Oliguria Clinical Presentation

  • Author: Prasad Devarajan, MD; Chief Editor: Craig B Langman, MD   more...
 
Updated: May 16, 2012
 

History

Careful evaluation of the patient's history and physical examination often reveals the cause of oliguria. This is especially important in prerenal and postrenal processes because early diagnosis and treatment frequently results in complete recovery.

Fluid losses

A recent history of diarrhea or vomiting should be sought because this is the most common cause in children.

Less commonly, fluid loss may result from traumatic hemorrhage or burns or following polyuric states, such as diabetes insipidus and diabetes mellitus.

The loss of intravascular fluid volume into the interstitial space accompanies surgery, shock syndromes, and nephrotic syndrome. Children with fluid losses may report thirst, dizziness, palpitations, and fatigue, and a history of weight loss may be present.

Drugs

A detailed history of recent medications should be obtained. In the presence of mild prerenal insufficiency, the administration of medications that impair renal autoregulation can precipitate oliguric acute renal failure.

Cyclosporine, tacrolimus, and contrast agents are direct afferent arteriolar constrictors that interfere with the myogenic response.

NSAIDs inhibit the renal synthesis of vasodilatory prostaglandins. They are an important cause when administered to febrile children with intercurrent dehydration.

Drugs that induce direct tubular necrosis include aminoglycosides, amphotericin B, cyclosporine, tacrolimus, antineoplastic agents (eg, methotrexate, cisplatin), and contrast agents. Acyclovir and sulfonamides can precipitate within the tubular lumen and result in obstruction.

In addition, a large number of medications, especially penicillins, cephalosporins, sulfonamides, ciprofloxacin, NSAIDs, and diuretics, can cause interstitial nephritis.

Endogenous tubular toxins

These include the following:

  • Myoglobin - Released following crush injuries, myositis, and prolonged grand mal seizures
  • Hemoglobin - Hemolysis
  • Uric acid -Tumor lysis syndrome

Diet

A history of ingesting undercooked meat may suggest the presence of hemolytic-uremic syndrome.

Symptoms of glomerular disease

Many children have a history of gross hematuria and edema. An antecedent streptococcal infection may suggest a postinfectious glomerulonephritis, and a history of bloody diarrhea often precedes the hemolytic-uremic syndrome.

Suspect systemic lupus erythematosus or allergic interstitial nephritis in children with fever, joint symptoms, and skin rashes who present with oliguria.

A history of recurrent sinusitis or lower respiratory tract infections may suggest Wegener granulomatosis, and hemoptysis may suggest Goodpasture disease.

Symptoms of urinary tract obstruction

These symptoms include the following:

  • Complete absence of urine output
  • Alternating periods of polyuria and oligoanuria
  • Poor urinary stream or dribbling

Symptoms of chronic renal failure

Although oliguria is usually acute at initial presentation, it may also be a presenting symptom of chronic renal failure. Children may have additional symptoms suggestive of previous renal disease, including the following:

  • Frequent urinary tract infections
  • Hematuria
  • Proteinuria
  • Hypertension
  • Edema
  • Fatigue
  • Pallor
  • Anorexia
  • Bone pain
Next

Physical Examination

Signs of intravascular volume depletion

The following may be noted:

  • Tachycardia
  • Orthostatic hypotension
  • Decreased skin turgor
  • Dry mucous membranes

Signs of acute renal failure

Children may present with edema, anemia, and signs of congestive heart failure, such as hepatomegaly, gallop rhythm, and pulmonary edema.

Hypertension is common, especially in acute glomerulonephritis, and may be secondary to volume overload and alterations in vascular tone.

Although many children with hypertension are asymptomatic, encountering patients with signs of congestive heart failure, visual disturbances, or encephalopathy is common.

Signs specific to the underlying renal disease

A butterfly rash on the face and joint swelling are highly suggestive of systemic lupus erythematosus.

Patients with Henoch-Schönlein purpura present with a characteristic purpuric rash over the buttocks and the extensor surface of the lower extremity.

Acute interstitial nephritis may be accompanied by fever, arthralgias, and fleeting, maculopapular or urticarial rashes. Various skin rashes may be detected in vasculitides.

Oliguria with palpable kidneys during infancy suggests renal vein thrombosis, polycystic kidneys, multicystic dysplasia, or hydronephrosis. In older children, enlarged kidneys should also raise the suspicion of tumors. A transplanted kidney that is tender to palpation is indicative of rejection.

Signs of postrenal failure

Poor urinary stream, urinary dribbling, and a palpably enlarged urinary bladder are indicative of obstruction. The external genitalia may reveal meatal stenosis or urethral trauma.

The diagnosis of obstruction may be strengthened by the reestablishment of urine output after the gentle passage of a catheter. Patients with indwelling urinary catheters who develop oliguria should undergo flushing of the catheter to rule out blockage.

Signs of chronic renal failure

The following may be noted:

  • Poor growth
  • Hypertension
  • Edema
  • Anemia
  • Renal osteodystrophy
Previous
Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Prasad Devarajan, MD  Louise M Williams Endowed Chair in Pediatrics, Professor of Pediatrics and Developmental Biology, Director of Nephrology and Hypertension, Director of Clinical Nephrology Laboratories, CEO of Dialysis Unit, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine

Prasad Devarajan, MD is a member of the following medical societies: American Heart Association, American Society of Nephrology, American Society of Pediatric Nephrology, National Kidney Foundation, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD  The Isaac A Abt, MD, Professor of Kidney Diseases, Northwestern University, The Feinberg School of Medicine; Division Head of Kidney Diseases, Children's Memorial Hospital

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology

Disclosure: NIH Grant/research funds None; Raptor Pharmaceuticals, Inc Grant/research funds None; Alexion Pharmaceuticals, Inc. Grant/research funds None

Additional Contributors

Laurence Finberg, MD Clinical Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine and Stanford University School of Medicine

Laurence Finberg, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Luther Travis, MD Professor Emeritus, Departments of Pediatrics, Nephrology and Diabetes, University of Texas Medical Branch School of Medicine

Luther Travis, MD is a member of the following medical societies: Alpha Omega Alpha, American Federation for Medical Research, International Society of Nephrology, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Cerda J. Oliguria: an earlier and accurate biomarker of acute kidney injury?. Kidney Int. Oct 2011;80(7):699-701. [Medline].

  2. Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. Aug 2004;8(4):R204-12. [Medline]. [Full Text].

  3. Mehrazma M, Hooman N, Otukesh H. Prognostic value of renal pathological findings in children with atypical hemolytic uremic syndrome. Iran J Kidney Dis. Nov 2011;5(6):380-5. [Medline].

  4. Adragna M, Balestracci A, García Chervo L, Steinbrun S, Delgado N, Briones L. Acute dialysis-associated peritonitis in children with D+ hemolytic uremic syndrome. Pediatr Nephrol. Oct 29 2011;[Medline].

  5. Bunchman TE, McBryde KD, Mottes TE, et al. Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol. Dec 2001;16(12):1067-71. [Medline].

  6. Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis. Jan 2005;45(1):96-101. [Medline].

  7. Mehta RL, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. Oct 2004;66(4):1613-21. [Medline].

  8. Parikh CR, Devarajan P. New biomarkers of acute kidney injury. Crit Care Med. Apr 2008;36(4 Suppl):S159-65. [Medline].

  9. Cantarovich F, Rangoonwala B, Lorenz H, et al. High-dose furosemide for established ARF: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Am J Kidney Dis. Sep 2004;44(3):402-9. [Medline].

  10. Gambaro G, Bertaglia G, Puma G, D'Angelo A. Diuretics and dopamine for the prevention and treatment of acute renal failure: a critical reappraisal. J Nephrol. May-Jun 2002;15(3):213-9. [Medline].

  11. Abuelo JG. Normotensive ischemic acute renal failure. N Engl J Med. Aug 23 2007;357(8):797-805. [Medline].

  12. American Society of Nephrology. American Society of Nephrology Renal Research Report. J Am Soc Nephrol. Jul 2005;16(7):1886-903. [Medline]. [Full Text].

  13. Andreoli SP. Acute renal failure. Curr Opin Pediatr. Apr 2002;14(2):183-8. [Medline].

  14. Bonventre JV, Zuk A. Ischemic acute renal failure: an inflammatory disease?. Kidney Int. Aug 2004;66(2):480-5. [Medline].

  15. Chertow GM, Burdick E, Honour M, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. Nov 2005;16(11):3365-70. [Medline].

  16. Devarajan P. Cellular and molecular derangements in acute tubular necrosis. Curr Opin Pediatr. Apr 2005;17(2):193-9. [Medline].

  17. Devarajan P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol. Jun 2006;17(6):1503-20. [Medline].

  18. Devarajan P, Goldstein SL. Acute renal failure. In: Kher KK, Schnaper HW, Makker SP. Clinical Pediatric Nephrology. Second Edition. Oxon, UK: Informa Healthcare; 2007:3770390.

  19. Friedewald JJ, Rabb H. Inflammatory cells in ischemic acute renal failure. Kidney Int. Aug 2004;66(2):486-91. [Medline].

  20. Goldstein SL. Pediatric acute kidney injury: it's time for real progress. Pediatr Nephrol. Jul 2006;21(7):891-5. [Medline].

  21. Goldstein SL. Pediatric acute renal failure: demographics and treatment. Contrib Nephrol. 2004;144:284-90. [Medline].

  22. Gouyon JB, Guignard JP. Management of acute renal failure in newborns. Pediatr Nephrol. Sep 2000;14(10-11):1037-44. [Medline].

  23. Klahr S, Miller SB. Acute oliguria. N Engl J Med. Mar 5 1998;338(10):671-5. [Medline].

  24. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. Jan 29-Feb 4 2005;365(9457):417-30. [Medline].

  25. Lameire NH, De Vriese AS, Vanholder R. Prevention and nondialytic treatment of acute renal failure. Curr Opin Crit Care. Dec 2003;9(6):481-90. [Medline].

  26. Mehta RL, Chertow GM. Acute renal failure definitions and classification: time for change?. J Am Soc Nephrol. Aug 2003;14(8):2178-87. [Medline]. [Full Text].

  27. Molitoris BA, Sutton TA. Endothelial injury and dysfunction: role in the extension phase of acute renal failure. Kidney Int. Aug 2004;66(2):496-9. [Medline].

  28. Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet. Nov 13-19 2004;364(9447):1814-27. [Medline].

  29. Rabb H, Colvin RB. Case records of the Massachusetts General Hospital. Case 31-2007. A 41-year-old man with abdominal pain and elevated serum creatinine. N Engl J Med. Oct 11 2007;357(15):1531-41. [Medline].

  30. Racusen LC. The morphologic basis of acute renal failure. In: Molitoris BA, Finn WF, eds. Acute Renal Failure. Philadelphia, PA: WB Saunders; 2004:1-12.

  31. Safirstein RL. Acute renal failure: from renal physiology to the renal transcriptome. Kidney Int Suppl. Oct 2004;S62-6. [Medline].

  32. Schrier RW. Need to intervene in established acute renal failure. J Am Soc Nephrol. Oct 2004;15(10):2756-8. [Medline]. [Full Text].

  33. Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med. Jul 8 2004;351(2):159-69. [Medline].

  34. Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. Jul 2004;114(1):5-14. [Medline]. [Full Text].

  35. Siegel NJ, Van Why SK, Devarajan P. Pathogenesis of acute renal failure. In: Avner ED, Harmon WE, Niaudet P, eds. Pediatric Nephrology. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:1223.

  36. Star RA. Treatment of acute renal failure. Kidney Int. Dec 1998;54(6):1817-31. [Medline].

  37. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. Aug 17 2005;294(7):813-8. [Medline].

  38. Warnock DG. Towards a definition and classification of acute kidney injury. J Am Soc Nephrol. Nov 2005;16(11):3149-50. [Medline].

 
Previous
Next
 
Pathogenesis of prerenal failure.
Compensatory mechanisms for preventing a fall in glomerular filtration rate (GFR) in the presence of prerenal failure.
Mechanisms of intrinsic acute renal failure.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.