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ANURIA, TYPES &

MANAGEMENT
BY
DR KHALID FAROUK,
FRCS, FCPS-Urol
UROLOGIST & KIDNEY TRANSPLANT SURGEON
ASSTT PROF UROLOGY, FUMC
ANURIA
• SYN: SUPPRESSION OF URINE
• DEFINITION
COMPLETE ABSENCE OF URINE
PRODUCTION FOR 24 HOURS

*THE PATIENT HAS NOT PASSED THE


URINE & THE BLADDER IS ALSO EMPTY
EVEN ON CATHETERISATION
OLIGURIA
• OLIGO=SMALL
• DEFINITION:

URINE OUTPUT IN 24 HOURS IS


LESS THAN 300 ml
KIDNEY PERFUSION

• KIDNEY PERFUSION WITH


OXYGENATED BLOOD IS
FUNDAMENTAL FOR PRODUCTION OF
URINE
AETIOLOGY OF ANURIA

• REDUCED BLOOD FLOW


• HYPOXIA
• SEPSIS
• OBSTRUCTION (URETERIC)
TYPES OF ANURIA

• PRERENAL

• RENAL

• POSTRENAL (OBSTRUCTIVE)
PRERENAL ANURIA
• HYPOVOLUMIA
– DEHYDRATION
• PROLONGED VOMITING
• DIARRHOEA
• BURNS
– BLOOD LOSS
– SEPSIS (GRAM NEGATIVE SEPTICEMIA)
– CARDIOGENIC SHOCK
– SPINAL/EPIDURAL ANAESTHESIA
RENAL ANURIA
• DRUGS
• POISONS
• CONTRAST MEDIA
• ECLAMPSIA
• CRUSH SYNDROME
• INCOMPATIBLE BLOOD TRANSFUSION
• DISSEMINATED INTRAVASCULAR
COAGULATION
OBSTRUCTIVE ANURIA

• CALCULI
– BILATERAL URETERIC CALCULI
– SOLITARY KIDNEY: OBSTRUCTED URETER
• PELVIC MALIGNANCY (CA CERVIX)
• SURGERY
• RETROPERITONEAL FIBROSIS
• BILHARZIASIS
EVALUATION

• HISTORY
• CLINICAL EXAMINATION
• INVESTIGATIONS
THINGS TO DO
• CATHETERISE THE PATIENT
• RESTORE CIRCULATORY VOLUME DEFICIT
IN A DEHYDRATED PATIENT
– IV FLUIDS
– CVP 7-9 cm H2 O
– DOPAMINE, MANNITOL
– FRUSEMIDE 80 mg IV
• CORRECT HYPOXIA
• IV ANTIBIOTICS IF PATIENT IS HAVING
SEPSIS
URGENT INVESTIGATIONS
• URINE RE (IF A VAILABLE)
• XRAY KUB AREA ( WITHOUT
PREPATION)
• ULTRASOUND SCAN URINARY TRACT
• SERUM UREA
• SERUM CREATININE
• SERUM ELECTRTOLYTES
• BLOOD CP
PHASES OF THE ILLNESS

• OLIGURIC PHASE (ONE WEEK +-)

• DIURETIC PHASE

• RECOVERY PHASE
ACUTE TUBULAR NECROSIS
• REPLACE THE FLUID LOST
– INSENSIBLE LOSSES ( 500-800ml)
– OUTPUT
• MAINTAIN SERUM ELECTROLYTES
• PREVENT INFECTION
• NUTRITIONAL SUPPORT
• CONSIDER DIALYSIS
DIALYSIS

• PERITONEAL
• HEMODIALYSIS
INDICATIONS FOR DIALYSIS
• HYPERKALEMIA (K > 7 mmol/L)
• METABOLIC ACIDOSIS
(HCO3 < 12 mmol/L)
• PULMONARY OEDEMA
• PERICARDIAL EFFUSION
• CNS CHANGES
POSTRENAL ANURIA
• URETERS HAVE BEEN LIGATED
• BILATERAL URETERIC CALCULI
• SOLITARY KIDNEY, WITH
OBSTRUCTED URETER
• CARCINOMA OF CERVIX
• CARCINOMA OF PROSTATE
• CARCINOMA OF URINARY BLADDER
THE TREATMENT

• REMOVE THE OBSTRUCTION


• CIRCUMVENT / BYPASS THE
OBSTRUCTION
• DIVERT THE URINE

• DEFINITE SOLUTION
POSSIBLE OPTIONS

• URETERIC STENTING
• PERCUTANEOUS NEPHROSTOMY
• DEFINITE SURGERY
– STONE REMOVAL
– URETERIC REIMPLANTATION
THANK YOU