Oliguria R34

Oliguria was already described at the time when Hippocrates recognized the prognostic importance of urine excretion. In the 2nd century, Galen suggested using urine excretion as an indicator of kidney function.

Heberden described renal failure associated with oliguria as "ischiuria renalis" (Haider 2021).

Between the two world wars, Reinwein described oliguria associated with high specific urine weight. In 1942, Nonnenbruch summarized oligoanuria in the extrarenal renal syndrome (Mohr 1968).

Oliguria is defined as a reduction in daily urine output to < 500 ml (Herold 2020). In the Anglo-Saxon world, the term oliguria is used only when urine output is < 400 ml / d (Kasper 2015). Oliguria is the leading symptom of acute renal failure (Kuhlmann 2015).

The Acute Dialysis Quality Initiative Group defines oliguria as a decreased urine output of < 0.3 ml / kg / h lasting for at least 24 h (Haider 2021).

Oliguria may occur in the context:

• prerenal renal failure due to exsiccosis as so-called functional oliguria (Braun 2022)
• intra- or postrenal renal failure (Scheurlen 2013)
• chronic renal insufficiency (Braun 2022)

Oliguria can occur at any age.

The cause of an oliguria can be in the prerenal, intrarenal or postrenal area.

• prerenal renal failure:
  • Shock
  • traumatic
  • cardiac
  • anaphylactic
• cardiovascular dysfunction.
  • z. e.g. through heart failure
• Lack of volume
  • Lack of fluids (especially for the elderly)
  • iatrogenically reduced fluid intake with parenteral nutrition
• Renal insufficiency
  • 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 V. or A. renali
  • acute glomerulonephritis
  • Acute tubule necrosis, for example.
    • ischaemic or
    • toxicological

• postrenal renal failure:
  • Obstruction of the upper urinary tract in e.g.
  • nephrolithiasis
  • Urothelial carcinoma
  • M. Ormond (retroperitoneal fibrosis of unknown cause [Staubach 2008])
• Obstruction of the lower urinary tract in e.g.
  • benign prostate hyperplasia
  • Bladder carcinoma
  • Phimosis
• neurogenic bladder

(Hautmann 2006 / Brunkhorst 2010)

If the oliguria is the only symptom, an obstruction of the urinary tract should be excluded first (Keller 2010).

In all other cases, an immediate anamnestic, physical, apparatus and laboratory chemical examination - adapted to the respective symptomatology - is necessary to find the cause.

Differential diagnosis is anuria, in which daily urine output is < 100 ml / d (Herold 2020), and functional oliguria, in which there is a reduction in daily urine output due to a decrease in the glomerular filtration rate (Herold 2022).

The therapy depends on the underlying disease causing the oliguria.

If left untreated,(functional) oliguria always progresses to acute renal failure (Scheurlen 1988).

1. Brunkhorst R et al (2010) Differential diagnosis and differential therapy: Decisions in internal medicine. Urban and Fischer Publishing House Munich 12
2. Hautmann R et al (2006) Urology Springer Verlag 48
3. Herold G et al (2020) Internal medicine. Herold Publisher 599
4. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 289 - 293
5. Keller C K et al (2010) Practice of nephrology. Springer publishing house 185
6. Kuhlmann U et al (2015) Nephrology: Pathophysiology - Clinic - Kidney replacement procedure. Thieme 473
7. Mohr L et al (1968) Manual of Internal Medicine. Volume Eight: Kidney Diseases. Springer Publishing House Berlin 944
8. Scheurlen P G et al (1989) Differential diagnosis in internal medicine. Springer Publishing House 506
9. Staubach K H et al (2008) Viererverband kleine operative Fächer: Short textbook on urology, ophthalmology, ENT, orthopaedics. Elsevier Urban and Fischer publishing house 20