Treatment Approach
- Major goal of treatment of prerenal oliguria/anuria is to restore intravascular volume.
- Oliguria/anuria due to intrinsic renal conditions needs to be managed by a pediatric nephrologist.
- Urology needs to be consulted in patients with postrenal obstructive lesions.
Specific Treatments
- A dehydrated child with oliguria/anuria should receive a fluid bolus of normal saline or lactated Ringer’s solution at 20 mL/kg to restore fluid volume.
- Depending on response, another bolus may be needed.
- Estimation of volume status is needed to begin and continue fluid therapy.
- Amount is assessed by history and physical exam that includes assessment of:
- Body weight
- Anterior fontanelle in infants
- Heart rate
- Mucous membranes
- Skin turgor
- Capillary refill
- Peripheral edema
- Blood pressure
- Children with oliguria and volume overload may:
- Benefit from furosemide
- Require fluid restriction
- Need blood pressure and acid-base monitoring
- Children with oliguria due to obstruction may require urinary catheterization.
- Relief of obstruction may be followed by postobstructive diuresis and may need fluid/electrolyte replacement.
When to Admit
When to Refer
- Refer to a nephrologist or admit (or both) if child has any of the following:
- Persistent oliguria or anuria despite adequate fluid challenge in a dehydrated child
- Persistent oliguria or anuria that continues after removal of the offending nephrotoxins
- Oliguria or anuria associated with:
- Swelling
- Hypertension
- Gross hematuria
- Abnormal blood chemistry
- Severe systemic signs or symptoms
- Urology referral for oliguria or anuria caused by obstructive uropathy
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