STUDY - Technical - New Dacian's Medicine
Anuria
(Classical / Allopathic Medicine)
Clinically defined
as urine output of less than 75 ml daily, anuria indicates
either urinary tract obstruction or renal failure due to
various mechanisms. (See Major causes of acute renal failure.)
Fortunately, anuria is rare; even in those with renal failure,
the kidneys usually produce at least 75 ml of urine daily.
Because urine
output is easily measured, anuria rarely goes undetected.
However, without immediate treatment, it can rapidly cause
uremia and other complications of urine retention.
HISTORY:
Ask the patient about changes in his voiding pattern.
Determine the amount of fluid normally ingested each day, the amount of fluid ingested in the past 24 to 48 hours, and the time and amount of the patient's last urination.
Review the patient's medical history, noting especially previous kidney disease, urinary tract obstruction or infection, prostate enlargement, renal calculi, neurogenic bladder, congenital abnormalities, and abdominal, renal, or urinary tract surgery.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about changes in his voiding pattern.
Determine the amount of fluid normally ingested each day, the amount of fluid ingested in the past 24 to 48 hours, and the time and amount of the patient's last urination.
Review the patient's medical history, noting especially previous kidney disease, urinary tract obstruction or infection, prostate enlargement, renal calculi, neurogenic bladder, congenital abnormalities, and abdominal, renal, or urinary tract surgery.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Inspect and palpate the abdomen for asymmetry, distention, or bulging.
Inspect the flank area for edema or erythema, and percuss and palpate the bladder.
Assess a urine sample for cloudiness and foul odor.
Take the patient's vital signs.
Inspect and palpate the abdomen for asymmetry, distention, or bulging.
Inspect the flank area for edema or erythema, and percuss and palpate the bladder.
Assess a urine sample for cloudiness and foul odor.
Major causes of
acute renal failure
Prenatal causes:
Prenatal causes:
- decreased
cardiac output
- hypovolemia
- peripheral
vasodilation
- renovascular
obstruction
Intrarenal causes:
- acute tubular
necrosis
- cortical
necrosis
-
glomerulonephritis
- papillary
necrosis
- renal vascular
occlusion
- vasculitis
Postrenal causes:
- bladder
obstruction
- ureteral
obstruction
- urethral
obstruction
ALERT:
After detecting anuria, determine if urine formation is occurring and:
- catheterize the patient to relieve a lower urinary tract obstruction or to check for residual urine
- obtain kidney function studies
- assess the patient for signs of fluid overload.
After detecting anuria, determine if urine formation is occurring and:
- catheterize the patient to relieve a lower urinary tract obstruction or to check for residual urine
- obtain kidney function studies
- assess the patient for signs of fluid overload.
SPECIAL
CONSIDERATIONS:
Restrict the patient's fluid intake until the cause of anuria is determined. Monitor vital signs, intake and output, and kidney function studies. If anuria is caused by an obstruction, prepare the patient for surgery.
Restrict the patient's fluid intake until the cause of anuria is determined. Monitor vital signs, intake and output, and kidney function studies. If anuria is caused by an obstruction, prepare the patient for surgery.
PEDIATRIC
POINTERS:
Anuria in neonates is defined as the absence of urine output for 24 hours. It can be classified as primary or secondary. Primary anuria results from bilateral renal agenesis, aplasia, or multicystic dysplasia. Secondary anuria, which is associated with edema or dehydration, results from renal ischemia, renal vein thrombosis, or congenital anomalies of the genitourinary tract.
Anuria in children commonly results from loss of renal function.
Anuria in neonates is defined as the absence of urine output for 24 hours. It can be classified as primary or secondary. Primary anuria results from bilateral renal agenesis, aplasia, or multicystic dysplasia. Secondary anuria, which is associated with edema or dehydration, results from renal ischemia, renal vein thrombosis, or congenital anomalies of the genitourinary tract.
Anuria in children commonly results from loss of renal function.
AGING ISSUES:
In elderly patients, anuria is commonly a gradual manifestation of an underlying pathology. A hospitalized or bedridden elderly patient may be unable to generate the pressure necessary to void if he remains in the supine position.
In elderly patients, anuria is commonly a gradual manifestation of an underlying pathology. A hospitalized or bedridden elderly patient may be unable to generate the pressure necessary to void if he remains in the supine position.
PATIENT
COUNSELING:
If the patient requires immediate surgery or dialysis, provide him with support. Instruct the patient on what to expect from diagnostic testing and treatment, and answer questions.
If the patient requires immediate surgery or dialysis, provide him with support. Instruct the patient on what to expect from diagnostic testing and treatment, and answer questions.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)