Anuria and oliguria
By:
الدكتور
حارث محمد قنبر السعداوي
اختصاص جراحة الكلى واملسالك البولية والتناسلية والعقم
كلية طب الكندي
-
جامعة بغداد
Anuria and oliguria
Anuria:
no output of urine
Oliguria:
Diminished output of urine with less than 300 mL output in 24 hours.
The causes may be divided into:
• prerenal (where less fluid is delivered to the kidney for filtration)
• renal (where the kidney is unable to produce urine because of
intrinsic disease)
• postrenal (where the kidney is obstructed and the urine cannot be
excreted).
Prerenal causes:
Anything that reduces the blood flow to the kidney may cause anuria.
Thus,
shock from (hemorrhage, myocardial infarction, dehydration, drugs, or
septicemia) may be the cause
CHF in which the effective renal plasma flow is reduced.
Intestinal obstruction or intense diarrhea may cause the loss of
enormous amounts of fluid through vomiting or diarrhea and the
accompanying shock results in anuria
Embolic glomerulonephritis, bilateral renal artery thrombosis, and
dissecting aneurysms may cause renal shutdown.
Renal causes: (VINDICATE)
V- Vascular lesions include embolic glomerulonephritis and dissecting
aneurysm; transfusion reactions ,intravascular hemolysis of any cause.
I
-
Inflammatory lesions include pyelonephritis, necrotizing papillitis, and
renal tuberculosis.
N
-
Neoplasms of the kidney rarely cause anuria because only one kidney is
affected at a time.
D
-
Degenerative conditions are unlikely to cause anuria.
I
-
Intoxication from numerous antibiotics (e.g., gentamycin, sulfa,
streptomycin) and from gold, arsenic, chloroform, carbon tetrachloride, or
phenol,
C - Congenital disorders include polycystic kidneys and medullary sponge
kidneys.
A - Autoimmune disorders form the largest group of renal causes of anuria.
Lupus erythematosus, polyarteritis nodosa, acute glomerulonephritis,
amyloidosis, and scleroderma
T
-
Trauma includes contusions and lacerations of the kidney for
completeness
E
-
Endocrine disorders include diabetic glomerulosclerosis, necrotizing
papillitis from diabetes, and nephrocalcinosis from hyperparathyroidism
Postrenal (obstructive) causes. SMINT –
S - stones: bilateral renal or ureteric stones or unilateral stone with non-
functioning other kidney, stricture.
M - Malformations may cause anuria; they include congenital bands,
aberrant vessels over the ureters, horseshoe kidney, and ureteroceles.
I - Inflammation includes cystitis, urethritis, and prostatitis, Billharisiasis.
N - Neoplasms include carcinomas of the bladder obstructing both ureters,
prostatic hypertrophy, and carcinomas of the uterus or cervix involving
both ureters.
N also signifies neurologic disorders such as polio, multiple sclerosis,
and acute trauma to the spinal cord that may cause anuria.
T -Trauma signifies surgical ligation of the ureters, ruptured bladder, and
instrumentation of the urinary tract
Approach to the Diagnosis:
The initial workup includes:
- CBC
- urinalysis; urine culture and sensitivity, examination of the urine for casts,;
- plain X- ray of the abdomen for kidney size & any urinary stones;
- chest x-ray; and ECG.
-The bladder is catheterized for residual urine and if this is significant postrenal azotemia
is likely.
- cystoscopy and retrograde pyelography once the patient
’
s condition is stabilized.
- Ultrasonography can be used to determine if there is significant residual urine also.
- CT scan of the abdomen
Treatment
• If volume depletion is the cause, intravenous saline and plasma volume
expanders are given while carefully monitoring the urine output. If this is
ineffective, furosemide and a mannitol drip can be utilized to reestablish
urine output.
• Inotropic support with dopamine to improve cardiac efficacy & increase RBF
• Obstructive renal failure is treated by removal of the obstruction by surgery,
if the patient is too ill, then the use of percutanous nephrostomy catheters,
or double J catheter fixed internally by the use of cystoscopy.
• Peritoneal dialysis.
• Haemodialysis.