- Less than 1 mL/kg/hour in infants.
- Less than 0.5 mL/kg/hour in children.
- Less than 400 mL/day in adults.
- Pre-renal causes include may include dehydration, vascular collapse, low cardiac output.
- Renal problems are associated with structural renal damage, e.g. acute tubular necrosis, primary glomerular diseases or vascular lesions.
- Post-renal causes are any mechanical or functional obstruction to the flow of urine. The most common cause is a blocked catheter. This usually responds to release of the obstruction.
- Absolute decrease in blood volume due to trauma, hemorrhage, burns, diarrhea or sequestration of fluid as in pancreatitis or abdominal surgery.
- Relative decrease in blood volume in which the primary disturbance is an alteration in the capacitance of the vasculature due to vasodilation. This is commonly encountered in sepsis, hepatic failure, nephrotic syndrome, and use of vasodilatory drugs including anesthetic agents.
- Decreased cardiac output that can happen in many clinical situations.
- Decreased renal perfusion pressure that may be due to structural causes such as thromboembolism, atherosclerosis, dissection, inflammation (vasculitis especially scleroderma) affecting either the intra or extrarenal circulation. Although renal arterial stenosis present as subacute or chronic renal dysfunctions, renal atheroembolic disease can present as AKI with acute oliguria. Renal atheroemboli usually affects older patients with a diffusive erosive atherosclerotic disease. It is most often seen after manipulation of the aorta or other large arteries during arteriography, angioplasty or surgery. This condition may also occur spontaneously after treatment with heparin, warfarin or thrombolytic agents. Drugs such as cyclosporin, tacrolimus and ACE inhibitors cause intrarenal vasoconstriction resulting in reduced renal plasma flow. Rarely, decreased renal perfusion may also occur as a result of an outflow problem such as renal vein thrombosis or abdominal compartment syndrome which is a symptomatic organ dysfunction that results from an increase in intra-abdominal pressure.
- Abdominal compartment syndrome leads to AKI and acute oliguria mainly by directly increasing renal outflow presure, thus reducing renal perfusion. Other possible mechanisms decreasing renal perfusion pressure include directly parenchymal compression, is the primary mechanism of renal dysfunction. Genreally intra-abdominal pressure can lead to oliguria and prssure usually lead to anuria.
- There may be signs due to acute kidney injury (AKI), e.g. edema, anemia.
- Signs of congestive heart failure, e.g. gallop rhythm and hepatomegaly.
- Hypertension may be present.
- Signs of the underlying disease, e.g. a butterfly rash on the face and joint swelling suggest systemic lupus erythematosus.
- Urinalysis: Urine is analyzed in the laboratory to look for protein, white cells and red cells to identify a kidney or bladder infection, or kidney inflammation (glomerulonephritis).
- Urine culture: In this test, a sample of urine is monitored to see if bacteria grow. This test is used to confirm a kidney or bladder infection.
- Intravenous pyelogram (IVP): In this x-ray test, a dye (also called a contrast medium) is injected into an arm vein. The dye collects in the kidneys and is excreted in the urine, providing an outline of the entire urinary system. An IVP is particularly helpful for identifying kidney stones, though other problems, such as a tumour, can be detected with this test.
- Ultrasound: This test uses sound waves to help establish whether a kidney mass is a noncancerous (benign), fluid-filled cyst or a solid mass, such as a cancerous tumour. Ultrasound also can identify kidney stones.
- Computed tomography (CT) scan of the abdomen and pelvis: In a CT scan, a modified X-ray beam produces body images at different angles, offering a three-dimensional look at the inside of the kidneys, abdominal organs and pelvic organs. This test often is done with an injection of contrast dye, combining the features of an IVP and CT. When done this way, the test also is called a CT urogram.
- Cystoscopy: In this test, the doctor inserts a flexible telescope into the urethra and passes it into the bladder to inspect the bladder lining for tumours or other problems. This test usually is done with local anaesthesia and sedation.
- Blood tests: These can check for signs of urinary tract infection, renal failure, anemia (which often accompanies kidney problems), bleeding disorders, or abnormally high levels of blood chemicals that can encourage the formation of kidney stones. Additional testing for conditions causing kidney inflammation (such as auto-immune diseases) may be recommended, depending on the findings of the routine blood and urine tests.
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