Anuria, also called enuresis, refers to the lack of urine production. This can happen as a result of conditions like shock, severe blood loss and failure of the heart or kidneys. It can also be due to medications or toxins.

Anuria isn’t really a disease itself, but it’s a symptom of some other condition.

What Causes Anuria?

Anuria literally means no urine, or without urine. In practical terms, it means that one’s kidneys aren’t producing urine or that he/she is not passing urine (enuresis). Anuria is the most severe form of oliguria, which means that the kidneys aren’t producing enough urine.

Normal urine production is more than 500 milliliters (mL) or 17 ounces (oz) per day. Oliguria is defined as having 100 mL to 400 mL (3.3 to 13.5 oz) of urine per day and anuria (the most extreme of all of these) is defined as urine production of zero to 100 mL (0 to 3.3 oz) per day.

Causes of anuria

Anuria is mostly caused by problems in the kidneys, but it can also result from problems in the heart.

The Prerenal (the major cause of acute renal failure) causes of anuria include hypovolemia, sepsis, cardiogenic shock and hypoxia. Hypovolemia may result from inadequate fluid intake or its excessive loss from the body. Blood loss caused by injury and other causes also leads to hypovolemia. Cardiogenic shock due to myocardial infarction may result in low cardiac output and poorly oxygenated blood.

The renal causes are mostly due to damage or ischemia of the glomeruli and renal tubules. The main causes are incompatible blood transfusion, severe shock for a long period, myoglobinuria, the presence of myoglobin in the urine is associated with crush syndrome after major trauma; disseminated intravascular coagulation usually follows major sepsis or massive blood transfusion and may occur postpartum. Certain, nephrotoxic agents like contrast media for angiography, and toxins of eclampsia may lead to anuria.

Some of the causes of anuria include:

• Diabetes: When a person’s blood sugar is consistently high, it can result in diabetic ketoacidosis, and damage to the small blood vessels in the kidneys. This can cause acute renal failure and poor or absent urine production.
• Kidney stones: These stones can cause blockages in the kidneys or ureters, the tubes that transport urine from the kidneys to the urethra where it is passed out of the body.
• Kidney failure: Acute kidney failure occurs when the kidneys stop functioning and are unable to filter urine anymore.
• High blood pressure: Also known as hypertension, high blood pressure can damage the blood vessels in the kidneys over time. Without treatment, high blood pressure can lead to permanent kidney damage and anuria.
• Tumors: A growth on or near the kidney can cause a blockage and keep urine from passing out of the body.
• Heart failure: When a person has heart failure the heart cannot pump enough blood around the body. Processes in the body kick in if there is not enough fluid in the blood vessels. One of these is the kidneys ceasing to make urine to hold on to extra fluid.

Postrenal anuria is usually due to obstruction to flow the urine through the lower urinary tract. Calculus disease is a common cause of acute obstruction leading to anuria, e.g. the stone obstructing the ureter of the only functioning kidney.

The problem cause of anuria should be established. The bladder is catheterized if a voided sample cannot be obtained. Urine is checked for specific gravity, presence of casts (implying a renal cause), urine is sent for culture and microscopy.

The renal anuria due to acute tubular necrosis can be reversible and may progress through three recognizable phases: (1) phase of Oliguria; (2) phase of dieresis; and (3) phase of recovery.

During the Oliguria phase, excess fluid loads must be avoided and fluid intake restricted to match the reduced output plus insensible losses. Abnormal losses (vomiting, nasogastric suction, diarrhoea) will need to be monitored and replaced. Electrolyte balance needs to be maintained. Sodium chloride or bicarbonate should never be infused and fluid containing potassium should be prohibited.

During the diuretic phase which occurs round about the 8^th day. Glomerular function recommences but tubular function take time to recover. A heavy loss of sodium and potassium can be expected and fluid requirements be carefully judged.

In most patients the diuretic phase is followed by the recovery phase.

Renal replacement (in form of peritoneal dialysis or haemodialysis) is needed for those patients in whom the oliguric or anuric phase is associated with uremic symptoms or uncontrollable hyperkalaemia.

In patients too ill for surgery to remove the cause of obstruction to the upper urinary tract, the treatment of obstructive renal impairment is drainage either exteriorly using a nephrostomy or internally using an indwelling stent.

Symptoms

Anuria or not urinating is a symptom itself and not a medical condition. Sometimes, a person may also have signs of the condition that is causing the poor urine output.

The symptoms of kidney disease can include:

• swelling in the legs, feet, ankles, face
• rash or itching of the skin
• flank pain in the back or side
• nausea or vomiting
• shortness of breath
• dizziness
• difficulty concentrating
• fatigue

Symptoms of heart failure can include:

• shortness of breath
• swelling of the legs
• fatigue or dizziness
• nausea
• poor appetite
• high heart rate
• coughing or wheezing

Symptoms of diabetic ketoacidosis include:

• excessive thirst
• dry mouth
• vomiting
• abdominal pain
• diarrhea
• loss of appetite
• fatigue
• confusion
• fruity odor on the breath

Diagnosis

Non-obstructive anuria is accompanied by symptoms of uremia with vomiting, drowsiness, muscle twitch, headache, and asterixis. Urinary retention causes suprapubic pain, constant urgency, and a palpable bladder with dullness to percussion in the suprapubic region, check urine for blood or sugar.

The doctor will also ask about symptoms and changes in urination, including:

• swelling
• fatigue
• changes in appetite
• blood in the urine
• frequency of urination
• quantity of urine passed
• abdominal or flank pain

Some additional testes, such as blood testing for kidney function, urine testing for blood or sugar, a biopsy of the kidney or imaging tests, including X-rays, CT scans or MRI scans should be advise.

Hospitalization may be needed until a person’s kidney function has been restored or the cause of the anuria is determined.

Complications

If urine output cannot be restored, it can be life-threatening. The condition causing the anuria can also be very dangerous.

The primary complication of anuria is kidney damage or failure. This can be permanent and can cause someone to need dialysis or a kidney transplant.

Anuria can be fatal if not treated, so prompt treatment is vital if someone suspects anuria.

Allopathic Treatment for Anuria

If anuria is a sign of an underlying condition, treatment depends on what that underlying condition might be. Treatment may include managing the underlying cause of kidney injury, removal of urinary obstruction, or renal replacement therapy in cases of end-stage kidney disease or severe kidney damage.

Removing kidney stones or tumors

Someone with an obstruction in the kidneys, such as from a kidney stone or tumor, will need to have it removed. This may mean surgery, medication chemotherapy, or radiation therapy to shrink or remove the tumor or stone.

Kidney disease management

As we know that there is no any treatment for anuria in allopathic medicine accept of dialysis, which is a procedure that removes excess fluid, electrolytes, and waste products from the blood. Dialysis is performed in an outpatient clinic, or the hospital if needed, 3 to 4 times a week.

There are several ways to have dialysis. Normally, the blood is removed, passed through a special filter to take out the waste products, and then reinfused back into the body.

Someone with kidney damage and who is on dialysis may be a candidate for a kidney transplant. Not everyone is a candidate for this type of surgery because of the risks and long-term care necessary afterward.

When the cause of anuria is something like heart failure, sepsis, shock or respiratory failure, the first priority is to treat the condition causing the urinary issues.

If a blockage in the bladder is suspected, the treatment will be to drain the bladder using the appropriate type of catheter.

Homeopathic Treatment for Anuria

The selection of remedy is based upon the theory of individualization and symptoms. The aim of homeopathy is not only to treat Anuria symptoms but to address its underlying cause(s).

Arsenicum Album

Retention of urine, as from paralysis of the bladder. The shade of the urine is dark and full of albumen. Dyspnoea attacks are also observed while lying down during the night. Taking aconite produces a mucus and the patient gets relief. Difficult and painful emission of urine. Scanty urine, of a deep yellow colour. Urine aqueous, greenish, brownish, or turbid, with mucus-like sediment. Sanguineous urine. Violent and insupportable throbbings of the heart. Heart-beats irritable. Palpitation with anguish. Angina pectoris. Hydropericardium. Fatty degeneration.

Kalium Chloricum

Inflammation of the kidneys causes suppression – Kalium Chloricum is the best choice. Urine albuminous, scanty and suppressed, has high phosphoric acid content with low total solids, sometimes haematuria. Palpitation of heart with anxiety. Burning in region of heart (angina pectoris).

Cuprum Aceticum

Frequent attacks of angina pectoris coming on from exertion or excitement. Anemia. Pulse rapid. Breathlessness with dry cough. Cannot eat or drink without retching. Periodic, spasmodic, painful contraction of fingers and toes

Opium

Retention of urine, as from inactivity of the bladder. Retention of urine: from paralysis of fundus of bladder; from spasm of sphincter; from nursing after passion of nurse. Acute, spasmodic constriction of urethra, with passage of bloody urine. Scanty, deep/dark brown-coloured urine, with sediment like brick-dust. Emission of blood in urinating. Aching in chest, with shootings in sides during inspiration.-Tension and constriction in chest.-Heat and burning pain in chest, esp. in region of heart.-Suffocative attacks during sleep like nightmare. legs weakness, torpor. Paralysis of legs. Heaviness and swelling of feet. Chilblains on toes.

Prunus Spinosa

Cramps in bladder. Prunus Spinosa has shown great results in cases of involuntary urination in men with an enlarged prostate. Stream forked. Urine reaches glans penis and then returns. Spasmodic retention of urine. Tenesmus of bladder. Heart.-Furious beating, even when at rest, and great danger of suffocation from slightest motion; visible pulsation of carotids; face bloated and synotic; lips synotic. Restlessness in legs, has to change the position continually.

 Helleborus Niger

The suppression is due to nephritis – inflammation of the kidneys, urine suppressed, scanty and dark coloured with coffee ground sediment. Bladder distended and paralysed during pregnancy with frequent urge to pass urine and much pain; after great pressure there is only a scanty discharge.

Serum Anguillae

Serum Anguillae is one of the best remedies for high level of creatinine in blood with renal failure, oliguria, anuria and albuminuria. Subacute nephritis. Heart diseases, in cases of failure of compensation and impending asystole. acute nephritis. Kidney failure. It is prescribed when hypertension and oliguria without oedema is present. Albuminuria. Mitral insufficiency, asystolia with or without oedema, dyspnoea and difficult urinary secretion.

Aralia Hispida

Aralia hispida is very effective for high level of creatinine in blood. Dropsy of renal origin. Urinary tract infection. Urine scanty, leading to complete suppression of urine. Renal diseases with constipation.

Ampelopsis Quinquefolia

Renal dropsies, hydrocele, and chronic hoarseness. Uraemia or uremic coma. Vomiting, purging, tenesmus , cold sweat and collapse. Vomiting, purging with tenesmus.

Apis Mellifica

Urine suppressed; Anuria. Symptoms of this type include oedematous swelling on the face, paleness, headaches, pain in the back and limb, oedema pulmonum, swelling of various parts, oedema, red rosy hue, stinging pains, soreness etc. It is used when there are dull aches in the kidney, reduced urination, and micturition. The urine contains albumin in high levels and blood corpuscles. An eruption of the skin occurs, and the patient feels drowsy.

Solidago virgaurea

Solidago virgaurea is the homoeopathic replacement for a catheter. Scanty, reddish brown, thick sediment, dysuria, gravel. Difficult and scanty. Albumen, blood, and slime in urine. Pain in kidneys extend forward to abdomen and bladder. Clear and offensive urine. Sometimes makes the use of the catheter unnecessary. Oppressed breathing. Continuous dyspnoea.

 Berberis Vulgaris

Squeezing, with shootings, in the region of the heart. Palpitation of the heart. Swelling of the feet after movement, with sensation of burning, swelling of the heel, and cramp in the feet. Lancinating or tearing pulsating pain in the kidneys. Aching pains in the bladder. Bubbling sensation in region of kidneys.

Pareria Brava

Calculus. Dysuria, cannot pass urine in any position except on hands and knees. Urine smells strongly of ammonia, and contains a large quantity of viscid, thick, white mucus. Black, bloody, foaming urine, depositing a brick-dust sediment of uric acid; deep red and mucous urine. kidney to groin, following course of ureter. Bruised pains in region of kidneys.-Micturition difficult, with much straining only in drops. Enlargement of prostate gland, with retention of urine.

Belladonna

Urine retention. Acute urinary infections. Sensation of motion in bladder. Urine scanty, with tenesmus; dark and turbid, loaded with phosphates. Vesical region sensitive. Incontinence, continuous dropping. Frequent and profuse. Haematuria where no pathological condition can be found. Prostatic hypertrophy.  Violent palpitation, reverberating in head, with labored breathing. Palpitation from least exertion. Throbbing all through body. Dichroism. Heart seemed too large. Rapid but weakened pulse.

Staphysigaria

Cystitis in lying-in patients. Burning in urethra during micturition. needle-like stitches in region of kidneys. Prostatic troubles. Cystocele. Muscles, especially of calves, feel bruised. Backache. Tremulous palpitation of heart. Stitching pains in heart, or region of heart; stopping breathing. Swelling of instep. Swelling of metatarsal bones. Burning itching in toes.

Urea

Constant urging to urinate, beginning at root of penis. Constant urging, with much sediment in urine. From bladder to her groins a fatiguing, tearing pain. Profuse diuresis with rapid diminution of dropsy. Albuminuria; bloody urine; general dropsy; intermittent heart. Delirium, nose-bleed, urine brown, very albuminous; oedema of pudenda; ascites; pulse small, slow; attacks of suffocation.

Convallaria

Convallaria is used in case of nephritis occurring due to heart disorders. It is used when the heart functions irregularly and also in anasarca and ascites because of mitral insufficiency.

Stramonium

Suppression of urine, especially during typhus. Emission of urine, drop by drop. The bladder is empty. Loss of power in the bladder of the aged. Flow or urinary stream is slow. Rigor during urination. Constrictive oppression on chest. Pressure about heart. Angina pectoris. Pulse rapid, full, strong; irregular, hard, slow, small, frequent. Trembling of limbs.

Mercurius Corrosive

Intense burning in urethra. Urine hot, burning, scanty or suppressed; bloody, greenish discharge; suppressed urine. Albuminous. Tenesmus of bladder. Stabbing pain extending up urethra into bladder. Constriction of chest, breathes with pectoral muscles. Haemoptysis. Palpitation of heart in sleep. Pulse small, intermittent, irregular; rapid.

Clematis Erecta

Secretion of urine diminished; the last drops cause violent burning. Secretion slow and in a small stream. Contraction of the urethra, with the urine stopping suddenly, or only flowing drop by drop. Sharp stitch in the heart.

Terebenthine Oleum

Strangury, with bloody urine. Scanty, suppressed, odor of violets. Urethritis, with painful erections. Inflamed kidneys following any acute disease. Constant tenesmus. Difficult breathing, haemoptysis. Bloody expectoration. Frightful oppression in praecordial region. Pulse quick, small, thready, almost imperceptible; intermitting; irregular.

Camphor

Burning and strangury, with tenesmus of the neck of the bladder. Retention with full bladder.

Aconite

Suppression of urine, with pressure in the bladder and pains in the loins.-A frequent desire to discharge urine, accompanied by anxiety and pain. Enuresis, with thirst. Urine scanty, burning, deep red, and with a sediment of a brick colour. Bloody sediment in the urine. Short breathing. Breathing painful, anxious, and attended with groans, rapid and superficial, or full, noisy, and with the mouth open. Attack of suffocation, with anxiety. Palpitation of the heart, with anxiety. Inflammation of the heart. Chronic diseases of the heart. Attacks of fainting and tingling in the fingers.

Colchicum Autumnale

Urine dark, scanty or suppressed; bloody, brown, black, inky; contains clots of putrid decomposed blood, albumin, sugar. Anxiety in region of heart. Impulse not felt. Pericarditis, with severe pain, oppression and dyspnoea, pulse threadlike. Sound of heart become weaker, pulse of low tension.  Edematous swelling and coldness of legs and feet.

Digitalis

Urine continued urging, in drops, dark, hot, burning, with sharp cutting or throbbing pain. Suppressed. Ammoniacal, and turbid. Urethritis, phimosis, strangury, sediments. Desire to take a deep breath. Violent palpitation. Stitches in heart. Irregular heart especially of mitral disease. Very slow pulse. Intermits; weak. Cyanosis. Inequality of pulse. Pericarditis. Dilated heart, tired, irregular, with slow and feeble pulse. Hypertrophy with dilatation. Cardiac failure following fevers. Cardiac dropsy. Swelling of the feet. Fingers go to sleep easily.

Lycopodium

Pain in back before urinating; ceases after flow; slow in coming, must strain. Retention. Polyuria during the night. Heavy red sediment. Dyspnoea. Tensive, constrictive, burning pain in chest. Aneurism.  Aortic disease. Palpitation at night.

Kali Bichromicum

Ropy mucus in urine. Urethra becomes clogged up. Congestion of kidneys; nephritis, with scanty, albuminous urine and casts. Pyelitis; urine mixed with epithelial cells, mucus, pus, or blood. Hemato Chyluria.Heart dilatation, especially from coexisting kidney lesion. Cold feeling around heart. Bones feel sore and bruised. Very weak. Tearing pains in tibia.  Tendo Achilles swollen and painful. Pains in small spots.

Merc Corrosive

Intense burning in urethra. Urine hot, burning, scanty or suppressed; bloody, greenish discharge. Albuminous. Tenesmus of bladder. Stabbing pain extending up urethra into bladder. Perspiration after urinating.

Apocynum Cannabinum

Bladder much distended. Turbid, hot urine, with thick mucus and burning in urethra, after urinating. Little expulsive power. Dribbling. Strangury. Renal Dropsy.  Short, dry cough. Respiratory short and unsatisfactory. Sighing. Tricuspid regurgitation; rapid and feeble, irregular cardiac action, low arterial tension, pulsating jugulars, general cyanosis and general dropsy.

Coffea Cruda

Anuria. Oppression of the chest; obliged to take short inspirations. Palpitation of heart; violent, irregular, with trembling of limbs.-Nervous palpitation.-Palpitation after excessive joy, surprise. Trembling of the hands

Nitric Acid

Urine scanty, dark, offensive. Smells like horse’s urine. Cold on passing. Burning and stinging. Urine bloody and albuminous. Alternation of cloudy, phosphatic urine with profuse urinary secretion in old prostatic cases. Shortness of breath. Incontinence of urine. Painful emission of urine. Micturition in a thin stream. Swelling (dark red) of orifice of urethra. Needle-like stitches in orifice of urethra. Ulcers in urethra. Discharge of prostatic fluid after a difficult stool. Shortness of breath. Loss of breath and palpitation of heart. Dyspnoea. Pulse very irregular; one normal beat is often followed by two small rapid beats-the fourth entirely intermits; alternate hard, rapid, and small beats.

P. S : This article is only for doctors having good knowledge about Homeopathy and allopathy,  for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

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