Oliguria

Ref:StatPearls

. urinary output less than 400 ml per day or less than 20 ml per hour
. one of the earliest signs of impaired renal function
. Caused
– PRERENAL
– Hypovolemia
– less fluid intake
– bleeding
– GI fluid loss
– diarrhea
– vomiting
– nasogastric suction
– renal losses
– diuretics
– glycosuria
– third-spacing of fluid
– ascites
– pleural effusion
– trauma
– surgery
– burns
– sepsis
– anaphylaxis
– hepatic failure
– nephrotic syndrome
– vasodilatory drugs or anesthetic agents.
– Pump Failure
– Myocardial failure secondary to MI, PE, cardiac tamponade, and CHF
– Vascular
– Renal-artery or renal-vein occlusion
– thrombosis
– thromboembolism
– severe stenosis
– disrupted renal autoregulation secondary to ACEI
– RENAL
–
3
Vasculitis
–
2
glomerulonephritis
–
1
scleroderma
 – malignant hypertension
– interstitial nephritis
– Acute tubular necrosis (ATN)
– ischemia
– nephrotoxic substances
– gentamicin
– kanamycin
– mercury
– cisplatin
– radiographic contrast agents
– POSTRENAL
– Upper urinary tract obstruction due to ureteral obstruction of one or both sides
– Lower urinary tract obstruction (more common)
– bladder-outlet obstruction
– due to BPH, tumor, drugs, etc
. Urine analysis
– Gravity: >1.02 in prerenal and <1.01 in renal causes
– Urinary sodium concentration (mmol/liter) value is <20 in prerenal causes whereas it is
>40 in renal etiologies
– Fractional excretion of sodium (%) is <1% in prerenal and >1% in renal causes
– The ratio of urinary to plasma creatinine is >40 in prerenal causes, whereas <20 in
renal causes
– Urine osmolality is >500 in prerenal and <350 in renal etiologies
– ratio of urine to plasma osmolarity is >1.5 in prerenal and <1.1 in renal etiologies
– The blood urea nitrogen (BUN) to creatinine ratio is >20:1 in prerenal disease and <10:1
in renal diseases
– U/A, BUN/Cr, Uosmo

. Bladder ECHO
. Management
– volume overloading should be avoided at all costs and treated with diuresis or renal
replacement therapy if indicated
– MAP of 65-70 mmHg in non-hypertensive patients
– Record I/O
– Diuretic Therapy
– 當 fluid resuscitation fails 使⽤
– 如果無效更不可能是急性腎損傷
– FST is said to be nonresponsive if 1.0-1.5 mg/kg of furosemide produces a urine
output of 100 ml/h in the first two hours
– Nonresponsive FST is associated with a higher stage of AKI
. Complications
– Electrolyte imbalance
– Hyperkalemia
– metabolic acidosis
– salt, and water retention
– pulmonary edema
– ascites
– pleural effusions
– hyperphosphatemia
– hypocalcemia
– Neurologic
– drowsiness
– confusion
– somnolence
– hyperreflexia
– seizures
– coma
– Cardiovascular
– As a result of the fluid and salt imbalance
– congestive heart failure
– pulmonary edema
– hypertension
– hypotension may be seen, which is a manifestation of other concomitant
illnesses such as sepsis
– Electrocardiographic (ECG) changes due to hyperkalemia can be seen.
– In about a quarter of cases, arrhythmias may occur due to electrolyte imbalance.
– Pericarditis is also seen rarely and is a manifestation of uremia
– Gastrointestinal
– nausea
– vomiting
– ileus
– gastrointestinal hemorrhage
– gastritis
– Respiratory
– Kussmaul breathing due to metabolic acidosis.
– Musculoskeletal: muscle weakness or paralysis
– Pharmacological: As a result of the renal injury, the metabolism of various drugs is
slowed down, leading to an increased risk of toxicity. It warrants dose modification for
drugs
– Infectious: Increased risk of urogenital tract and respiratory infections as a result of
damage to the normal barriers, uremia, and inappropriate antibiotic usage. Prevention
of infectious complications requires close monitoring of the patient
– Hematological
– anemia
– decreased erythropoiesis
– hemolysis
– with hematocrit values between 20 and 30 percent