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{{SK}} Decreased urine output; reduced urine output | {{SK}} Decreased urine output; reduced urine output |
Revision as of 17:18, 11 July 2013
Oliguria Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Decreased urine output; reduced urine output
Overview
Oliguria and anuria are the decreased or absent production of urine, respectively.
Oliguria is defined as a urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children, and less than 400 mL/day (equals 17mL/hour) in adults.[1]
Causes
Common Causes
- ACE inhibitors
- Acute renal failure
- Acute tubular necrosis
- Aminoglycosides
- Analgesic nephropathy
- Capillary leak
- Dehydration
- Diarrhoea
- Diuretics
- Interstitial nephritis
- Massive bleeding
- Nephritic syndrome
- Nephrolithiasis
- Nephrotic syndrome
- Neurogenic bladder
- NSAIDs
- Posterior urethral valves
- Postpartum bleeding
- Prostate enlargement
- Renal artery thrombosis
- Sepsis
- SIADH
- Third space losses
- Urethral trauma
Causes by Organ System
Causes in Alphabetical Order
The mechanisms causing oliguria can be divided into several categories:
Prerenal
In response to hypoperfusion of the kidney (e.g. as a result of dehydration by poor oral intake, diarrhea, massive bleeding or sepsis)
Renal
Due to kidney damage (severe hypoperfusion, rhabdomyolysis, medication)
Postrenal
As a consequence of obstruction of the urine flow (e.g. enlarged prostate, tumor compression urinary outflow, expanding hematoma or fluid collection)
The decreased production of urine may be a sign of dehydration, renal failure or urinary obstruction/urinary retention.
Postoperative Oliguria
Patients usually have a decrease in urine output after a major operation that may be a normal physiological response to:
- Fluid/blood loss – decreased glomerular filtration rate secondary to hypovolemia and/or hypotension
- Response of adrenal cortex to stress -increase in aldosterone (Na and water retention) and antidiuretic hormone (ADH) release
Oliguria in Infants
Oliguria, when defined as less than 1 mL/kg/h, in infants is not considered to be a reliable sign of renal failure.[2]==Risk Factors== Patients having any of the conditions mentioned in the causes are at risk of oliguria.
Natural History, Complications and Prognosis
Although a significant decrease in urine output may indicate a serious, even life-threatening condition, adequate urine output can be restored with prompt medical treatment.
Diagnosis
History and Symptoms
History of
- Time pattern
- When did this begin?
- Did it occur suddenly?
- Has it rapidly become worse?
- Quality
- How much does the patient drink each day?
- Does drinking more increase the daily urine output?
- How much urine does the patient produce each day?
- What color is the urine?
- Aggravating factors
- Other
- What medications does the patient take?
- Does the patient have any allergies?
- Does the patient have access to adequate fluids?
- Medical history
Laboratory Findings
- Blood studies to monitor electrolytes and kidney function.
- Urine tests, including tests for infection.
Treatment
Medical Therapy
It mainly depends on the cause:
Home Care
The patient should follow prescribed fluid regimens and measure urine output as directed.
Primary Prevention
Prevention depends on the underlying cause.
References
- ↑ Klahr S, Miller S (1998). "Acute oliguria". N Engl J Med. 338 (10): 671–5. PMID 9486997. Free Full Text.
- ↑ Arant B (1987). "Postnatal development of renal function during the first year of life". Pediatr Nephrol. 1 (3): 308–13. PMID 3153294.