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Oliguria

Oliguria. Cedric Dupont Eisner, H.S.D., B.A., M.D. An example of Oliguria:.

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Oliguria

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  1. Oliguria Cedric Dupont Eisner, H.S.D., B.A., M.D.

  2. An example of Oliguria:

  3. 74 yo female with hx of severe poorly controlled HTN presents for urgent coronary artery revascularization. One wk prior to admission she suffered acute MI with acute pulm edema requiring tracheal intubation and mech vent. Preop creat 2.2 mg/dL. Cardiac sx is uneventful except for low oup during CPB which persists postop. In the ICU her ABG and lung mechanics permit extubation the morning after sx. However, oliguria persists despite tx with furosemide, ethacrynic acid, and bumetanide. Rising PA pressures and met acidosis necessitates cont veno-venous HD. Her postop course is complicated by ARF, int pulm edema requiring reintubation, rapid a fib, pneumonia, recurrent GI bleed and ileus. One month after surgery she remains in the ICU, undergone Billroth II partial gastrectomy for bleeding peptic ulcer and trach for vent wean. Pt O.M.

  4. OLIGURIABoring STUFF • UOP <0.5 cc/kg/hr (for >2 hrs) • Simpler <400 mL/day • What do these numbers relate to?

  5. Oliguria:The numbers relate… • The vol. required to clear the daily obligatory waste

  6. Oliguria:Why we like to look at Pee • Why important? • Marker of Acute Hypoperfusion • Marker of Nepron damage and/or long term hypoperfusion • Marker of obustruction

  7. Renal Anatomy for dummies

  8. Oliguria:Causes • HYPOPERFUSION (SHOCK) (PRERENAL) • RENAL INJURY • POSTRENAL OBSTRUCTION

  9. Oliguria-Flow Diagram

  10. FENA

  11. Oliguria-PRERENAL • Definition: • “Flow is slow-ACUTELY” • Decreased Cardiac Output-Decreased flow • Volume depletion/loss • Cardiac failure/shock/aortic renal clamping • Distributive Shock (like SIRS, sepsis)

  12. Oliguria-PRERENAL con’t • Physiology: • Hypoperfusion afferents dilate->efferents constrict->INCREASING filtration fraction • What you see on labs: • Na is retained b\c tubules have more time to reabsorb • Low FENA, low UNa

  13. Oliguria-Renal • Definition: • “Damaged Tubules” • Examples: • Long term PRERENAL-ischemia (ATN) • Glomerular Dz • Vascular Dz • Renal Tubular Dz • Interstitial Dz • Nephrotoxic Rx

  14. Oliguria-Renal con’t • Physiology: • Gradients/transporters don’t work • What you see on labs: • Na can’t be retained/conserved • High FENA, High UNa

  15. Table

  16. Oliguria-Post Renal • Definition: • Easiest one to figure out = Obstruction after the kidneys • Examples: • Strictures • Bladder/Catheter obstruction • Bilateral ureteral obstruction

  17. Oliguria:Why we like to look at Pee • Why important? • Marker of Acute Hypoperfusion • PRE RENAL • Marker of Nepron damage and/or long term hypoperfusion • RENAL • Marker of obustruction • POST RENAL

  18. TX of Oliguria • Examine urine and collecting system • Restore intravascular vol. (hemodynamic stability) • Diuretics • Furosemide bolus/infusion • Combo Therapy • Dopamine • Fenoldopam • Butmetamide • Ethacrynic Acid • Hydrodiuril • Metolazone

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