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Reflex anuria: an old concept with new evidence


Reflex anuria (RA) was defined by Hull as cessation of urine output from both kidneys due to irritation or trauma to one kidney or its ureter, or severely painful stimuli to other organs. This is not a common concept among urologists or nephrologists even though it has been proposed for more than half a century. The phenomenon has not been thoroughly understood. But intrarenal arteriolar spasm and ureteral spasm have gained wide acceptance as the mechanisms of RA. The present review summarized papers published up to now on RA, in order to depict the general profile of the disease and to further elucidate the pathogenesis of RA. A classification system of RA was proposed as neurovascular reflex, ureterorenal reflex, radiated renovascular reflex, renoureteral reflex, ureteroureteral reflex and radiated ureteral reflex, based on the two assumed mechanisms and the stimulus’ origins. All these types except renoureteral reflex had gained supporting evidence from animal experiments and/or clinical case reports. RA is a diagnosis of exclusion, only being considered after ruling out common and tangible etiologies such as ureteral calculi, acute tubular necrosis, renal vascular occlusion, hypovolemia, infection, etc. If the diagnosis has been established, treatment plan should be directed toward the mechanisms more than the causative factors. Abnormalities of the autonomic nerve system and congenital urogenital malformations incline people to RA. In summary, RA is a cessation of urine production caused by stimuli on kidney, ureter or other organs, through a mechanism of reflex spasm of intrarenal arterioles or ureters, leading to acute renal failure. It is a functional rather than parenchymal disease.

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  1. 1.

    Tomlin EM, Quilter TN (1953) Reflex anuria US. Armed Forces Med J 4:1211

  2. 2.

    Hipsley PL (1940) A critical review of cases of so-called reflex anuria, with the report of a case (case #6). Med J Aust 52:602–606

  3. 3.

    Sirota JH, Narins L (1957) Acute urinary suppression after ureteral catheterization: pathogenesis of reflex anuria. N Engl J Med 257:1111–1113

  4. 4.

    Hull JD, Kumar S, Pletka PG (1980) Reflex anuria from unilateral ureteral obstruction. J Urol 123:265–266

  5. 5.

    Kopp UC (1992) Renorenal reflexes: interaction between efferent and afferent renal nerve activity. Can J Physiol Pharmacol 70:750–758

  6. 6.

    Pomeranz BH, Birtch AG, Barger AC (1968) Neural control of intrarenal blood flow. Am J Physiol 215:1067–1081

  7. 7.

    Disalvo J, Fell C (1970) Changes in renal blood flow during renal nerve stimulation. Proc Sco Exp Biol Med 136:150–153

  8. 8.

    Block MA, Wakim KG, Mann FC (1952) Renal function during stimulation of renal nerves. Am J Physiol 169:670

  9. 9.

    Kervancioglu S, Sirikei A, Erbagci A (2007) Reflex anuria after renal tumor embolization. Cardiovasc Intervent Radiol 30:304–306

  10. 10.

    Hix EL (1958) Ureterorenal reflex facilitating renal vasoconstrictor responses to emotional stress. Am J Physiol 192:191

  11. 11.

    Francisco LL, Hoversten LG, Bone GFD (1980) Renal nerves in compensatory adaptation to ureteral occlusion. Am J Physiol 238:F229–F234

  12. 12.

    Songco A, Rattner W (1987) Reflex anuria. Urology 29:432–433

  13. 13.

    Maletz R, Berman D, Peelle K, Bernard D (1993) Reflex anuria and uremia from unilateral ureteral obstruction. Am J Kidney Dis 22:870–873

  14. 14.

    Catalano C, Comuzzi E, Davi L, Fabbian F (2002) Reflex anuria from unilateral ureteral obstruction. Nephron 90:349–351

  15. 15.

    Shearlock KT, Howard SS (1976) Postobstructive anuria: a documented entity. J Urol 115:212–213

  16. 16.

    Mnushkin A, Bogdanova L (1968) Reflex anuria during the acute period of myocardial infarction. Sov Med 31:78–81

  17. 17.

    Jeevagan V, Navinan M, Munasinghe A et al (2013) Reflex anuria following acute cardiac event. BMC Nephrol 14:106

  18. 18.

    Fang C (1986) Reflex anuria after retrograde cholangiography through t tube: a case report. Guizhou Med 10:34

  19. 19.

    Wolfe GA (1945) Mechanism of reflex anuria. Ann Intern Med 23:99

  20. 20.

    Lytton B, Kupfer DJ, Traurig AR (1967) The vesicorenal reflex. Invest Urol 4:521

  21. 21.

    Franklin KJ, Mcgee LE, Ullman EA (1951) Effects of severe asphyxia on the kidney and urine flow. J Physiol (London) 112:43

  22. 22.

    Shafik A (1998) Response of the renal pelvis and ureter to distension of the contralateral renal pelvis and ureter: identification of the reno-renal pelvic reflex. World J Urol 16:359–364

  23. 23.

    Shao H, Guo X, Chen X et al (2010) Three cases of adult reflex anuria. Chin J Urol 31:638

  24. 24.

    Liu C (1987) Retrograde urography caused reflex anuria. J Modern Urol 2:179

  25. 25.

    Suzuki T, Komuta H, Tsuchiya R (1966) Postrenal reflex anuria. Nippon Geka Hokan 35:421

  26. 26.

    Hayashi K, Horikoshi S, Hirano K, Shirato I, Tomino Y (1996) A case of reflex anuria and uremia related to a unilateral ureteral stone. Nihon Jinzo Gakkai Shi 38:460–462

  27. 27.

    Jv Heesewijk, E Scholten (1990) Reflex anuria: radiologic findings. Rofo 153:223–224

  28. 28.

    Parker RM, Basch RI, Harrison JH (1968) Unilateral vasoconstrictive anuria. Surg Gynec Obst 127:66

  29. 29.

    Singh K, Wang ML, Nakaska M (2011) Reflex anuria. BJU Int 108:793–795

  30. 30.

    Braam PF, Schreinemachers LM (1982) Reflex anuria. Ned Tijdschr Geneeskd 126:141–143

  31. 31.

    Flye MW, Anderson RW, Fish JC, Silver D (1982) Successful surgical treatment of anuria caused by renal artery occlusion. Ann Surg 195:346–353

  32. 32.

    Khan MA, Hunter JM, Tan C, Seleen M, Stride PJ (2012) Staphylococcal sepsis with multiple abscesses, urinary tract infection, and bilateral renal vein thrombosis in a patient with uncontrolled diabetes mellitus. Case Rep Med 2012:357502

  33. 33.

    Stefano VD, Martinelli I (2012) Abdominal thromboses of splanchnic, renal and ovarian veins. Best Pract Res Clin Haematol 25:253–264

  34. 34.

    Yang GF, Schoepf UJ, Zhu H, et al. (2012) Thromboembolic complications in nephrotic syndrome: imaging spectrum. Acta Radiol

  35. 35.

    Harris LA, Every MJV, Fundell LJ (2012) Acute bilateral renal vein thrombosis secondary to sepsis from pyelonephritis. Int Braz J Urol 38:132–134

  36. 36.

    Hecht EM, Hindman N, Huang WC, Rosenkrantz AB, Melamed J (2010) Extensive infiltrating renal cell carcinoma with minimal distortion of the renal anatomy mimicking benign renal vein thrombosis. Am J Kidney Dis 55:967–971

  37. 37.

    Cheung CM, Ponnusamy A, Anderton JG (2008) Management of acute renal failure in the elderly patient: a clinician’s guide. Drugs Aging 25:455–476

  38. 38.

    Green JT, Pham HT, Hollowell CP, Krongrad A (1997) Bilateral ureteral obstruction after asymptomatic appendicitis. J Urol 157:2251

  39. 39.

    Aronson DC, Moorman-Voestermans CG, Tiel-van Buul MM, Vos A (1994) A rare complication of acute appendicitis: complete bilateral distal ureteral obstruction. Lancet 344:99–100

  40. 40.

    Seeberg LT, Edenberg J, Saetren H (2005) Bilateral ureteral obstruction after appendicectomy. Surgeon 3:45–47

  41. 41.

    Kwon JH, Hwang EM, Choi BS, et al. (2007) Development of anuria after appendectomy in a patient with a distal ureteral stone in a single kidney. Yousei Med J 48:139–141

  42. 42.

    Wadhwa P, Gautam G, Aron M (2007) Contrast induced obstructive anuria in uretero-pelvic junction obstruction secondary to a crossing vessel in a solitary kidney. Int Urol Nephrol 39:33–34

  43. 43.

    Terauchi T, Makino H, Takano M, Takano Y, Sato I (1999) Anuria due to bilateral renal artery spasm during hysterectomy and oophorectomy. Masui 48:1011–1013

  44. 44.

    Yi B, Huang S, Wei M, Yuan J (2002) Reflex anuria in little children. Chin J Pediatr Surg 23:281–283

  45. 45.

    Tang X (2006) Reflex anuria: a report of 2 cases. Chin J Misdiagn 6:3867–3868

  46. 46.

    Wang C, Zou L, Liu Y (2002) Renorenal reflex anuria: a report of 5 cases. J Modern Urol 7:178

  47. 47.

    Zheng G, Wei X, Duan Y (1998) Unilateral ureteral stone-reflex anuria: a case report. J Modern Urol 3:22

  48. 48.

    Romero FT, Rodríguez JM, Navarro NC, Baena AG, Medina PM (1996) Retroperitoneal fibrosis without dilatation of the upper urinary tract and non-obstructive anuria. Arch Esp Urol 49:69–72

  49. 49.

    Jiang X, Li X, He Y et al (2010) The diagnosis and treatment of reflex anuria caused by renal colic. Chin J Postgrad Med 33:68–69

  50. 50.

    Wang X (1988) Observation and nursing of reflex anuria. J Nurses Train 3:28

  51. 51.

    Gholyaf M, Afzali S, Babolhavaegi H, Rahimi A, Wagharseyedayn SA (2009) Reflex anuria affecting both kidneys following hysterectomy. Saudi J Kidney Dis Transpl 20:120–123

  52. 52.

    Xie H, Xu M, Geng H et al (2005) Reflex anuria in children: a report of 7 cases. Chin J Pediatr Surg 26:638–641

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The authors wish to express great thanks to Yihong Jia (Plastic and Aesthetic Surgery Center, PUMCH) for his technical assistance.

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Correspondence to Zhigang Ji.

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Hou, W., Wen, J., Ji, Z. et al. Reflex anuria: an old concept with new evidence. Int Urol Nephrol 46, 323–328 (2014). https://doi.org/10.1007/s11255-013-0541-9

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  • Anuria
  • Renal artery
  • Ureteral colic
  • Renal disease
  • Oliguria