top of page

Author: 

Editor(s):

Updated:

ULY CLINIC

ULY CLINIC

13 Septemba 2025, 03:42:25

Oliguria

Oliguria
Oliguria
Oliguria


Oliguria is defined as a urine output of less than 400 mL in 24 hours. It is a cardinal sign of renal and urinary tract disorders and often occurs abruptly, sometimes indicating serious, potentially life-threatening hemodynamic instability.




History and Physical Examination


History

  • Usual daily voiding pattern: frequency, amount

  • Onset of urine changes: color, odor, consistency

  • Pain or burning on urination, fever

  • Daily fluid intake, recent changes in caffeine or alcohol consumption

  • Recent episodes of diarrhea or vomiting

  • Associated complaints: fatigue, anorexia, thirst, dyspnea, chest pain, weight changes

  • Past medical history: renal, urinary, cardiovascular disorders, trauma, surgery, blood transfusions

  • Exposure to nephrotoxic agents: heavy metals, solvents, anesthetics, contrast media

  • Medications: prescribed and over-the-counter


Physical Examination

  • Vital signs and weight

  • General appearance: edema or dehydration

  • Kidney assessment: palpation for tenderness/enlargement, CVA percussion

  • Flank inspection for edema/erythema

  • Auscultation: heart, lungs, flank area for bruits

  • Urine analysis: color, odor, sediment; reagent strip testing for glucose, protein, blood; specific gravity measurement


Medical causes

Condition

Features

Associated Findings

Acute tubular necrosis (ATN)

Abrupt (shock) or gradual (nephrotoxic) onset

Hyperkalemia, uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, Kussmaul respirations), edema, dyspnea

Calculi

Obstruction in kidneys, ureters, bladder, or urethra

Renal colic radiating to flank/suprapubic/genitals, urinary frequency/urgency, dysuria, hematuria, nausea, vomiting, hypoactive bowel sounds, abdominal distention, occasional fever/chills

Cholera

Severe water/electrolyte loss

Oliguria, thirst, weakness, muscle cramps, poor skin turgor, tachycardia, hypotension, abrupt watery diarrhea/vomiting

Acute glomerulonephritis

Rapid onset

Oliguria/anuria, mild fever, fatigue, hematuria, proteinuria, generalized edema, hypertension, headache, nausea/vomiting, flank/abdominal pain, pulmonary congestion

Heart failure

Low cardiac output

Dyspnea, fatigue, weakness, peripheral edema, jugular vein distention, tachycardia, crackles, orthopnea, cyanosis, clubbing, gallop, cardiomegaly, hemoptysis

Hypovolemia

Decreased circulating volume

Orthostatic hypotension, lethargy, fatigue, muscle weakness, anorexia, nausea, thirst, dizziness, sunken eyes, poor skin turgor, dry mucous membranes

Acute pyelonephritis

Sudden oliguria

Fever with chills, flank pain, CVA tenderness, nocturia, dysuria, hematuria, urinary frequency/urgency, cloudy urine, anorexia, diarrhea, nausea/vomiting

Chronic renal failure

End-stage kidney disease

Fatigue, weakness, irritability, uremic fetor, ecchymoses/petechiae, peripheral edema, hypertension, confusion, drowsiness, muscle twitching/cramps, neuropathies, anorexia, metallic taste, pruritus, pallor, yellow/bronze skin, seizures, coma, uremic frost

Bilateral renal vein occlusion

Rare

Acute low back/flank pain, CVA tenderness, fever, pallor, hematuria, enlarged kidneys, edema, possible uremia

Toxemia of pregnancy (severe preeclampsia/eclampsia)

Pregnancy-related

Elevated BP, dizziness, diplopia, blurred vision, epigastric pain, nausea/vomiting, irritability, frontal headache, generalized edema, rapid weight gain, seizures in eclampsia

Urethral stricture

Chronic obstruction

Oliguria, urethral discharge, urinary frequency/urgency, dysuria, pyuria, diminished urine stream, urinomas, urosepsis

Other causes

  • Diagnostic studies: radiographic contrast media nephrotoxicity

  • Drugs: decreased renal perfusion (diuretics), nephrotoxicity (aminoglycosides, chemotherapy), urine retention (adrenergics, anticholinergics), crystal-induced obstruction (sulfonamides, acyclovir)


Special considerations

  • Monitor vital signs, intake/output, and daily weight

  • Fluid restriction: usually 0.6–1 L above previous day’s urine output

  • Dietary modifications: low sodium, potassium, protein

  • Laboratory tests: BUN, creatinine, urine sodium/osmolality, urea/creatinine clearance

  • Imaging: X-ray, ultrasonography, CT scan, cystography, renal scan


Patient counseling

  • Educate on fluid and dietary restrictions

  • Discuss signs of worsening renal function


Pediatric pointers

  • Neonates: edema/dehydration; causes include congenital heart disease, respiratory distress syndrome, sepsis, hydronephrosis, ATN, renal vein thrombosis

  • Children 1–5 years: acute poststreptococcal glomerulonephritis, hemolytic-uremic syndrome

  • After 5 years: similar causes as adults


Geriatric pointers

  • May result from gradual progression of underlying disorder

  • Contributing factors: poor muscle tone, inactivity, inadequate fluid intake, infrequent voiding


References

  1. Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. USA: American Academy of Pediatrics; 2012.

  2. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008. p. 444–447.

  3. Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.

  4. Lehne RA. Pharmacology for Nursing Care. 7th ed. St. Louis, MO: Saunders Elsevier; 2010.

bottom of page