Which lab studies are performed in the evaluation of postrenal azotemia?

Updated: Sep 19, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Urinary indices in postrenal azotemia due to complete bilateral obstruction are usually nondiagnostic. The prima facie finding here is anuria, occasionally accompanied by hypertension. Urine output still may be present if overflow (in bladder outlet obstruction) or partial ureteral obstruction is present.

A Foley catheter should be inserted as part of the initial evaluation to rule out obstruction below the bladder outlet. Unilateral ureteral obstruction rarely leads to azotemia; it occurs acutely (as a result of obstruction from calculi, papillary necrosis, or hematoma), producing renal colic, or may be chronic and asymptomatic, producing hydronephrosis.

Bilateral partial obstruction may be associated with azotemia in the presence of normal urine output. When patients are subjected to maneuvers that increase urinary flow (eg, diuretic renography or perfusion pressure flow studies), they may exhibit an increase in size or pressure of the collecting system or experience pain.

In addition to azotemia, polyuria due to loss of concentrating ability and type 1 renal tubular acidosis, with hyperkalemia, hypercalcemia from a metastatic pelvic tumor, and elevated prostate-specific antigen (PSA) levels, may be clues to postrenal azotemia. Hydronephrosis in the absence of hydroureter may be seen in early (< 3 days) obstruction, retroperitoneal process, or partial obstruction.

Renal ultrasonography (see below) is the test of choice for ruling out obstructive uropathy. If the renal sonogram is equivocal, a furosemide (Lasix) washout scan (see Radionuclide Studies) should be performed.


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