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.^[1]

Causes

Common Causes

Causes by Organ System

Cardiovascular	Accelerated hypertension, Acute systemic inflammation following acute myocardial infarction, Aneurysmal rupture, Aortic valve ring and critical aortic stenosis, Atheroemboli, Bleeding, Bradyarrhythmias , Capillary leak, Cardiogenic shock, Cholesterol embolism, Complete heart block, Congenital heart disease, Dilated cardiomyopathies, Heart failure, Heat stroke, Hypovolemic shock, Malignant hypertension, myocardial depression , myocardial shock, Myocardial stunning , pericardial tamponade, , Preclampsia, Renal artery stenosis, severe constrictive pericarditis , Superior mesenteric artery occlusion, vasculitis
Chemical/Poisoning	Camphor, Carbon-monoxide
Dental	No underlying causes
Dermatologic	Anaphylaxis and anaphylactoid reactions, Erythroderma, Sweating
Drug Side Effect	ACE inhibitors, Amatoxins, Aminoglycosides, Amphotericin B, Analgesic nephropathy, Anthracyclines, Arsenic trioxide, Bacitracin, Bendamustine, Bleomycin, Capecitabine, Capreomycin, Carbon tetrachloride, Carboplatin, Carmustine, Cidofovir, Cisplatin, Cyclophosphamide, Cyclosporine, Cytarabine, Deferasirox, Etoposide, Exenatide, Fluconazole, Fludarabine and cladribine, Gallium nitrate, Gemcitabine, Gyromitrin, Hetastarch , Hydroxyurea, Ifosfamide, Intravenous immune globulin, Irinotecan, Lenalidomide, Lomustine, Malignant hyperpyrexia following anesthesia, Mannitol, Melphalan, Methotrexate, Micafungin, Mithramycin, Nitrosourea compounds, NSAIDs , Orellanine, Oxaliplatin, Para-amino salicylic acid, Pemetrexed, Pentamidine, Pentostatin, Polymyxin B, Rifampicin, Sulphinpyrazone, Sulphonamide crystalluria Cacluli, Synthetic cannabinoids , Tacrolimus, Taxanes, Telavancin, Temozolomide, Tenofovir, Topotecan, Valacyclovir, Vancomycin, Vinca alkaloids
Ear Nose Throat	No underlying causes
Endocrine	Acute pancreatitis, Addisonian crisis, Diabetic nephropathy, Hypercalciuria, Hyperosmolar non-ketotic diabetic coma, hypoaldosteronism, Myxedema coma, SIADH
Environmental	Burns, Heat stroke, Insect bites, Snake bite (Viperidae)
Gastroenterologic	Bowel strangulation, Colorectal cancer, Hemorrhagic pancreatitis, Hepatic vein thrombosis, Hepatorenal syndrome, Intestinal obstruction, , Intususception of intestine, Acute Pancreatitis, Retroperitoneal fibrosis, Third-space sequestration, Upper or Lower gastrointestinal bleeding
Genetic	Prune belly syndrome, Thrombotic thrombocytopenic purpura, Transient renal dysfunction of the newborn
Hematologic	Disseminated intravascular coagulation, Expanding hematoma, Mismatched blood transfusion, Myoglobinuria, Polycythemia, Porphyria, Renal artery thrombosis, Renal vein thrombosis, Thrombotic thrombocytopenic purpura, transfusion reactions
Iatrogenic	Diarrhea, external drainage, Malignant hyperpyrexia following anesthesia, Mismatched blood transfusion, Multiple organ dysfunction syndrome, Radiotherapy, sweating, Systemic inflammatory response syndrome , Vomiting
Infectious Disease	Diphtheria, Dobrava-Belgrade Virus, Endometriosis, Endotoxic shock, Enteritis, Epidemic dropsy, Hantavirus, Human monocytotropic ehrlichiosis, Lassa fever, Leptospirosis, Malignant malaria, Mycobacterium tuberculosis, Neisseria gonorrhoea, Post-streptococcal glomerulonephritis, Schistosoma haematobium, septic shock , Systemic inflammatory response syndrome , Toxic shock syndrome
Musculoskeletal/Orthopedic	Rhabdomyolysis, Cervical spine injury, Spinal cord compression, Crush syndrome, fractures, Massive bleeding, Multiple traumatic injuries
Neurologic	Cervical spine injury, Eclampsia, Intraventricular hemorrhage, Myelomatosis, Neurogenic bladder, neurogenic shock after central nervous system or spinal cord injury, Prolonged convulsions, Spinal cord compression
Nutritional/Metabolic	Adenine phosphoribosyltransferase deficiency, Bulimia, Cholesterol embolism
Obstetric/Gynecologic	Carcinoma of the uterine cervix, Cervical cancer, Endometriosis, Hydrometrocolpos, Hyperemesis gravidarum, Ovarian hyperstimulation syndrome, Perinatal asphyxia, Postpartum bleeding, Preclampsia, Toxemia of pregnancy (type of Toxemia), Twin twin transfusion
Oncologic	Benign Prostate hyperplasia, Bladder cancer, Leukaemia, Pelvic tumor, Prostate cancer, Tumor lysis syndrome
Ophthalmologic	No underlying causes
Overdose/Toxicity	Crush syndrome, Drug overdose, heavy metal poisoning , Heme pigments , Myoglobinuria, Porphyria, Radiocontrast media , Rhabdomyolysis, Tumor lysis syndrome
Psychiatric	Bulimia
Pulmonary	Alport syndrome, Massive pulmonary embolism,, Respiratory distress syndrome, Respiratory losses , Severe pulmonary hypertension, Tension pneumothorax
Renal/Electrolyte	Acute cortical necrosis, Acute glomerulonephritis, Acute interstitial nephritis, Acute on chronic renal failure , Acute pyelonephritis, Acute renal failure, Acute tubular necrosis, Addisonian crisis, Alport syndrome, Analgesic nephropathy, Bilateral renal vein occlusion, Burns, Chronic renal failure, End stage kidney disease, Glomerulonephritis , Hepatic vein thrombosis, Hepatorenal syndrome, Hydronephrosis, hypoaldosteronism, Interstitial nephritis, Intrinsic glomerular disease, Nephritic syndrome, Nephrocalcinosis , Nephrolithiasis, Nephrotic syndrome, Post-streptococcal glomerulonephritis, Prerenal failure, Renal insufficiency, Renal papillary necrosis, Renal vein thrombosis, salt-wasting nephropathies , Sulphonamide crystalluria Cacluli, Thrombotic thrombocytopenic purpura
Rheumatology/Immunology/Allergy	Anaphylaxis and anaphylactoid reactions, Antiphospholipid Antibody Syndrome, Disseminated intravascular coagulation, Lichen sclerosus et atrophicus, Mismatched blood transfusion, Multiple organ dysfunction syndrome, Systemic lupus erythematosis, Systemic inflammatory response syndrome , transfusion reactions, Transplant rejection, vasculitis
Sexual	Benign Prostate hyperplasia, Hydrometrocolpos
Trauma	Acute blood loss, Cervical spine injury, Crush syndrome, fractures, Massive bleeding, Multiple traumatic injuries, Neurogenic bladder, Neurogenic shock after central nervous system or spinal cord injury, Ruptured hematoma, Shock, Upper or Lower gastrointestinal bleeding
Urologic	Benign Prostate hyperplasia, Bladder cancer, Bladder outlet obstruction, Hydronephrosis, Kidney stone, Nephrotic syndrome, Obstruction of the urinary tract, Pelvic tumor, Prostate cancer, Schistosoma haematobium, Sulphonamide crystalluria Cacluli, Ureterocele, Urethral catheterization, Urethral stricture, Urethral trauma
Miscellaneous	Puerperal shock, Radiotherapy, Surgery complication

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
- Has there been fever?
- Has there been diarrhea?
- Has there been vomiting? With or without nausea?
- Is thirst decreased?
- What other symptoms does the patient have?
Other
- What medications does the patient take?
- Does the patient have any allergies?
- Does the patient have access to adequate fluids?
Medical history
- Has the patient had any recent injuries such as burns?
- Has the patient been sick?
- Does the patient have a history of a problem with the 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

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.

de:Oligurie it:Oliguria sk:Anúria sl:Oligurija

Template:WikiDoc Sources

[1] Klahr S, Miller S (1998). "Acute oliguria". N Engl J Med. 338 (10): 671–5. PMID 9486997. Free Full Text.

[2] Arant B (1987). "Postnatal development of renal function during the first year of life". Pediatr Nephrol. 1 (3): 308–13. PMID 3153294.

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