Anuria R34

Hippocrates, born in ancient Greece in 460 B.C.E. (Choulant 1828), was the first to describe urinary retention and called it "ischuria" (Baehrens 1829).

Anuria is a symptom of disturbed diuresis (Herold 2020). One speaks of anuria if the urine excretion is < 100 ml / d. If no more urine is produced at all, it is a so-called "complete anuria" (Staubach 2008).

However, it is not only the amount of urine produced by anuria that is limited, but also the quality of urine (Hautmann 2006).

Anuria can occur at any age.

The cause of anuria can be prerenal, intrarenal or postrenal. The most common cause is prerenal (Staubach 2008).

• prerenal renal failure:
  • Shock
    • traumatic
    • cardiac
    • anaphylactic
  • cardiovascular incompetence
    • z. e.g. through heart failure
  • Lack of volume
  • Lack of fluids (especially for the elderly)
  • iatrogenically reduced fluid intake with parenteral nutrition
  • Renal failure (acute or chronic)
  • Reduced intravascular volume within the scope of a:
    • Pancreatitis
  • reduced intra-arterial volume by e.g.:
    • Cirrhosis of the liver
    • nephrotic syndrome
  • disturbances of intrarenal haemodynamics by e.g.:
    • NSAIDs (can lead to preglomerular vasoconstriction)
    • ACE inhibitors (can lead to post-glomerular vasoconstriction)

• Intrarenal renal failure:
  • vascular causes such as:
    • Thrombosis, embolism or stenosis of the renal vein or artery
  • acute glomerulonephritis (especially in the rapidly progressive form [Kasper 2015])
  • acute necrosis of the renal cortex or
  • acute tubule necrosis e.g.
    • ischemic or toxic condition

• postrenal renal failure:
  • Obstruction of the upper urinary tract by e.g.
    • Nephrolithiasis
    • Urothelial carcinoma
    • M. Ormond (retroperitoneal fibrosis of unknown cause [Staubach 2008])
  • Obstruction of the lower urinary tract e.g.
    • benign prostate hyperplasia
    • Bladder carcinoma
    • Phimosis
    • neurogenic bladder (Kasper 2015 / Brunkhorst 2010 / Hautmann 2006)

Depending on the cause of urinary retention, anuria can occur suddenly or develop chronically (Kuhlmann 2015).

Anamnestic, physical, apparatus and laboratory chemical examinations should be carried out immediately - adapted to the respective symptomatology - to find the cause.

The leading symptom of postrenal anuria is an empty bladder that can be displayed sonographically (Hautmann 2006).

Differential diagnosis is to be made for oliguria in which the daily urination lies between >100 ml to < 500 ml / d (Herold 2020).

The therapy depends on the underlying disease causing the anuria.

Prognostically, it is crucial whether the cause of anuria is chronic or acute renal failure, since only the acute form allows "restitutio ad integrum" (Schmelz 2014).

An untreated anuria is always lethal.

1. Baehrens J F (1829) Hippocrates' urinary theory, in its true value: claimed by Dr. Fr. Baehrens. Büschler'sche Verlags- Bookstore 371
2. Brunkhorst R et al (2010) Differential diagnosis and differential therapy: Decisions in internal medicine. Urban and Fischer Publishing House Munich 12
3. Choulant L (1828) Handbook of Bibliography for the Older Medicin for the knowledge of Greek, Latin and Arabic writings in the medical field and the bibliographical differentiation of their different editions, translations and explanations. Publisher of Leopold Voss 9
4. Hautmann R et al (2006) Urology Springer Verlag 28
5. Herold G et al (2020) Internal medicine. Herold Publisher 599
6. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 1790
7. Kuhlmann U et al (2015) Nephrology: Pathophysiology - Clinic - Kidney replacement procedure. Thieme 473
8. Schmelz H U et al. (2014) Specialist knowledge in urology: Differentiated diagnostics and therapy. Springer publishing house 663
9. Staubach K H et al (2008) Viererverband kleine operative Fächer: Short textbook on urology, ophthalmology, ENT, orthopaedics. Elsevier Urban and Fischer publishing house 5, 13