What is Oliguria ? Definition

Oliguria is a medical term for decreased urine output (less than 400 ml urine output in adults, less than 1ml/kg/h in infants and less than 0.5 ml/kg/h in children). Oliguria could indicate that there is something wrong in your kidney. It is one of the criteria for diagnosing acute kidney injury/acute renal failure.

Oliguria Vs Anuria

Oliguria is a significant decreased in urine output while anuria is the absence of urine. ⁽⁴⁾

Oliguria Causes

There are various factors leading to decreased urine output. These include the following:

• Acute bacterial infection – Some infections caused by bacteria can severely affect the functions of the kidneys. A perfect example is cholera. It is a bacterial infection in which the patient has dehydration secondary to loss of fluid and electrolyes. Other symptoms include excessive thirst, vomiting, diarrhea, weakness, rapid heart rate, and hypotension.
• Acute glomerulonephritis – It is characterized by fatigue, high blood pressure, abdominal pain, nausea and vomiting, mild fever, and pulmonary congestion. These symptoms can trigger oliguria.
• Cardiac-related problems – A significant decreased in cardiac output could lead to increased renal perfusion. The urine output decreases along with other symptoms like difficulty breathing, weakness, dry cough, rapid heartbeat, and peripheral edema.
• Hypovolemia – It is characterized by a decreased circulation of fluid in the body.
• Post-surgical response – Patients who undergone surgical procedure may sometimes experience oliguria as a body’s response to fluid and blood loss, fever, and dehydration. It could also be caused by post-operative drugs such as methotrexate and diuretics.
• Urinary obstruction – Some conditions can obstruct the flow of urine such as in the case of enlarged prostate.
• Dehydration – Lack of fluid intake could result to a decreased urine output. ^{(1, 5, 8)}

Image 1: A comparison between a healthy kidney and a diseased kidney
Picture Source: s3.postimg.org

Picture 2: A close monitoring and management of patients with oliguria
Photo Source: www.nursingtimes.net

Oliguria Signs and Symptoms

Cardinal oliguria symptoms are an abnormal decrease in the urine output. It varies according to age. In adults, oliguria is suspected if the patient’s urine output is less than 40 ml/day. Other associated symptoms are:

• Diarrhea
• High fever
• Light-headedness ⁽¹⁾
• Dizziness
• Palpitations
• Vomiting
• Muscle weakness
• Difficult breathing
• Lack of appetite (anorexia) ⁽⁷⁾

When to contact your doctor?

You should immediately contact your doctor if you notice any of the following:

• A decreased in urine output that has been going on for almost a week.
• You have bouts of diarrhea long with vomiting and high fever.
• If your urine output decreases for a few days along with rapid pulse rate, dizziness, and light-headedness. ⁽⁸⁾

Tests and Diagnostic Procedures

To thoroughly assess the medical condition of the patient, the doctor will conduct a complete physical examination. The past medical history and past surgical history will also be obtained. To accurately diagnose the urine output, the doctor will ask for the time pattern of urination, when the condition began, how long has it been going on, and the water intake and output ratio.

Aggravating factors will be thoroughly assessed too such as ongoing infection, recent surgical procedure, medications taken including maintenance medication, and the likes. ^{(1, 2, 6)}

To assess oliguria in acute renal failure as well as nephrotic syndrome oliguria, diagnostic procedures and lab work will be obtained. These are the following:

1. Urinalysis – This test is ordered to detect the presence of inflammation or infection in the bladder and kidneys.
2. Urine culture – This is to detect the presence of bacteria in the urine.
3. Intravenous Pyelogram – A dye is injected into the vein to check for kidney stones and tumor.
4. Ultrasound – Used to detect cyst or mass in the kidney.
5. Pelvic CT scan – It is ordered to view the kidneys pelvic, and abdominal organs.
6. Cystoscopy – A flexible telescope is inserted into the urethra. It passes into the bladder to check for the presence of tumor and other problems in the lining of the bladder. The patient is sedated and put on a local anesthesia to remain comfortable during the procedure.
7. Blood Test – A complete blood count is ordered to check for signs of urinary tract infection and other kidney-related problems. ^{(1, 4, 8)}

Oliguria Treatment

The treatment of oliguria is focused on the root cause of the problem. A reduced urine output is a clinical symptoms that can be easily reversed. There are various ways to do and some of them are the following:

• Catheter insertion – A urinary catheter is placed to relieve obstruction. It facilitates accurate measurement of the urine output. A urinary catheter is included in the postoperative oliguria management.
• IV fluid – If the patient is severely dehydrated causing the urine output to decrease dramatically, the patient should be hospitalized and be given IV fluids. If oliguria is a side effect of a certain medication, then the drug should be stopped immediately.
• Dialysis – A patient suffering from kidney disease should undergo a dialysis with the supervision of the health care provider. The patient is strongly advised to see a kidney specialist/urologist to thoroughly assess the condition of the kidney and to come up with a tested and proven effective medical remedy. ^{(5, 8, 9, 10)}

Nursing care plan for oliguria

The nursing goal of treating patients with oliguria is more on the supportive and prevention management. The symptoms of the patient will be improved significantly. Any potential danger should be minimized and tracked the earliest time possible to avoid further complications.

Nursing care plan for oliguria includes the following:

• Monitoring of intake and output – Everything that gets in and out of the patient’s body should be monitored including the oral intake, urine output, vomitus, intravenous fluids, ice chips, and liquid medications. The urine output should not only be measured, but also insensible losses like sweat, diarrhea, nasogastric outputs, and wound drainage.
• Monitor urine’s specific gravity – The ability of the kidney to concentrate urine should be checked. A patient with renal failure has a urine specific gravity less than 1.010. It is an indicator that the kidney has lost its ability to concentrate urine.
• Check the patient’s weight – The patient’s body weight should be monitored daily. To accurately measure the weight, the patient should be weighed the same time each day using the same weight equipment and clothing. If the patient’s weight increases despite low urine output, it could indicate that the patient’s body retain fluids. You should watch for any symptoms of edema (swelling), especially pitting edema. If you noticed periorbital edema, it is a positive sign of fluid shift. ^{(2, 3, 5, 7)}

If you have been suffering from oliguria for more than three days, you should immediately seek medical help.

References:

1. emedicine.medscape.com
2. https://en.wikipedia.org
3. www.myvmc.com
4. www.healthline.com
5. www.medicalook.com
6. www.healthhype.com
7. www.belmarrahealth.com
8. www.redurine.com
9. www.ranker.com
10. Critical Care Nephrology By Claudio Ronco, Rinaldo Bellomo, John A. Kellum

Citrobacter freundii, are aerobic gram-negative bacilli. They are long, about 1-5 μm in length and are rod-shaped. A few of them are non-motile, but most of them move using their flagella. They contain two membranes, both the inner and outer.

The space in between the two membranes is called periplasmic space. Citrobacter freundii characteristics are described as opportunistic. They cause a number of infections. In fact, they are the one responsible for infections of the urinary tract, respiratory tract, and blood infections, to name a few.

About 29% of opportunistic infection is caused by Citrobacter freundii.

Citrobacter freundii have the ability to grow on glycerol. They can also metabolize lactose or citrate. On the positive note, Citrobacter freundii have a beneficial role in the environment. They reduce nitrate to nitrite in the environment, which plays an important part in the nitrogen cycle.

About 85% of the earth’s atmosphere contains nitrogen. ^{(1, 2, 3, 4)}

Citrobacter freundii habitat

The natural habitat of citrobacter freundii is the environment. It thrives in soil, water, sewage, food, and even in the human and animal’s intestinal tract. A water containing citrobacter freundii is an indication that it is contaminated. They can be found on the organs of diseases animals, especially amphibians, reptiles, mammals, and birds. ⁽²⁾

Citrobacter freundii symptoms

Citrobacter freundii being an opportunistic microbe can cause severe infections. However, it can only affect humans with weak immune system or those immune compromised. If you are healthy, you are less likely to get infected by this microbe.

What are the citrobacter freundii symptoms? They vary on the types and severity of the infection. ⁽⁶⁾

Image 1: An imaging study of Citrobacter Freundii
Picture Source: image.slidesharecdn.com

Photo 2: How C. freundii organism looks like
Image Source: slideplayer.com

Urinary tract infection secondary to C. freundii

Citrobacter Freundii causes infection when spread into the urinary system. A sexual intercourse or wiping back to front after a bowel movement can lead to urinary tract infection. Symptoms include the following:

• Pain (burning feeling) when urinating
• Scanty urine
• Presence of blood in the urine
• Foul smelling urine
• Fever
• The urge to urinate increases
• Pain in the pelvis and lower back ⁽⁷⁾

Inflammatory changes in the intestine

Citrobacter freundii in stool is one of the reasons why there are inflammatory changes in the intestines. The usual symptoms include the following:

• Nausea
• Gastric upset
• Weight loss ⁽⁵⁾

Neonatal Meningitis

Citrobacter freundii is associated with neonatal meningitis. What is meningitis? It is the inflammation of the meninges (the covering of the brain). Citrobacter freundii can cross the blood-brain barrier. It can reside in the brain and even replicate too.

It is the primary reason why the mortality rate is high in people with meningitis. The usual clinical features of neonatal meningitis secondary to Citrobacter freundii include the following:

• High grade fever
• Seizure
• Vomiting (projectile in nature) ⁽⁸⁾

Respiratory Tract Infection

• Fever and chills
• Productive cough with a white to yellow sputum
• Chest pain
• Labored breathing
• Gastric upset in some patients ( diarrhea and abdominal pain) ⁽⁸⁾

Diagnosis

To accurately diagnose the presence of Citrobacter freundii, various diagnostic procedures should be performed including x-ray, sonogram, bacterial culture and imaging. It is a must to come up with a quick and accurate diagnosis so that the infection will be treated right away. ⁽⁹⁾

Treatments for Citrobacter freundii infection

Infections caused by Citrobacter freundii bacteria is treated using antibiotics. The usual antibiotics of choice are cephalosporins, fluoroquinolones, and carbapenems. The doctor will determine the right antibiotic of choice. Basically, the health care professional will take into consideration the vulnerability of the bacteria to antibiotics as well as the site of the infection. ^{(9, 10)}

Citrobacter freundii treatment using antibiotics is modified because some strain of citrobacter freundii developed resistance to a certain number of antibiotics. To hasten the healing process, supportive treatment is given to the patient along with tested and proven effective antibiotic of choice.

During the course of treatment, it is important to be open to your health care provider. If you have any allergy to antibiotics, you should inform your physician right away to prevent adverse reactions.

Antibiotics offer a quick relief from the symptoms that are currently bothering you. Even so, you should continue taking the antibiotics until your doctor tells you to stop. This is to prevent recurring infection. If you are experiencing any side effects, you should inform your doctor right away.

This is to avoid another infection and prevent worsening of your condition. If you are suffering from severe Citrobacter freundii infection, the antibiotic is given to you via intravenous route every eight hours until you no longer have fever. This typically lasts for three days. After that, you can take oral antibiotics.

On the other hand, if you are suffering from mild Citrobacter freundii infection, you will be required to take oral antibiotics for two weeks or until the infection subsides. ^{(4, 5, 7)}

Prognosis

Citrobacter freundii infection has a moderate prognosis. It is important to treat the infection right away. Neglected cases of Citrobacter freundii infection could lead to severely poor prognosis. If the infection is left untreated, the patient could die.

If you are suffering from urinary tract infection secondary to Citrobacter freundii infection, the prognosis is good. However, the prognosis is moderate to poor in patients with peritonitis (inflammation of the lining of the abdomen). In the case of people with meningitis caused by Citrobacter freundii infection, the prognosis is poor. In fact, the death rate ranges from 25% to 50%.

Those who survived the infection have a tendency to suffer from neurological problems. It affects about 75% of patients who survived meningitis. For good prognosis, early detection and treatment of the infection is a must. If you are ill for three days, you should consult your doctor.by doing so, you will be able to prevent further infection and worsening of the condition. ^{(4, 5, 9, 10)}

References:

1. https://en.wikipedia.org
2. https://microbewiki.kenyon.edu
3. www.microbiologyinfo.com
4. www.antimicrobe.org
5. www.ncbi.nlm.nih.gov
6. www.phac-aspc.gc.ca
7. www.thistle.co.za
8. www.independent.co.uk
9. emedicine.medscape.com
10. Principles and Practice of Pediatric Infectious Diseases E-Book By Sarah S. Long, Charles G. Prober, Marc Fischer