Anuria( absence of urine) - Causes, symptoms and treatment. MF.

Anuria is a clinical symptom that is manifested by the complete absence of urine in the bladder and, as a consequence, by the cessation of discharge from the urethra.

Causes of anuria

Since anuria is a complete absence of urine in the bladder, it is logical that the problem lies above this organ, namely, in the ureters or kidneys. As a classic example in the medical literature, the cause of anuria is called blockade of the ureter by urinary calculus( "stone").But if you understand, in order to completely stop the outflow of urine into the bladder, it is necessary that both ureters be blocked simultaneously. It is necessary to agree that such a clinical situation in practical medicine is quite rare, therefore it must be considered with maximum criticism.

Much more often anuria is observed in other diseases. For example, with cancer of neighboring organs, when a tumor, reaching a large size, can symmetrically squeeze the ureters, blocking the outflow of urine from the kidneys into the bladder.

In addition, anuria is often observed in patients with cardiovascular insufficiency. As you know, if the level of pressure in the renal artery does not exceed 80 mm of mercury, the kidneys simply stop filtering the urine.

In addition, severe poisoning with alcohol or metals can also contribute to a violation of filtration and, as a result, lead to the development of anuria. Of course, do not forget about kidney diseases, such as chronic pyelonephritis or glomerulonephritis, which lead to a gradual thinning of the renal parenchyma and a violation of urine filtration. Despite the fact that today they are no longer of great importance in the development of anuria, but sometimes such clinical examples come across.

Anuria can also develop because of a blood transfusion, which differs from the recipient's blood in a group or in rhesus. Often, such cases were observed in wartime, when there was not enough time for a thorough check of the blood group and the biological fluid was poured, based on the history data.

Diseases leading to anuria

The first frequency of disease in which a similar clinical symptom is observed is cardiovascular failure. You can recognize pathology by the characteristic appearance of a sick person with blue fingers, ear lobes, lips and nose. In addition, such patients complain of shortness of breath, dry cough, accompanied by the allocation of a small amount of sputum and pain in the heart. Quite often these patients have hypertensive crises, but at the time of anuria there is just another condition - pronounced hypotension. If, on the background of these complaints, urine withdrawal is noted, then such a patient needs immediate consultation of the urologist and the therapist.

As already mentioned, anuria can occur with large tumors that compress the lumen of the ureters. In this case, patients should be concerned about complaints of persistent aching pain in the lower back, as urinary retention develops not spontaneously, but gradually. Together with this, weight loss can be noted, which is one of the non-specific signs of a cancerous tumor.

Despite the fact that bilateral ureter blockade does not develop very often, urolithiasis also needs to be considered as one of the diseases in which uremia can be observed. In this case, patients have a typical picture of renal colic when they complain of sharp pain in the lower back, which is accompanied by a lack of excretion of urine.

If we are talking about pyelonephritis as a reason for the development of anuria, then it must be remembered that such a clinical condition develops only in chronic forms of the disease. Such patients complain of periodic pain in the kidney area, which are accompanied by common symptoms and fever. But with glomerulonephritis, there is no such symptomatology and an accurate diagnosis can be made only from the results of the histological examination of the kidney parenchyma.

Anuria can occur with some infectious diseases such as yellow fever, HFRS, leptospirosis, cholera.

Clinical diagnosis for anuria

It should be noted that if a patient does not have a single gram of urine per day, this does not mean that he has anuria. First of all, it is necessary to exclude acute urinary retention, when it is excreted by the kidneys, but does not leave the bladder because of the block at the level of the prostate or urethra. In addition, in countries of the equatorial climate with minimal consumption of liquid, there may be a physiological absence of urine, which can not be interpreted as anuria.

Thus, in order to diagnose anuria, it is necessary to conduct one of the fundamental studies in urology - excretory( excretory) urography. In this case, if urine is not contrasted at all, or it can only be seen in the kidney cavity, it means that the patient does have anuria and it needs to conduct an additional series of studies to determine its cause.

Anuria on the excretory urogram of

First of all, ultrasound examination of the kidneys and bladder, which makes it possible to exclude not only urolithiasis, but also any oncological processes in the cavity of the small pelvis.

If this method does not give a definitive answer regarding the causes of anuria, the patient needs to perform several laboratory tests that will help to establish the correct diagnosis. First of all, it is necessary to collect blood for a general analysis. If this study finds a large number of white blood cells, then we can talk about the inflammatory cause of the disease. Confirm the assumption of the results of a general analysis of urine is impossible, since this biological fluid simply does not stand out.

Computed tomography of the organs of the retroperitoneal space is performed in order to detect oncological diseases and to exclude abnormalities of kidney development. Also, using this method, you can assess the state of the renal parenchyma and determine whether it is affected by a purulent process.

When anuria is mandatory, it is necessary to detect the level of urea and creatinine, as they are fully responsible for the functional state of the kidneys and show how much this body does not cope with its excretory function.

Cystoscopy is often used among instrumental diagnostics in anuria. It is she who gives the clearest differential diagnosis of anuria and acute urinary retention. If anuria is exposed by mistake, but in fact there is an acute retention of urine, then when the cystoscope is inserted into the cavity of the body, the doctor discovers a complete bladder. If there is indeed anuria, then there is a sleeping bladder and the absence of urine from the orifices of the ureters. It should be noted that cystoscopy can be not only a diagnostic, but also a curative procedure. For example, if the cause of anuria is the ureteral obstruction with a stone, then this question can be solved by stent placement in the ureter.

Symptomatic treatment of anuria

After confirming the diagnosis of anuria, even before determining the exact cause of this pathology, patients are already taking certain measures aimed at eliminating anuria. First of all, they are prescribed loop diuretics, such as furosemide. If the cause of anuria was cardiovascular disorders, then for some time after the administration of furosemide it was possible to obtain the first portion of urine. Quite the opposite situation is observed, say, with bilateral ureter obstruction. After the injection of a diuretic, only an increase in clinical symptoms is observed. In a way, this is a kind of test that allows you to distinguish the renal anuria from the adrenal.

If, against the background of the diuretic, there is an increase in clinical symptoms, then resort to the second stage of symptomatic therapy - the imposition of nephrostomy. The nephrostome allows to "unload" the kidney, which leads to an instant improvement in the clinical state due to the elimination of the urinary block.

If we are talking about uremia, which is associated with a direct violation of the renal membrane, and diuretics are ineffective in this situation, then doctors have only one way out - to transfer the patient to an artificial kidney apparatus. After the patient's condition improves, it can conduct further diagnostic search and try other methods of treatment.

Hemodialysis

Complications of anuria

Since the function of the kidneys is directly impaired in anuria, the protein metabolism products, which are normally excreted by this organ, remain and accumulate in the blood. This leads to another serious urological symptom - uremia.

If such a clinical condition does not lend itself to medical or instrumental correction, the patient is impaired by the function of the nervous structures of the brain, which in turn leads to a whole series of neurological symptoms that find their logical conclusion in a coma. As you know, uremic coma is very serious, not only in terms of treatment, but also in terms of prognosis. Even those patients who manage to avoid the lethal end, can come out of a coma with a clear neurological deficit.

To which doctor to apply for anuria

Naturally, consultation of a urologist is very important in such clinical situations, but sometimes there are times when it is just a waste of time for both the patient and the doctor. For example, if a patient has consumed a small amount of water during a day, in a hot climate or active occupation by physical labor, then he has nothing to worry about a small amount of urine. Just the next day, you need to do a little research - to record the amount of fluid consumed and allocated throughout the day. To the latter, you need to add 300 ml to the loss with sweat and breathing. If the numbers mentioned are approximately the same, it means that the kidneys work perfectly normal. In a situation where the amount of liquid consumed will significantly exceed the amount of excreted urine and at the same time obvious signs of edema will be visible on the patient's body, then it is necessary to immediately run to the urologist for an appointment.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.