oliguria
Introduction
Introduction The normal healthy person has a urine output of about 1500~2 000ml for 24 hours; 24 hours of urine is less than 400ml, or less than 17ml per hour is called oliguria, and less than 50ml is called anuria. Seen in heart, kidney disease and shock patients. Pathological urine output can be seen in severe diarrhea and severe vomiting, when children are dehydrated; and more common causes are kidney diseases, such as urethral stricture obstruction, acute nephritis, acute exacerbation of chronic nephritis, various kidneys caused by chronic kidney disease In the period of functional failure and acute renal failure, if there is no urine, the kidney function is seriously impaired. Therefore, when it is found that the amount of urine is reduced and the cause cannot be found, it is necessary to go to the hospital in time to avoid delaying the condition.
Cause
Cause
First, the cause classification
1. Prerenal oliguria: Insufficient renal perfusion due to various reasons, the glomerular filtration rate is drastically reduced, said prerenal oliguria, no urine.
(1) Insufficient blood volume: starting with functional oliguria and no urine, once the blood volume is replenished, the urine volume is immediately restored; if it is not diagnosed and treated in time, it can cause organic kidney damage. Acute renal failure, showing oliguria, no urine, seen in severe dehydration, major bleeding, large area burns.
(2) shock: shock for various reasons reduces renal perfusion pressure, glomerular filtration rate is seriously insufficient, seen in anaphylactic shock hemorrhagic shock, cardiogenic shock, toxic shock and so on.
(3) Reduction of cardiac output: At this time, the blood supply to the kidney decreased significantly, which was seen in left heart failure, severe arrhythmia, pericardial tamponade and constrictive pericarditis.
(4) Hepatorenal syndrome: advanced cirrhosis, severe ascites, severe hypoperfusion of the kidney, oliguria, no urine, once the cirrhosis of the ascites is relieved, the kidneys can recover, and the amount of urine increases. In liver and kidney syndrome, the pathological examination of the kidney is normal.
2. Renal oliguria without anuria
(1) substantial renal damage: whether it is primary glomerulonephritis or secondary to systemic lupus erythematosus, nodular polyarteritis or infective endocarditis, dermatomyositis, etc., can cause renal parenchymal damage Even kidney function damage or failure causes oliguria and anuria. Chronic renal failure in the late kidney atrophy, glomerular filtration rate decreased, urine output can be significantly reduced or even no urine; acute renal failure oliguria anuria, showing oliguria and no urine.
(2) renal interstitial disorders: the most common drug allergies such as penicillin, sulfa drugs, rifampicin, aminoglycoside antibiotics and other causes of renal interstitial damage. Also seen in advanced renal dysfunction in chronic pyelonephritis. Acute pyelonephritis is seen in renal papillary necrosis. Heavy metal salt poisoning is found in mercury, lead, arsenic, gold and other poisoning.
(3) renal vascular disease: renal cortical vasospasm or embolism, renal blood supply reduced oliguria and urine, seen in disseminated intravascular coagulation (DIC) pregnancy-induced hypertension syndrome, large area burns.
3. Post-renal oliguria and anuria: common in urinary tract obstruction such as stones, tumors, enlarged prostate or prostate cancer, diabetic neurogenic bladder.
Second, the mechanism
For some reasons, the renal blood flow is drastically reduced. The severe renal perfusion or the kidney itself affects the glomerular filtration function and the lower urinary tract obstruction. Clinically, the three links often have a causal relationship with each other. For example, in the early stage of insufficient blood volume, only renal hypoperfusion is insufficient. If it cannot be diagnosed and treated in time, it can cause renal parenchymal damage. Even if the blood volume is supplemented, the urine volume will not be restored immediately. . Lower urinary tract obstruction, early renal filtration function is normal, if not relieved obstruction, massive hydronephrosis, compression of renal parenchyma caused by cortical atrophy, severely affect glomerular filtration, at this time or to relieve urinary tract obstruction Do not increase the amount of urine immediately. If the kidney is not treated in time, the edema will gradually increase, affecting the function of the gastrointestinal tract and reducing the blood volume. At this time, the renal function damage is accelerated, and the urine volume is further reduced.
Examine
an examination
Related inspection
Cortisone water test B factor dysentery bacillus detection gonorrhea bacteriological detection of amyloid in prostatic fluid
Physical examination: pay attention to dehydration, blood pressure and peripheral circulation perfusion, bleeding point, purple epilepsy, rash and so on. Lower urinary tract obstruction focuses on the prostate, bladder volume and palpation of the kidney.
Laboratory examination: urine volume should be recorded on a daily basis, and the relative density of urine in urine should be checked repeatedly, which is helpful for diagnosing substantial renal damage and renal failure and judging dehydration. Blood routine hematocrit is powerful in judging blood volume. If necessary, subclavicular puncture and central venous pressure are more reliable in determining blood volume. Blood biochemical examination focuses on renal function, acid-base balance, electrolyte examination, and suspected disseminated intravascular coagulation should be routinely examined by DIC.
Device examination B-ultrasound, CT, MRI examination to help determine stone tumor, prostatic hypertrophy, hydronephrosis and tuberculosis and so on.
Diagnosis
Differential diagnosis
It should be differentiated from more urine and no urine.
History: Focus on water loss, blood loss, history of drug allergy poisoning, history of shock, history of kidney disease, history of urinary dysfunction, history of diabetes, etc. Pay attention to the amount of urine.
1 oliguria with renal colic is seen in renal artery thrombosis or embolism, kidney stones.
2 oliguria with palpitations and shortness of breath, chest tightness can not be seen in the heart and insufficiency.
3 oliguria with large amounts of proteinuria, edema, hyperlipidemia and hypoproteinemia found in nephrotic syndrome.
4 oliguria with fatigue, anorexia, ascites and skin yellow staining found in liver and kidney syndrome.
5 oliguria with hematuria, proteinuria, hypertension and edema found in acute nephritis, acute nephritis.
6 oliguria with fever, low back pain, urinary frequency, urgency, urinary pain, seen in acute pyelonephritis.
7 oliguria with dysuria is seen in the prostate hypertrophy.
