retinopathy (diabetic? HTN?)
nasal ulcer or crusting (ANCA?)
tonsilar exudate (PIGN)
oral ulcers (autoimmune and SLE)
Important exam findings in cardiac
S3
Heart Rythm
Important exam findings in lungs
crackles
pleural effusions
Important exam findings in abdominal exam
abdominal bruits (RAS, AAA, iliac) palpable kidney (ADPKD or transplant usually RLQ) Tense abdomen ascites
Important exam findings in skin exam
malar rash palpable purpura (vasculitis) non-blanching purpura (thrombocytopenia) buttock and leg purpura (HSP) livedo reticularis emboli drug rash
Important exam findings in MSK
synovitis
myalgia
CVA tenderness