Oliguria or hypouresis is the low output of
urine
Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra.
Cel ...
specifically more than 80 ml/day but less than 400ml/day.
[Boon et al, Davidson's Principles & Practice of Medicine (20th Ed), p475] The decreased output of urine may be a sign of
dehydration
In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
,
kidney failure
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...
,
hypovolemic shock,
hyperosmolar hyperglycemic nonketotic syndrome (HHNS),
multiple organ dysfunction syndrome
Multiple organ dysfunction syndrome (MODS) is altered organ (anatomy), organ function in an acutely ill patient requiring medicine, medical intervention to achieve homeostasis.
Although Irwin and Rippe cautioned in 2005 that the use of "multiple ...
,
urinary obstruction
Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include urinary incont ...
/
urinary retention
Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...
,
diabetic ketoacidosis (DKA),
pre-eclampsia
Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...
, and
urinary tract infection
A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
s, among other conditions.
Beyond oliguria is
anuria
Anuria is nonpassage of urine, in practice is defined as passage of less than 100Harrison's Principles of Internal Medicine, 19E PAGE 292 milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occu ...
, which represents an absence of urine, clinically classified as below 80 or 100 ml/day.
The term oliguria is derived from ''oligo''-meaning "small, little," + -''uria'', from the Greek word ''ouron,'' meaning ''"''urine".
Definition
Oliguria is defined as a urine output that is less than 1 mL/kg/h in infants,
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less than 0.5 mL/kg/h in children,
[ and less than 400 mL][ or 500 mL]
Last full review/revision March 2009 by Soumitra R. Eachempati per 24h in adults - this equals 17 or 21 mL/hour. For example, in an adult weighing 70 kg it equals 0.24 or 0.3 mL/hour/kg. Alternatively, however, the value of 0.5 mL/kg/h is commonly used to define oliguria in adults as well.[
]
Diagnostic approach
Perform ultrasound examination of the kidney to rule out obstructive processes.
The mechanisms causing oliguria can be categorized globally in three different categories:
* Prerenal: in response to hypoperfusion
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
of the kidney (e.g. as a result of dehydration
In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
by poor oral intake, cardiogenic shock
Cardiogenic shock (CS) is a medical emergency resulting from inadequate blood flow due to the dysfunction of the ventricles of the heart.Textbooks of Internal MedicinHarrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Compan ...
, diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
, G6PD deficiency
Glucose-6-phosphate dehydrogenase deficiency (G6PDD), which is the most common enzyme deficiency worldwide, is an inborn error of metabolism that predisposes to red blood cell breakdown. Most of the time, those who are affected have no symptoms. ...
, massive bleeding
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
or sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
)
* Renal: due to kidney damage (severe hypoperfusion
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
, rhabdomyolysis
Rhabdomyolysis (also called rhabdo) is a condition in which damaged skeletal muscle breaks down rapidly. Symptoms may include muscle pains, weakness, vomiting, and confusion. There may be tea-colored urine or an irregular heartbeat. Some of th ...
, medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
)
* Postrenal: as a consequence of obstruction of the urine flow (e.g. enlarged prostate
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
, tumour compression urinary outflow, expanding hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
or fluid collection)
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
Aldosterone is the main mineralocorticoid steroid hormone produced by the zona glomerulosa of the adrenal cortex in the adrenal gland. It is essential for sodium conservation in the kidney, salivary glands, sweat glands, and colon. It plays a c ...
(Na and water retention) and antidiuretic hormone
Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the AVP gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It then travel ...
(ADH) release
Babies
Oliguria, when defined as less than 1 mL/kg/h, in infant
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
s is not attributed to kidney failure.
See also
* Polyuria
Polyuria () is excessive or an abnormally large production or passage of urine (greater than 2.5 L or 3 L over 24 hours in adults). Increased production and passage of urine may also be termed diuresis. Polyuria often appears in conjunction wit ...
(excessive urine production)
* Anuria
Anuria is nonpassage of urine, in practice is defined as passage of less than 100Harrison's Principles of Internal Medicine, 19E PAGE 292 milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occu ...
(absolute lack of urine output)
* Intraabdonmial hypertension (IAH) and Abdominal Compartment Syndrome (ACS)
References
External links
{{Urinary system symptoms and signs
Symptoms and signs: Urinary system