Oliguria

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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.

Causes

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, tumour 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 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.

Risk Factors

Patient 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 do you drink each day?
  • Does drinking more increase your urine output?
  • How much urine do you produce each day?
  • What color is the urine?
• Aggravating factors
  • Has there been fever?
  • Has there been diarrhea?
  • Has there been vomiting? With or without nausea?
  • Is thirst decreased?
  • What other symptoms do you have?
• Other
  • What medications do you take?
  • Do you have any allergies?
  • Do you have access to adequate fluids?
• Medical history
  • Have you had any recent injuries such as burns?
  • Have you been sick?
  • Do you have a history of a problem with your kidneys or bladder?

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
• Follow prescribed fluid regimens and measure urine output as directed.

Primary Prevention

Prevention depends on the underlying cause.