Nonoliguric versus oliguric acute kidney injury
- Orfeas Liangos, MD, FASN
Orfeas Liangos, MD, FASN
- Adjunct Assistant Professor of Medicine
- Tufts University School of Medicine
- Bertrand L Jaber, MD, MS, FASN
Bertrand L Jaber, MD, MS, FASN
- Professor of Medicine
- Tufts University School of Medicine
The glomerular filtration rate (GFR) may fall to very low levels in patients with acute intrinsic kidney injury (AKI). However, a low GFR is not necessarily associated with a parallel reduction in urine output, which can vary from oliguria (<400 to 500 mL/day) to normal values (eg, 1 to 2 L/day) [1,2].
Although oliguria is common in patients with AKI, anuria (urine output <50 to 100 mL/day) is rare. Anuria is most often seen in two conditions: shock and complete bilateral urinary tract obstruction. Other, less common causes are the hemolytic-uremic syndrome, renal cortical necrosis, bilateral renal arterial obstruction, and rapidly progressive (crescentic) glomerulonephritis, particularly antiglomerular basement membrane (GBM) antibody disease.
DETERMINANTS OF URINE OUTPUT
The difference in urine output between oliguric and nonoliguric AKI may be due to one of two factors: Nonoliguric patients may have a higher glomerular filtration rate (GFR) than those with oliguria, and/or they may reabsorb less in the tubules. If, for example, the GFR falls to 7 L/day (equal to 5 mL/min), the urine output will be relatively normal at 1 to 2 L/day if only 5 to 6 L are reabsorbed.
Declines in urine output may not only be a result of AKI, but also predict its development. This was suggested in a retrospective analysis of 390 critically ill patients with septic shock . Oliguria, defined as urine output <0.5 mL/kg per hour and observed within the first 12 hours following recognition of septic shock, was positively associated with the development of AKI (defined by a serum creatinine increment according to the Kidney Disease: Improving Global Outcomes [KDIGO] stage II criteria), need for renal replacement therapy (RRT), and 28-day mortality (odds ratio [OR] 1.19, 95% CI 1.10-1.28). In this study, more than five hours of consecutive oliguria predicted subsequent AKI KDIGO stage II or greater with an accuracy of 82 percent .
Studies in animal models have shown that there is less morphologic and functional damage in nonoliguric compared with oliguric AKI . There is also evidence in humans suggesting that the absence of oliguria in AKI generally reflects less severe disease [1,5-7]. The following observations from different studies are illustrative:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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