Anuria, Types & Management

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

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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