Causes of Anuria
List of causes of Anuria
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Anuria)
that could possibly cause Anuria includes:
More causes:
see full list of causes for Lack of urine
Causes of Anuria (Diseases Database):
The follow list shows some of the possible medical causes of Anuria
that are listed by the Diseases Database:
Source: Diseases Database
Anuria Causes: Book Excerpts
Anuria as a complication of other conditions:
Other conditions that might have
Anuria as a complication may,
potentially, be an underlying cause of Anuria.
Our database lists the following as having
Anuria as a complication of that condition:
Anuria as a symptom:
Conditions listing Anuria
as a symptom may also be potential underlying causes of Anuria.
Our database lists the following as having
Anuria as a symptom of that condition:
Medications or substances causing Anuria:
The following drugs, medications, substances or toxins are some of the possible
causes of Anuria as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
Read more about medication causes of Anuria
Related information on causes of Anuria:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Anuria may be found in:
Causes of Anuria: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Anuria.
Bladder distention:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Benign prostatic hyperplasia (BPH). With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
❑ Bladder calculi. Bladder calculi may produce bladder distention, but more commonly produce pain as the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
❑ Bladder cancer. By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
CULTURAL CLUE: Bladder cancer is twice as common in Whites as in Blacks. It's relatively uncommon among Asians, Hispanics, and Native Americans.
❑ Multiple sclerosis. With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from the interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte's sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski's sign, and ataxia.
❑ Prostate cancer. Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
CULTURAL CLUE: Prostate cancer is more common in blacks than in other ethnic groups.
❑ Prostatitis. With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; a tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare. However, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and a dull pain radiating to the lower back, buttocks, penis, or perineum.
❑ Spinal neoplasms. Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
❑ Urethral calculi. With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
❑ Urethral stricture. Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
❑ Catheterization. Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
❑ Drugs. Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Anuria:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Acute tubular necrosis. Oliguria (occasionally anuria) is a common finding with acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
❑ Cortical necrosis (bilateral). Cortical necrosis is characterized by a sudden change from oliguria to anuria, along with gross hematuria, flank pain, and fever.
❑ Glomerulonephritis (acute). Acute glomerulonephritis produces anuria or oliguria. Related effects include a mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
❑ Hemolytic-uremic syndrome. Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He may also show signs of upper respiratory tract infection.
❑ Renal artery occlusion (bilateral). Renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; a fever up to 102° F (38.9° C); and diastolic hypertension.
❑ Renal vein occlusion (bilateral). Renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli — a common complication — produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub and, possibly, hemoptysis.
❑ Urinary tract obstruction. Severe urinary tract obstruction can produce acute and sometimes total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or an altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
❑ Vasculitis. Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmia, pallor and, possibly, skin lesions, urticaria, and purpura.
Other causes
❑ Diagnostic tests. Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
❑ Drugs. Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Oliguria:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acute tubular necrosis (ATN)
An early sign of ATN, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias), uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Calculi
Oliguria or anuria may result from calculi lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic — excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, a fever and chills.
Cholera
In cholera, which is a bacterial infection, severe water and electrolyte loss lead to oliguria, thirst, weakness, muscle cramps, decreased skin turgor, tachycardia, hypotension, and abrupt watery diarrhea and vomiting. Death may occur in hours without treatment.
Glomerulonephritis (acute)
Acute glomerulonephritis produces oliguria or anuria. Other features are a mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, a headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and a productive cough).
Heart failure
Oliguria may occur in left-sided heart failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, jugular vein distention, tachycardia, tachypnea, crackles, and a dry or productive cough. In advanced or chronic heart failure, the patient may also develop orthopnea, cyanosis, clubbing, a ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia
Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute)
Accompanying the sudden onset of oliguria in acute pyelonephritis are a high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient also experiences anorexia, diarrhea, and nausea and vomiting.
Renal failure (chronic)
Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, a metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral)
Bilateral renal vein occlusion occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, a fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Toxemia of pregnancy
In severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and a severe frontal headache. Typically, oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester, or more than 1 lb (0.45 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture
Urethral stricture produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and a diminished urine stream. As the obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies
Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs
Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bladder distention:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia (BPH)
In BPH, bladder distention develops gradually as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but pain is usually the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It’s usually most severe when micturition ceases. The pain may be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Cultural Cue: Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
In this neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. In some patients, urine retention and bladder distention are the only signs.
Cultural Cue: Prostate cancer is more common in Blacks than in other ethnic groups.
Prostatitis
In acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and a sensation of suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Bladder distention is rare in chronic prostatitis, which may be accompanied by perineal discomfort, a sensation of suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that often mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
In urethral calculi, urethral obstruction leads to interrupted urine flow and bladder distention. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation due to catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute tubular necrosis
Oliguria (occasionally anuria) is a common finding in acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Cortical necrosis (bilateral)
Cortical necrosis is characterized by a sudden change from oliguria to anuria along with gross hematuria, flank pain, and fever.
Glomerulonephritis (acute)
Glomerulonephritis produces anuria or oliguria. Related effects include mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome
Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He may also show signs of upper respiratory tract infection.
Papillary necrosis (acute)
Bilateral papillary necrosis produces anuria or oliguria as well as flank pain, costovertebral angle tenderness, renal colic, abdominal pain and rigidity, fever, vomiting, decreased bowel sounds, hematuria, and pyuria.
Renal artery occlusion (bilateral)
Renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral)
Renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli—a common complication—produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub, and possibly hemoptysis.
Urinary tract obstruction
Severe obstruction can produce acute and sometimes total anuria alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Vasculitis
Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmias, pallor, and possibly skin lesions, urticaria, and purpura.
Other causes
Diagnostic tests
Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs
Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Oliguria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute tubular necrosis (ATN)
An early sign of ATN, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias); uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul’s respirations); and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Benign prostatic hyperplasia
This disorder, which is common in men older than age 50, in rare cases may cause oliguria resulting from bladder outlet obstruction. More common symptoms include urinary frequency or hesitancy, urge or overflow incontinence, decrease in the force of the urine stream or inability to stop the stream, nocturia and, possibly, hematuria.
Bladder neoplasm
Uncommonly, this disorder may produce oliguria if the tumor obstructs the bladder outlet. The cardinal signs of such obstruction include urinary frequency and urgency, as well as gross hematuria, which may lead to clot retention and flank pain.
Calculi
Oliguria or anuria may result from stones lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic—excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, fever and chills.
Cholera
In this bacterial infection, severe water and electrolyte loss lead to oliguria, thirst, weakness, muscle cramps, decreased skin turgor, tachycardia, hypotension, and abrupt watery diarrhea and vomiting. Death may occur in hours without treatment.
Cirrhosis
In severe cirrhosis, hepatorenal syndrome may develop with oliguria, in addition to ascites, edema, fatigue, weakness, jaundice, hypotension, tachycardia, gynecomastia, testicular atrophy, and signs of GI bleeding such as hematemesis.
Glomerulonephritis (acute)
This disorder produces oliguria or anuria. Other features are mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and productive cough).
Heart failure
Oliguria may occur in left ventricular failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, distended jugular veins, tachycardia, tachypnea, crackles, and a dry or productive cough. In advanced heart failure, the patient may also develop orthopnea, cyanosis, clubbing, ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia
Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute)
Accompanying the sudden onset of oliguria in this disorder are high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient also experiences anorexia, nausea, diarrhea, and vomiting.
Renal artery occlusion (bilateral)
This disorder may produce oliguria or, more commonly, anuria. Other features include severe, constant upper abdominal and flank pain, nausea and vomiting, and hypoactive bowel sounds. The patient also develops a fever 1 to 2 days after the occlusion, as well as diastolic hypertension.
Renal failure (chronic)
Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral)
This disorder occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Retroperitoneal fibrosis
Oliguria may result from bilateral ureteral obstruction by dense fibrous tissue. Other effects include hematuria, diffuse low back pain, anorexia, weight loss, nausea and vomiting, fatigue, malaise, low-grade fever, and elevated blood pressure.
Sepsis
Any condition that results in sepsis may produce oliguria, along with fever, chills, restlessness, confusion, diaphoresis, anorexia, vomiting, diarrhea, pallor, hypotension, and tachycardia. The patient may exhibit signs of local infection, such as dysuria and wound drainage. In severe infection, he may develop lactic acidosis marked by Kussmaul’s respirations.
Toxemia of pregnancy
In severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and severe frontal headache. Typically, the oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester, or more than 1 lb (0.5 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture
This disorder produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and diminished urine stream. As obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies
Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs
Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anuria/Oliguria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Acute tubular necrosis
❑ Prerenal azotemia
❑ Tubular toxins
❑ Bladder outlet obstruction
❑ Bilateral renal artery occlusion
❑ Nephrosclerosis
❑ Acute glomerulonephritis
❑ Interstitial nephritis
❑ Renal artery thrombosis
❑ Renal vein thrombosis
❑ Ureteral calculus with a solitary kidney
❑ Pelvic tumor
❑ Retroperitoneal fibrosis
❑ Infiltrative renal disease
❑ Vasculitis
❑ Rhabdomyolysis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Bladder distention:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
See Bladder distention: Causes and associated findings, pages 46 and 47.
Benign prostatic hyperplasia (BPH)
With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but more commonly it produces pain as its only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis (MS)
With MS, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, a boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare. However, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that usually mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Anuria:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Acute tubular necrosis (ATN)
Oliguria (occasionally anuria) is a common initial finding with ATN. Associated symptoms may reflect the underlying cause, such as hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, convulsions, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Cortical necrosis (bilateral)
Bilateral cortical necrosis is characterized by a sudden change from oliguria to anuria, along with gross hematuria, flank pain, and fever.
Glomerulonephritis (acute)
Acute glomerulonephritis produces anuria or oliguria. Related effects include mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome
Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymosis, edema, hematuria, and pallor. He may also show signs of an upper respiratory tract infection.
Papillary necrosis (acute)
Bilateral papillary necrosis produces anuria or oliguria. It also produces flank pain, costovertebral angle tenderness, renal colic, abdominal pain and rigidity, fever, vomiting, decreased bowel sounds, hematuria, and pyuria.
Renal artery occlusion (bilateral)
Bilateral renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral)
Bilateral renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli — a common complication — produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub, and possibly hemoptysis.
Urinary tract obstruction
Severe obstruction can produce acute, and sometimes, total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Vasculitis
Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmias, pallor, and possibly skin lesions, urticaria, and purpura.
Other causes
Diagnostic tests
Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs
Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially aminoglycosides, are the most typically seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bladder distention:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
With benign prostatic hyperplasia (BPH), bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
CULTURAL CUE:Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Anuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute tubular necrosis
Oliguria (occasionally anuria) is a common finding in acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Glomerulonephritis (acute)
Acute glomerulonephritis produces anuria or oliguria. Related effects include mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome
Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He may also show signs of upper respiratory tract infection.
Renal artery occlusion (bilateral)
Bilateral renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral)
Bilateral renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli — a common complication — produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub and, possibly, hemoptysis.
Urinary tract obstruction
Severe urinary tract obstruction can produce acute and sometimes total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Other causes
Diagnostic tests
Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs
Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Oliguria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute tubular necrosis
An early sign of acute tubular necrosis, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias), uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Calculi
Oliguria or anuria may result from calculi lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic — excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, fever and chills.
Glomerulonephritis (acute)
Acute glomerulonephritis produces oliguria or anuria. Other features are mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and productive cough).
Heart failure
Oliguria may occur in left-sided heart failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, distended jugular veins, tachycardia, tachypnea, crackles, and a dry or productive cough. In advanced heart failure, the patient may also develop orthopnea, cyanosis, clubbing, ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia
Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings in hypovolemia include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute)
Accompanying the sudden onset of oliguria in acute pyelonephritis are high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient with acute pyelonephritis also experiences anorexia, nausea, diarrhea, and vomiting.
Renal artery occlusion (bilateral)
Renal artery occlusion may produce oliguria or, more commonly, anuria. Other features include severe, constant upper abdominal and flank pain, nausea and vomiting, and hypoactive bowel sounds. The patient also develops a fever 1 to 2 days after the occlusion, as well as diastolic hypertension.
Renal failure (chronic)
Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral)
Renal vein occlusion occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Sepsis
Any condition that results in sepsis may produce oliguria, along with fever, chills, restlessness, confusion, diaphoresis, anorexia, vomiting, diarrhea, pallor, hypotension, and tachycardia. The patient may exhibit signs of local infection, such as dysuria and wound drainage. In severe infection, he may develop lactic acidosis marked by Kussmaul’s respirations.
Toxemia of pregnancy
In severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and severe frontal headache. Typically, the oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester or more than 1 lb (0.5 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture
Urethral stricture produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and diminished urine stream. As obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies
Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs
Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bladder distention:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi.Bladder calculi may produce bladder distention, but more commonly pain is the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer.By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis.With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from the interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte's sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski's sign, and ataxia.
Prostate cancer.Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis.With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; a tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare; however, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and a dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms.Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi.With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture.Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization.Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs.Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Anuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute tubular necrosis.Oliguria (occasionally anuria) is a common finding with acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul's respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Cortical necrosis (bilateral).Cortical necrosisis characterized by a sudden change from oliguria to anuria, along with gross hematuria, flank pain, and fever.
Glomerulonephritis (acute).Acute glomerulonephritisproduces anuria or oliguria. Related effects include a mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome.Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He also may show signs of upper respiratory tract infection.
Renal artery occlusion (bilateral).Renal artery occlusionproduces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; a fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral).Renal vein occlusionoccasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli—a common complication—produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub and, possibly, hemoptysis.
Urinary tract obstruction.Severe urinary tract obstruction can produce acute and sometimes total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or an altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Vasculitis.Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmia, pallor and, possibly, skin lesions, urticaria, and purpura.
Other causes
Diagnostic tests.Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs.Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Oliguria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute tubular necrosis (ATN).An early sign of ATN, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias), uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul's respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Calculi.Oliguria or anuria may result from calculi lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic—excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, fever and chills.
Cholera. With cholera, severe water and electrolyte loss lead to oliguria, thirst, weakness, muscle cramps, decreased skin turgor, tachycardia, hypotension, and abrupt watery diarrhea and vomiting. Death may occur in hours without treatment.
Glomerulonephritis (acute).Acute glomerulonephritis produces oliguria or anuria. Other features are a mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and a productive cough).
Heart failure.Oliguria may occur with left-sided heart failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, jugular vein distention, tachycardia, tachypnea, crackles, and a dry or productive cough. With advanced or chronic heart failure, the patient may also develop orthopnea, cyanosis, clubbing, a ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia. Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute).Accompanying the sudden onset of oliguria with acute pyelonephritis are a high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient also experiences anorexia, diarrhea, and nausea and vomiting.
Renal failure (chronic).Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, a metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral).Bilateral renal vein occlusion occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Toxemia of pregnancy.With severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and a severe frontal headache. Typically, oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester, or more than 1 lb (0.45 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture.Urethral stricture produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and a diminished urine stream. As the obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies.Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs.Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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