Additional evaluation

Additional evaluation may be of aid in the diagnosis of acute uremia. Severe hypocalcemia at the onset of oliguria occurs in rhabdomyolysis and pancreatitis. Very high levels of uric acid accompany tumor lysis, trauma, or muscle damage. Eosinophilia is frequent in acute interstitial nephritis. Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura are characterized by hemolytic anemia, thrombocytopenia, and the presence of schistocytes, and disseminated intravascular coagulation is characterized by anemia, thrombocytopenia, and prolonged prothrombin, partial thromboplastin, and thrombin times associated with low fibrinogen titers and elevated levels of fibrin degradation products.

Ultrasonography can evaluate the number and the size of the kidneys, the thickness of the parenchyma and its echogenicity, and the presence of hydronephrosis (it should be remembered that its absence does not completely rule out obstruction), and Doppler tests provide information on renal arterial flow.

The only way to carry out a correct diagnosis in oligoanuric patients in whom prerenal and postrenal causes can be excluded and renal causes are not completely clear is a renal biopsy.

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