Oliguria

Oliguria General Information

The low production of urine is the main characteristic of Oliguria and is a sign that the body has a renal failure, is dehydrated or may be an alert for a urinary retention or obstruction. We can define this disease as a urine output that has a value under 1 mL/kg/h in small children, under 0.4 mL/kg/h in older kids and under 300 mL/day in adults. It is very important to be investigated because the early cases can be reversed and renal failure avoided. This disease can lead to another one, more severe, that refers to the absence of urine, called anuria. The causes of Oliguria are many and different including: outlet obstruction (postrenal), intrinsic kidney disorders (renal) and blood-flow related (prerenal). All these causes are results of other disorders. For example, postrenal causes can be obstructive, from neurogenic bladder to stones, prostatic hypertrophy and Foley catheter obstruction. Prerenal disease comes from a renal hypoperfusion that is a sign of low cardiac output, hypovolemia or sepsis (a low resistance of the vascular system). Acute tubular necrosis leads to renal causes, such as nephrotoxic drugs, hypoperfusion, rhabdomyolysis. A major and serious operation could determine a decrease in the urine output caused by stress (when the production of ADH-antidiuretic hormone and aldosterone increase) or a blood and fluid loss. Oliguria is very often met in the acute phase and demands hard work from the doctor in order to diagnose it. The therapeutic area may be reduced so that it is vital to detect this disease on time, before resulting in intrinsic renal failure.

Oliguria Symptoms

Oliguria affects people of any age, sex and race. Although, it is more frequent among new born and in small children who are very predisposed to illnesses causing dehydration. The causes that make the urine output go low under the normal values are determined of other disorders. An enlarged prostate leads to a total urinary tract obstruction, severe infections to shocks, simultaneous fever, nausea, vomiting and diarrhea to dehydration, and the main deficiency of this disease. The kidneys are injured by some medications and therapy, such as immunosuppressant drugs, chemo and certain antibiotics. When going to a medical check, the signs that should be sought are: hypovolemia, cardiac failure, sepsis, outlet obstruction that results after a palpable bladder distention and urine colored in black (suggestion of myoglobinuria). The symptoms vary from those a glomerular disease to urinary tract obstruction or a renal failure that might be chronic. A patient may present a poor urinary dribbling or stream and alternative periods of oligo-anuria and polyuria. Oliguria may be it self a sign of chronic renal failure. Symptoms of anterior renal disorders usually appear in children. They can accuse hematuria, edema, frequent urinary tract infections, bone pain, tiredness, proteinuria, pallor, hypertension and anorexia. There may appear some physical symptoms, such as orthostatic hypotension, dry mucous membranes, tachycardia and decreased skin turgor. Infants also suffer of physical manifestations of acute renal failure, such as pulmonary edema, gallop rhythm, signs of congestive heart failure, anemia or hepatomegaly. A loss of weight, a poor growth, renal osteodystrophy or hypertension must be remembered.

Oliguria Treatment

Indifferently of the Oliguria cases, you must go to consult a pediatric urologist (for management of obstruction) or a pediatric nephrologist. But there are some exceptions, for example children who have a mild nephrotoxic injury and respond to discontinuing medication or children who have a prerenal insufficiency as a result of dehydration and have a prompt response a therapy with fluids. Although the results are great leading to a fast health improvement, these method of treatment is not available for patients who are hypotensive and with a multiorgan damage. If the urine flow is not established, the potassium cannot be administrated. Until the levels of potassium start to fall and Oliguria improves, the potassium must be withheld. If this disease has an overload volume, the fluid must be restricted and proceed with intravenous furosemide. An acute tubular necrosis is observed if the organism does not respond to furosemide so that the specialists will go on a removal of the liquid by dialysis. Some of the doctors consider hemofiltration another good option if there are signs of pulmonary edema.