This topic comes up fairly frequently. The usual trend is to ask for a list of differentials in the context of some sort of oliguric scenario, eg. "this post-AAA repair patient is producing no urine; why is that?" In the absence of anything terribly clever, one can always fall back on the old "pre, intra, post" classification of the causes.
Previous such scenarios have included the following CICM SAQs:
- Question 29 from the second paper of 2019 (list of differentials after AAA repair)
- Question 9.3 from the second paper of 2018 (pseudorenal failure due to bladder rupture)
- Question 13.3 from the second paper of 2016 (interstitial nephritis due to a β-lactam)
- Question 11 from the first paper of 2008 (list of differentials in a septic patient)
- Question 2a from the second paper of 2001 (list of differentials in a septic patient)
Pre-renal |
Intra-renal |
Post-renal |
|
|
|
This list can be reorganised into aetiological categories according to a familiar acronymic structure (VINDICATE).
Vascular causes |
|
Infectious causes |
|
Neoplastic causes |
|
Drug-related causes |
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Idiopathic causes |
|
Congenital causes |
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Autoimmune causes |
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Traumatic causes |
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Endocrine causes |
|
References
Oh's Manual: Chapter 47 (pp. 535) Acute kidney injury by Rinaldo Bellomo
Schrier, Robert W., et al. "Acute renal failure: definitions, diagnosis, pathogenesis, and therapy." The Journal of clinical investigation 114.1 (2004): 5-14.
Perazella, Mark A., and Glen S. Markowitz. "Drug-induced acute interstitial nephritis." Nature Reviews Nephrology 6.8 (2010): 461-470.
Heyns, C. F., and P. D. Rimington. "Intraperitoneal rupture of the bladder causing the biochemical features of renal failure." British journal of urology 60.3 (1987): 217-222.
Sockett, D. C., et al. "Metabolic changes due to experimentally induced rupture of the bovine urinary bladder." The Cornell veterinarian 76.2 (1986): 198-212.
Kilari, S. K., et al. "Pseudo-renal failure due to intraperitoneal bladder rupture and silent subdural hematoma following a fall in an alcoholic." International urology and nephrology 39.3 (2007): 947-949.
Wystrychowski, A., M. Nowicki, and F. Kokot. "Hyponatraemic renal pseudofailure—don't forget the possibility of uroperitoneum." Nephrology Dialysis Transplantation 11.12 (1996): 2491-2492.
Pintar, Thomas J., and Russell A. Wilke. "Urinary ascites: spontaneous bladder rupture presenting as acute oliguric renal failure." The American journal of medicine 105.4 (1998): 347-349.