Evaluation and Treatment of Acute Oliguria

Oliguria is one of the most common clinical problems encountered by physicians caring for perioperative patients in the ICU. Often oliguria is the first sign of acute kidney injury and therefore prompt recognition and treatment is critical. Acute kidney injury carries significant morbidity and mortality. Hence, the presence of oliguria should alert the clinician to undertake a diligent search for any correctable underlying causes. Ensuring adequate renal perfusion through optimization of volume status, cardiac output, and blood pressure together with avoidance of nephrotoxins is key. Diuretic use may not alter the need for renal replacement therapy or outcomes. Diuretics may be required to treat fluid overload, but they are not treatments for oliguria. Early renal replacement therapy should be considered in patients with oliguria secondary to AKI and fluid overload especially if they fail to respond to diuretics.