Oliguria

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Contents 1 More Specific Terms 2 Introduction 3 Etiology 4 Laboratory 5 Management 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• anuria

Introduction

• Urine output < 400 mL/day or < 20 mL/hour in adults, < 240 mL/day in children, & < 15-20 mL/kg/day in neonates. Urine flows less than this are insufficient to excrete the daily osmolar load.

Etiology

• pre-renal

• hypovolemia

• hemorrhage
• dehydration

• gastrointestinal losses
• renal losses ( diuretics)

• decreased effective blood volume

• vasodilation

• pharmacologic agents
• sepsis
• anaphylaxis

• sequestration of extracellular fluid ( 3rd spacing)

• burns
• abdominal surgery
• peritonitis
• pancreatitis
• congestive heart failure ( CHF)
• cardiogenic shock
• hepatorenal syndrome
• hypoalbuminemia

• renal

• acute tubular necrosis ( ATN)

• ischemia

• hypotension
• sepsis

• nephrotoxin

• aminoglycosides
• radiographic contrast agent

• rhabdomyolysis
• eclampsia

• vascular disease

• renal vein thrombosis
• renal vasculitis
• malignant hypertension

• bilateral renal cortical necrosis
• end-stage renal disease ( ESRD)
• acute glomerulonephritis
• hemolytic-uremic syndrome ( HUS)
• acute interstitial nephritis ( AIN)
• hypercalcemia
• urine paraproteins

• multiple myeloma
• Waldenstrom's macroglobulinemia
• amyloidosis

• urinary crystals

• post-renal (rare in children)

• bilateral ureteral obstruction

• external compression

• retroperitoneal fibrosis
• tumor
• lymph nodes

• intrinsic occlusion

• urinary calculus
• tumor

• bladder outlet obstruction

• neurogenic bladder
• urinary calculus
• tumor
• posterior urethral valves - newborn males

• urethral obstruction

• prostatic enlargement
• stricture
• trauma

• congenital malformation of kidney

• children

Laboratory

• urine output
• urinalysis

• protein by dipstick
• microscopy

• tubular epithelial cells
• RBC
• RBC casts
• WBC casts

• urinary indices*
• serum chemistries

• urea nitrogen
• creatinine

• complete blood count (CBC)
• renal ultrasound
• cystoscopy & retrograde pyelogram
• renal flow scan *Indices of oliguria

*                                    prerenal      ATN* 
*   urine osmolality (mOsm/L)        > 500        < 350 
*   urine/plasma creatinine          > 40         < 20 
*   BUN/creatinine (plasma)          > 20         < 15 
*   FENA#                            < 1%         > 3%

• * acute tubular necrosis
• # fractional excretion of sodium

Management

• catheterize bladder - relieve obstruction
• optimize arterial blood volume & cardiac status

• fluid challenge with saline unless in CHF
• restrict salt & water intake if in CHF

• discontinue nephrotoxic agents
• maintain electrolyte balance
• maintain acid-base status
• treat hypertension
• treat hypotension
• monitor input & output
• maintain urine output after hemodynamics & arterial blood volume is maximized

• loop diuretics
• low-dose dopamine

• hemodialysis

More General Terms

• sign/symptom

Additional Terms

• acute renal failure (ARF)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 523-525
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 596

oliguria