Etiology varies with age, and the common causes in neonates and children are listed separately.

Subjects with acute renal failure secondary to nephrotoxins, interstitial nephritis, and perinatal asphyxia frequently do not have oliguria.

Principal causes of oliguric acute renal failure in neonates

Prerenal causes include the following: Perinatal asphyxia Respiratory distress syndrome Hemorrhage (eg, maternal antepartum, twin-twin transfusion, intraventricular) Hemolysis Polycythemia Sepsis or shock Congenital heart disease Dehydration Drugs (eg, indomethacin, maternal NSAIDs, maternal ACE inhibitors) Intrinsic renal causes include the following: Acute tubular necrosis Exogenous toxins (eg, aminoglycosides, amphotericin B, contrast agents) Endogenous toxins (eg, hemoglobin, myoglobin, uric acid) Congenital kidney disease (eg, agenesis, polycystic kidney, hypoplasia, dysplasia) Vascular (eg, renal vein thrombosis, renal artery thrombosis) Transient renal dysfunction of the newborn Postrenal causes include the following: Bladder outlet obstruction (eg, posterior urethral valves, meatal stenosis) Neurogenic bladder Ureteral obstruction, bilateral Principal causes of oliguric acute renal failure in children Prerenal causes include the following: GI losses (eg, vomiting, diarrhea) Blood losses (eg, hemorrhage) Renal losses (eg, diabetes insipidus, diabetes mellitus, diuretics, salt-wasting nephropathy) Cutaneous losses (eg, burns) Third space losses (eg, surgery, trauma, nephrotic syndrome, capillary leak) Shock (eg, septic, toxic, anaphylactic) Impaired autoregulation (eg, cyclosporine, tacrolimus, ACE inhibitors, NSAIDs) Impaired cardiac output (eg, congenital and acquired heart disease) Intrinsic renal causes include the following: Acute tubular necrosis (eg, prolonged prerenal failure) Glomerulonephritis Interstitial nephritis, vascular (eg, hemolytic-uremic syndrome, vasculitis) Exogenous toxins (eg, aminoglycosides, amphotericin B, cyclosporine, chemotherapy, heavy metals, contrast agents) Endogenous toxins (eg, hemoglobin, myoglobin, uric acid) Transplant rejection Postrenal causes include the following:

Bladder outlet obstruction (eg, posterior urethral valves, blocked catheter, urethral trauma) Neurogenic bladder

Ureteral obstruction, bilateral

Urine output - decreased

Decreased urine output is defined as producing less than 500 milliliters of urine in 24 hours. Considerations Although a significant decrease in urine output may indicate a serious, even life-threatening condition, adequate urine output can be restored with prompt medical treatment. Causes

Dehydration due to vomiting, diarrhea, or fever, with a lack of adequate fluid intake Total urinary tract obstruction, such as from an enlarged prostate Severe infection or any other medical condition leading to shock Use of certain medications such as anticholinergics, methotrexate, and diuretics

Home Care Follow prescribed fluid regimens and measure urine output as directed. When to Contact a Medical Professional Contact your health care provider if you have:

A noticeable and consistent decrease in urine output Vomiting , diarrhea, or high fever and are unable to replace fluids by mouth A decrease in urine output associated with dizziness, lightheadedness, or rapid pulse

What to Expect at Your Office Visit The health care provider will perform a physical exam and ask questions about your medical history and symptoms, including:

Time pattern o When did this begin? o Did it occur suddenly? o Has it rapidly become worse? Quality o How much do you drink each day? o Does drinking more increase your urine output? o How much urine do you produce each day? o What color is the urine? Aggravating factors

o o o o o

Has there been fever? Has there been diarrhea? Has there been vomiting? With or without nausea? Is thirst decreased? What other symptoms do you have? What medications do you take? Do you have any allergies? Do you have access to adequate fluids?

Other
o o o

Medical history o Have you had any recent injuries such as burns? o Have you been sick? o Do you have a history of a problem with your kidneys or bladder?

Tests that may be done include:

Blood studies to monitor electrolytes and kidney function CT (cat) scan of the abdomen Intravenous pyelogram (IVP) Renal scan Abdominal ultrasound Urine tests, including tests for infection

Alternative Names Oliguria References Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3. Molitoris BA. Acute kidney injury. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 121.