Introduction: Psychic anuria is an old term, referring to a very rare psycho-urological event that has scarcely been studied so far. Materials and Methods: A retrospective study of the patients with psychic anuria presented to Assiut Urology and Nephrology Hospital during the period July 1991–June 2016 was done. Psychic anuria was defined, and the demographic and clinical characteristics including the methods of diagnosis and management were studied. Results: Of more than 3,800 cases of anuria, 9 female patients (0.24%) experienced psychic anuria in the age range of 17–43 years. Cardinal clinical findings included anuria for 36–72 h with absence of organic causes and normal renal function tests. Psychosocial risk factors were reported in the 9 cases. Anuria was documented by reliable history (56%) or observable urine collection (44%). Diagnosis was done by exclusion, where the investigations revealed no organic causes. Seven cases responded to the placebo intervention and 2 cases were self-limiting and resolved spontaneously. Conclusions: Psychic anuria is an extremely rare urological emergency that presents, mainly, in young adult females with unknown mechanisms. Renal vasoconstriction following psychosocial stressors is suggested. It is diagnosed by exclusion and resolves spontaneously or responds to placebo intervention as a mental distraction technique.

Keywords:
Anuria, Hysterical anuria, Placebo effect, Psychic anuria, Reflex anuria, Renal vasospasm
1.
Basile DP, Anderson MD, Sutton TA: Pathophysiology of acute kidney injury. Compr Physiol 2012; 2: 1303–1353.
2.
Singh K, Wang ML, Nakaska M: Reflex anuria. BJU Int 2011; 108: 793–795.
3.
Tracy E: Reflex renal suppression. J Urol 1950; 64: 63–73.
4.
Hou W, Wen J, Ji Z, Chen J, Li H: Reflex -anuria: an old concept with new -evidence. Int Urol Nephrol 2014; 46: 323–328.
5.
Morris CH, Windsor NS: Anuria psychic? Nova Scot Med Bull 1935; 14: 292.
6.
Edward JF: Psychic Anuria. Urologic Cutan Rev 1940; 44: 394–397.
7.
Auerback A, Burkland CE, Parade GW, Ross JC, Smith DR, Williams WW: Functional disturbances; in Andersson L, Gittes RF, Goodwin WE, Lutzeyer W, Zingg E (eds): Encyclopedia of Urology. Berlin Heidelberg, Springer-Verlag, 1960, vol. 12, p 312.
8.
Sachs BD: The false organic-psychogenic distinction and related problems in the classification of erectile dysfunction. Int J Impot Res 2003; 15: 72–78.
9.
Doleys DM, Meredith RL: Urological disorders; in Doleys DM, Meredith RL, Ciminero AR (eds): Behavioral Medicine. Boston, MA, Springer, 1982.
10.
Sakakibara R, Uchiyama T, Awa Y, Liu Z, Yamamoto T, Ito T, Yamamoto K, Kinou M, Yamaguchi C, Yamanishi T, Hattori T: Psychogenic urinary dysfunction: a uro-neurological assessment. Neurourol Urodyn 2007; 26: 518–524.
11.
Bhatia MS, Goyal A, Saha R, Doval N: Psychogenic polydipsia – management challenges. Shanghai Arch Psychiatry 2017; 29: 180–183.
12.
Cumston CG: The Surgical Aspects of Anuria. The Annual Meeting of the American Urological Association. Boston, USA, June 1906.
13.
Adediran S, Dhakarwal P: Reflex anuria: a rare cause of acute kidney injury. J Com Hosp Int Med Persp 2014; 2014: 23423.
14.
Chapman BJ, Horn NM, Robertson MJ: Renal blood-flow changes during renal nerve stimulation in rats treated with alpha-adrenergic and dopaminergic blockers. J Physiol 1982; 325: 67–77.
15.
Eloul L, Ambusaidi A, Al-Adawi S: Silent epidemic of depression in women in the Middle East and North Africa Region: emerging tribulation or fallacy? Sultan Qaboos Univ Med J 2009; 9: 5–15.
16.
Lee JY, Brook JS, Finch SJ, De La Rosa M, Brook DW: Joint trajectories of cigarette smoking and depressive symptoms from the mid-20s to the mid-30s predicting generalized anxiety disorder. J Addict Dis 2017; 36: 158–166.
17.
Pandya SK: Understanding brain, mind and soul: contributions from neurology and neurosurgery. Mens Sana Monographs 2011; 9: 129–149.
18.
Ball D: Metabolic and endocrine response to exercise: sympathoadrenal integration with skeletal muscle. J Endocrinol 2015; 224:R79–R95.
19.
Chrousos GP: Organization and integration of the endocrine system. Sleep Med Clin 2007; 2: 125–145.
20.
Morgan JA, Corrigan F, Baune BT: Effects of physical exercise on central nervous system functions: a review of brain region specific adaptations. J Mol Psychiatry 2015; 3: 3.
21.
Kajantie E, Phillips DI: The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology 2006; 31: 151–78.
22.
Kurtz A: Endocrine functions of the renal interstitium. Pflugers Arch 2017; 469: 869–876.
23.
Xu J, Li G, Wang P, Velazquez H, Yao X, Li Y, Wu Y, Peixoto A, Crowley S, Desir GV: Renalase is a novel, soluble monoamine oxidase that regulates cardiac function and blood pressure. J Clin Invest 2005; 115: 1275–1280.
24.
Kuro OM: Phosphate and Klotho. Kidney Int Suppl 2011; 79:S20–S23.
25.
Chen CD, Sloane JA, Li H, Aytan N, Giannaris EL, Zeldich E, Hinman JD, Dedeoglu A, Rosene DL, Bansal R, Luebke J, Kuro-o M, Abraham CR: The antiaging protein Klotho enhances oligodendrocyte maturation and myelination of the CNS. J Neurosci 2013; 33: 1927–1939.
26.
Mitra V, Metcalf J: Metabolic functions of the liver. Anesth Intens Care Med 2009; 10: 334–335.
27.
Johnson MH: How does distraction work in the management of pain? Curr Pain Headache Rep 2005; 9: 90–95.
28.
Sliwinski J, Elkins GR: Enhancing placebo effects: insights from social psychology. Am J Clin Hypn 2013; 55: 236–248.
29.
Hipsley PL: A critical review of cases of so-called reflex anuria, with the report of a case (case #6). Med J Aust 1940; 52: 602–606.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.