Tuesday, February 7, 2023

Oliguria

Background

Oliguria is defined as a urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children, and less than 400 mL daily in adults. It is one of the clinical hallmarks of renal failure and has been used as a criterion for diagnosing and staging acute kidney injury (AKI), previously referred to as acute renal failure. At onset, oliguria is frequently acute. It is often the earliest sign of impaired renal function and poses a diagnostic and management challenge to the clinician. (See Presentation and Workup.)

A standardized definition of AKI has recently been proposed by the Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group, which identifies and stages AKI based on changes in serum creatinine from baseline or a decrease in urine output (oliguria) as shown below.

KDIGO Staging of AKI (Open Table in a new window)

Stage Serum creatinine Urine output
1

Increase by 1.5-1.9 times baseline within 7 days

OR

Increase by 0.3 mg/dL (26.5 µmol/L) or more within 48 hours

Less than 0.5 mL/kg/h for 6-12 hours
2 Increase by 2-2.9 times baseline Less than 0.5 mL/kg/h for 12 hours or longer
3

Increase by 3 times baseline or greater

OR

Increase to 4 mg/dL (353.6 µmol/L) or greater

OR

Renal replacement therapy initiation

OR

In patients younger than 18 years, decrease in estimated GFR to less than 35 mL/min/1.73m2

Less than 0.3 mL/kg/h for 24 hours or longer

OR

Anuria for 12 hours or longer

 

Not all cases of acute kidney injury are characterized by oliguria. Renal failure that results from nephrotoxic injury, interstitial nephritis, or neonatal asphyxia is frequently of the nonoliguric type, is related to a less severe renal injury, and has a better prognosis. In addition, the degree of oliguria depends on hydration and the concomitant use of diuretics.

In most clinical situations, acute oliguria is reversible and does not result in intrinsic renal failure. However, identification and timely treatment of reversible causes is crucial because the therapeutic window may be small. (See Prognosis, Presentation, Workup, Treatment, and Medication.)

Patient education

For patient education information, see the Diabetes Center, as well as Acute Kidney Failure and Chronic Kidney Disease.

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