How I Approach... Anuria and Acute Kidney Injury

Introduction

Reduced or no urine production (oliguria and anuria respectively) is always an acute, life-threatening situation and can be indicative of, or occur during, other disorders. Oliguria is defined as urine production of <0.5 mL/ kg/h or <2 mL/kg/h on infusion therapy; anuria is defined as urine production <0.2 mL/kg/h or unmeasurable. [...]

Key Points

• Pre- and post-renal causes of oliguria/anuria should be identified by means of clinical examination and urine specific gravity.

• Depending on the condition, emergency therapy includes treatment for shock, acid-base neutralization and balancing of electrolyte.

• After rehydration, diuresis may be stimulated by forced infusion or osmotic diuresis; furosemide for hyperkalemia and overhydration is also recommended.

• Vital parameters, including blood pressure, urine production, electrolyte and acid-base status must be closely monitored.

• Peritoneal or hemodialysis should always be considered if 12-24 hours of therapy is unsuccessful.