Fluid balance and continence care
Barbara Smith, Linda Field in Nursing Care, 2019
Certain abnormalities occur in the production and the elimination of urine: Polyuria: this is the production by the kidneys of abnormally high amounts of urine, sometimes as much as several litres per day. Polyuria is usually associated with diseases such as diabetes mellitus, diabetes insipidus and chronic nephritis (inflammation of the nephrons within the kidney).Oliguria: this is decreased urine output, usually less than 500 mL a day or 30 mL an hour. Oliguria often indicates impaired blood flow to the kidneys or impending renal failure and should be dealt with immediately.Anuria: this is the absence of urine production. Anuria is a serious medical condition that usually follows oliguria. It must be treated immediately in order to prevent death from renal failure. Renal dialysis is used when the kidneys are no longer able to filter blood.
Example interview questions
David McGowan, Helen Sims in Making the Most of Your Medical Career, 2021
In this scenario you are being asked to assess an anuric post-operative patient. To ascertain the cause of this, you need to have a clear understanding of the patient’s fluid balance state. Categorise causes of anuria into pre-renal, renal and post-renal. In simple terms, the vast majority of surgical patients will either have pre-renal (i.e. shock, dehydration) or post-renal (i.e. obstructive) causes of oliguria. Your clinical assessment of a patient should clearly reveal which category is the cause of the patient’s anuria. Don’t forget it is important to note the urine output trend; that is, has the urine output gradually tapered off or has it stopped abruptly? The latter would suggest a possible obstructive cause; is the catheter kinked? If the urine output has gradually tapered off it suggests a pre-renal or renal cause. In this scenario, if you are told the patient is hypotensive, tachycardic and spiking temperatures and day 10 post Hartmann’s procedure then you would be highly suspicious of an abdominal collection causing septic shock resulting in anuria or oliguria. Low urine output management is determined by cause. For example, post-renal causes require intervention to relieve obstruction (e.g. catheter, ureteric stent or nephrostomy), while pre-renal causes require adequate fluid resuscitation.
Other lower urinary tract disorders
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
In those cases in which injury to the lower urinary tract goes unnoticed at the time of operation, the patient is likely to develop symptoms and signs within a few days postoperatively. These may include fever, abdominal or flank pain, abdominal distension, sepsis, decreased urine output and rising serum creatinine and leukocytosis. These result from the extravasation of urine into the peritoneal cavity or from ureteric obstruction. However, the presentation may be delayed and the patient subsequently complains of persistent discharge from a fistula or abdominal wound. Anuria may occur if there is bilateral ureteric injury. Sometimes, ureteric obstruction is only discovered many years later as an incidental finding.
Effects of sacubitril-valsartan in patients undergoing maintenance dialysis
Published in Renal Failure, 2023
Ying Ding, Li Wan, Zhou-cang Zhang, Qing-hua Yang, Jia-xiang Ding, Zhen Qu, Feng Yu
We retrospectively reviewed the data of ESRD patients undergoing HD or PD for at least 3 months in the Department of Nephrology, Peking University International Hospital from January 2015 to April 2022. All patients were regularly followed in the dialysis clinics. Patients with anuria were also included in the study. Those who received SV treatment for more than two weeks were enrolled in the SV group. Age and sex-matched patients who did not receive SV were selected from the rest as the control group (flow-chart presented as Figure 1). PD patients were treated with continuous ambulatory PD (CAPD) or automated PD (APD). HD patients were treated with thrice weekly intermittent HD (IHD). Patients prior prescribed ACEI or ARB were stopped 36 h before switching to SV treatment. SV was initiated by a small dose (50–100mg daily) and gradually titrated to the maximum tolerated dose. Other treatments did not change. The research complied with the Declaration of Helsinki, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The study was approved by the China Ethics Committee of Registering Clinical Trials (Ethics number: ChiECRCT20200463) and all participants provided written informed consent.
A longitudinal analysis of the relationship between serum uric acid and residual renal function loss in peritoneal dialysis patients
Published in Renal Failure, 2020
Chiehlun Yang, Xinxin Ma, Wenbo Zhao, Yanru Chen, Hongchun Lin, Dan Luo, Jun Zhang, Tanqi Lou, Yu Peng, Hui Peng
We identified 265 CAPD patients who fulfilled the inclusion criteria. Sixty-four PD patients were excluded from the analysis in accordance with the exclusion criteria, and consequently a total of 201 patients were included (Figure 1). Among patients enrolled, 21 (10.45%) patients transferred to hemodialysis or other dialysis centers, 21 (10.4%) underwent renal transplantation, 29 (14.4%) died, and 130 (64.7%) remained on CAPD (Figure 1). The baseline demographic and clinical statistics of the cohort are presented in Table 1, together with time-averaged values and medications used during follow-up period. The mean age of the patients was 48.32 ± 14.16 years and 60.7% of them were male (n = 122). Chronic glomerulonephritis (58.21%) was the most common cause of ESRD in these patients. Meanwhile, a higher percentage of CVD was observed in male patients. The mean UA level was 7.13 ± 3.26 mg/dL at baseline, with no gender difference. Only 10.5% of the study population received UA-lowering therapy at baseline. During the follow-up period of 23.43 ± 16.60 months, Eighty-six patients (42.8%) out of the 201 patients progressed to anuria. The blood pressure level, serum creatinine, and BUN level in all patients was significantly decreased during follow-up compared with baseline. However, TA-UA in both male and female patients was higher than baseline UA. Also, there was a significant increase in usage of urate-lowering drug, diuretics and RAS inhibitors during follow-up (Table 1).
Clinical features of children with anti-CFH autoantibody-associated hemolytic uremic syndrome: a report of 8 cases
Published in Renal Failure, 2022
Qian Li, Xinxin Kong, Minle Tian, Jing Wang, Zhenle Yang, Lichun Yu, Suwen Liu, Cong Wang, Xiaoyuan Wang, Shuzhen Sun
All patients showed typical manifestations of HUS, such as hemolytic anemia, thrombocytopenia, and acute kidney injury. All patients showed edema, gross hematuria, foamy urine, and jaundice. Seven patients (87.5%) presented with bleeding points on the skin and mucous membranes. Additionally, gastrointestinal bleeding and/or nosebleed was present in 2 patients (25%). Oliguria or anuria was seen in 6 cases (75%). Five patients (62.5%) presented with liver involvement. Hypertension was present in 2 patients (25%). One patient (25%) presented with pancreatitis (Case 4). One patient (25%) died of pulmonary hemorrhage (Case 1). One patient (25%) presented with convulsions caused by hypertension encephalopathy (Case 8) (Table 1).
Related Knowledge Centers
- Acute Kidney Injury
- Diabetes
- Mercury Poisoning
- Oliguria
- Urine
- Neoplasm
- Heart Failure
- Kidney
- Prostate
- Kidney Stone Disease