Three groups of reasons
- Prerenal - kidneys are not damaged, but not enough blood is supplied to them: dehydration, blood loss, shock, heart failure, severe vomiting and diarrhea, diuretic overdose
- Renal - the renal tissue itself is damaged: acute tubular necrosis, drug injury, acute glomerulonephritis, interstitial nephritis, poisoning, long-term compartment syndrome, sepsis
- Postrenal (obstructive) - the kidneys are working, but urine cannot come out: stones in both ureters or a stone in a single kidney, tumors, external compression, prostate adenoma with urinary retention, strictures
Постренальная форма — самая благодарная для лечения: устранение препятствия нередко полностью восстанавливает функцию почек. Именно поэтому УЗИ почек при внезапной анурии выполняется в первую очередь — оно быстро отвечает на вопрос, есть ли обструкция.
The most common provocateurs in real life
- Dehydration in the heat, with intestinal infections, in elderly people with insufficient drinking
- Taking non-steroidal anti-inflammatory drugs, especially due to dehydration and blood pressure medications
- Some antibiotics and other potentially nephrotoxic drugs
- Contrast studies in patients with already reduced renal function
- A stone blocking a single or only functioning kidney
- Bilateral ureteral obstruction in pelvic tumors
- Acute urinary retention in prostate adenoma
- Severe infections and sepsis
- Massive physical activity with muscle destruction - rhabdomyolysis
- Dietary supplements and herbal preparations of unknown composition
Symptoms
- A sharp decrease in the amount of urine or its complete absence
- Swelling in the legs, face, fluid accumulation
- Shortness of breath due to fluid accumulation in the lungs
- Nausea, vomiting, lack of appetite
- Weakness, drowsiness, confusion
- Itchy skin
- Increased blood pressure
- Heart rhythm disturbances due to high potassium levels
- With obstruction - pain in the lower back or, conversely, its complete absence with gradual compression
- Sometimes the amount of urine remains normal, but the function decreases - non-oliguric form
Diagnostics: what to do first
- Оценка состояния, давления, объёма выделяемой мочи
- Креатинин, мочевина, калий, натрий, кислотно-щелочное состояние — срочно
- УЗИ почек и мочевого пузыря — ключевой первый шаг: расширение лоханок указывает на обструкцию, переполненный мочевой пузырь — на задержку мочи
- Катетеризация мочевого пузыря при подозрении на задержку мочи
- Общий анализ мочи с микроскопией осадка — помогает отличить преренальную форму от повреждения самой ткани
- КТ без контраста при подозрении на камни
- Оценка всех принимаемых препаратов
- Дополнительные исследования по показаниям: иммунологические анализы, биопсия почки
The logic of the first hours is simple and universal: replenish fluid if there is dehydration; abolish everything nephrotoxic; rule out and immediately remove obstruction. These three steps solve a significant portion of cases.
Treatment
- Eliminating the cause is the basis of treatment
- Fluid replacement in the prerenal form
- Discontinuation of nephrotoxic drugs and dose adjustment of others
- Bladder catheterization or cystostomy for urinary retention
- Ureteral stenting or percutaneous nephrostomy for obstruction - sometimes on both sides
- Treatment of infection and sepsis
- Monitor potassium levels—life-threatening hyperkalemia requires immediate correction
- Correction of acidosis and water balance
- Dialysis for uncontrolled hyperkalemia, severe acidosis, fluid overload and uremia
- Strict recording of fluids drunk and urine excreted
После устранения обструкции нередко начинается фаза обильного мочеотделения: почки выводят большой объём жидкости и электролитов. Это ожидаемо, но требует наблюдения и восполнения потерь, иначе развивается обезвоживание и нарушения электролитного баланса.
After recovery
- Monitoring creatinine and urine analysis for several months - function is not always fully restored
- Elimination of the root cause: stone removal, treatment of prostate adenoma, correction of stricture
- Reviewing medications you take regularly with your doctor
- Blood pressure control
- Drinking enough fluids, especially in hot weather and during physical activity
- Be careful with contrast studies in the future - inform your doctors about the episode.
- Understanding that acute injury increases the risk of later chronic kidney disease
Where to contact in Tashkent
If there is a sharp decrease in the amount of urine, emergency assistance is needed: laboratory, ultrasound, and the ability to immediately drain the kidneys if obstruction is detected.
In Tashkent, such urological care, including ureteral stenting and percutaneous nephrostomy on both sides, is provided at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have kidney stones and notice that your urine has decreased significantly, don’t wait. With obstruction, time directly determines whether kidney function is fully restored. Clinic contacts are below.
