The causes, symptom of Anuria and how to Cure it
The etymological break down of the work Anuria comes down to, “an” and “uria” where the former means absence and the latter means uria. So Anuria can be taken to mean “no urination”, however in the clinical term, this is not exactly the case. In the medical term, Anuria means excreting equal to or less than 100 mL urine per day. In case of Anuria, the Kidneys do produce urine but to a limited degree. The word Anuria is a result of coinage, which stands for the situation of having urine output of very low caliber. If proper medical assistance in not taken at the right time, it can actually be a reason of death to the Anuria sufferer.
People often confuses the term Oliguria with Anuria. However the two has similarities both in their pronunciations and their characteristics but they are not quite the same thing. Oliguria means excretion of equal or less than 500 mL urine per day. Oliguria is a primary sign of having kidney problems whereas Anuria is more advance stage of having kidney problems.
Cause of Anuria
It is important to find out what exactly is causing you the distress. Doctor do not always give the same treatments for Anuria problem, as the stage may vary. Also every patient is different and they may got the disease from different causes. There are 3 major causes for which a patient may become liable to anuria. These causes are,
- Prerenal Causes
- Renal Causes
- Postrenal causes
Below we would put more light on these 3 causes in details.
In this stage, anuria refers to the inconsistency of the blood vessels which supply the kidneys. The kidneys are not vascularized, more so around the medullary part. The blood supply has to be high, by any chance if the blood supply is low then the other organs suffer due to low blood supply and low oxygen supply. The kidney is an organ of elimination and it cannot be left in low oxygen or low blood supply condition.
Below are a list of prerenal causes of anuria for adults and children:
- Fluid loss related to use of drains
- Pulmonary edema
- Intraoperative fluid loss
2. systemic vascular resistance
- Side effects of drugs
- Antihypertensive drugs
3. Heart Failure
- Cardiac tamponade
- Decreased cardiac output
- Myocardial infarction
- Increased intra-abdominal pressure
- Diabetes insipidus
- Diabetes mellitus
- Compression of the inferior vena cava
- Direct compression of the renal vein
In neonates, additional prerenal causes are the following :
- Congenital heart disease
- Respiratory distress syndrome
- Perinatal asphyxia
- NSAIDs or ACE inhibitors used by the mother
While preneral causes dealt with the kidney blood vessels, the Renal causes deals with the kidney itself. Renal Tubules and Glomerulus these diseases are a reason of having low urine output. Because of these two diseases the parenchyma cannot effectively filter the urine. Because there is a problem with filtering the urine, it invariably results in low urine output.
Below is the list of renal causes of anuria for all age groups :
- Nephrotoxic drugs
- Autoimmune diseases
- Family history of renal diseases
- Endogenous toxins
- Muscle trauma
- Systemic diseases
- Vascular diseases such as vasculitis, renal artery or vein thrombosis, haemolytic uremic syndrome
- Congenital kidney diseases
While prerenal cause dealt with before the kidney, renal cause dealt with the kidney itself, the postrenal cause deals with the problems of “after the kidney”. This means any type of obstacle of urine flow.
Renal causes are just there to detect what exactly pulled the trigger, there is not noted renal diseases that exist. The actual problem lies into the postrenal causes, that is in the obstruction of the urine output. In the postrenal causes, the urine is unable to pass through the structures properly.
Below is the list of postrenal causes of anuria in Adults:
- Lower urinary tract symptoms (LUTS)
- Mass in the neck of the urinary bladder
- Retroperitoneal fibrosis
- Benign prostatic hypertrophy
- Kinks in the catheter (if the patient uses one)
Below are the list of postrenal causes of anuria in children and neonates:
- Bilateral ureteral obstruction
- Posterior urethral valves
- Stenosis of urinary meatus
- Neurogenic bladder
Treatment for Anuria
Excretion of 250-500 mL urine per day is the key to increase the urine output. In order to have a properly functions kidney, the blood pressure has to sustain in a normal rate and the heart rate should also be stabilized. Doctors advise the patients to have about 0.5 mL urine output per hour.
In Cardiopulmonary Resuscitation a central venous catheter is attached. The central venous pressure gets maintained at 8-12 mmHg. The Blood pressure is examined accurately with an arterial line. Inotropes come to help when fluid challenge fails.
The drugs that are being used need to be examined carefully, if they are have any toxic like substances which can be proved harmful for the kidney, immediately the drugs is omitted from usage. To release the obstruction and treat the underlying infection, decreasing the intra abdominal pressure is necessary.
Hyperkalemia is the medical emergency that an aguria patient faces when their potassium level goes down to >6.5 mmol/L. The patient’s ECG resembles T waves. Ventricular arrhythmias is also shown.
Treatment for Anuria in Children
Dehydration occurs in children and neonates more than it does in adults. Dehydration among the children is usually treated with the range of 20 mL/kg fluid bolus of lactated Ringer’s solution. If the fluid range is overloaded then furosemide therapy and fluid restriction is ordered. In postrenal condition, urinary catheterization is performed.