Causes of oliguria, anuria, and ARF

• Common causes of oliguria, anuria, or ARF are best defined in relation to the patient’s age.
• Prerenal ARF caused by dehydration is the most common cause of oliguria/anuria (70% of community-acquired cases of ARF and up to 60% of hospital-acquired cases).
• Renal ARF caused by intrinsic renal damage can be categorized into 3 types.
  • Acute tubular necrosis (ATN) results from prolonged ischemia or drug- or toxin-mediated renal tubular injury (reversible).
  • Glomerular lesions may occur with postinfectious glomerulonephritis.
  • Vascular lesions may occur with hemolytic-uremic syndrome or Henoch-Schönlein purpura.
• Postrenal ARF
  • Mechanical or functional obstruction to urine flow
    • May be in lower urinary tract, eg, posterior urethral valves
    • May be bilaterally in the upper tract, eg, bilateral ureteropelvic junction obstruction (rare)
  • Unilateral obstruction can cause ARF in patients with only 1 functioning kidney.
  • More common in newborns than in older infants

Most common causes of oliguria and anuria in neonates and children

• Neonates
  • Prerenal
    • Perinatal asphyxia
    • Respiratory distress syndrome
    • Hemorrhage
    • Sepsis or shock
    • Congenital heart disease
    • Dehydration
    • Drugs (indomethacin, maternal use of ACE inhibitors or nonsteroidal antiinflammatory drugs)
  • Renal
    • Acute tubular necrosis
    • Exogenous toxins (aminoglycosides, amphotericin B)
    • Endogenous toxins (hemoglobin, myoglobin, uric acid)
    • Congenital kidney diseases
    • Vascular (renal vein thrombosis, renal artery thrombosis)
  • Postrenal
    • Posterior urethral valves
    • Meatal stenosis
    • Bilateral ureteral obstruction
    • Neurogenic bladder
• Children
  • Prerenal
    • Dehydration
    • Hemorrhage
    • Burns
    • Third-space loss (surgery, trauma, nephrotic syndrome)
    • Renal loss (diabetes mellitus, diabetes insipidus, diuretics)
    • Shock
    • Decreased cardiac output
  • Renal
    • Acute tubular necrosis
    • Glomerulonephritis
    • Exogenous toxins (aminoglycosides, amphotericin B)
    • Endogenous toxins (hemoglobin, myoglobin, uric acid)
    • Vascular (hemolytic-uremic syndrome, vasculitis)
  • Postrenal
    • Posterior urethral valves
    • Meatal stenosis
    • Bilateral ureteral obstruction
    • Neurogenic bladder