Prerenal oliguria Dx/Rx

Basic, Clinical - Renal/Urine/Electrolytes

Definition : Oliguria that is caused by hypoperfusion of the kidneys

Causes : Most commonly due to hypovolemia (check a CVP); however, must also consider other causes such as cardiogenic shock, sepsis, acute blood loss.

Diagonisis :

  • Urinary sodium should be less than 20 as it is the kidney’s response to low perfusion
  • It may also be prudent to calculate a FENa or fractional excretion or sodium or FEUrea *fractional excretion of urea* (if the pt. has been on diuretics)

(FENa) = (PCr * UNa ) / (PNa x UCr) % FEUrea – (FEUrea) = (SerumCr * UUrea ) / (SerumUrea x UCr) %

The etiology is most likely pre-renal if:

  • The FENa is less than 1%
  • The FEUrea is low i.e. <35

Treatment : The mainstay of treatment is correction of the underlying cause: hypovolemia (fluid resuscitation), hypotension (inotropes or vasopressors), sepsis (antibiotics and vasopressors), acute blood loss (transfusion and/or fluid resuscitation).


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