Anuria

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Ok, so my patient is in ESRD and recently stopped producing urine all together - anuric, anuresis....

I'm only asking this question because I have stupidly left my medical dictionary book in school and am off for the next two weeks - STUPID STUPID STUPID me! But anyway - my question is, I understand she is in end stage renal disease so obviously her kidneys are not functioning. She has been going for hemodialysis for the past year... what happens to the urine?? Maybe that sounds like a stupid question - but I'm curious, any fluids she takes in or any food she eats, how is this excreted now?

Am i making sense in my question?

I guess I'm just not really familiar in the specifics of End stage Renal disease nor am I familiar with anuria because this is the first patient I've had with either. If any of you can reference a site to look at or some other information it would be great. I've been searching online and can't seem to find anything really useful except the definition of both.

THANKS!

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Specializes in Hospital Education Coordinator.

she is not making urine probably. Fluids can be excreted thru the kidney or bowel, so I believe she is either excreting them thru the bowel or retaining them. Solids are not affected - they are excreted thru the bowel of course. She is retaining the toxins and waste that normally is excreted thru the urine which will put her in grave danger when the toxin level exceeds the body's ability to deal with it.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

in esrd the kidneys are not making urine. the fluid builds up in the person's system. they are often on a fluid restriction. fluid is removed during hemodialysis. the patient will be weighed before and after dialysis to help determine how much water weight was dialyzed off.

  • http://www.kidneyschool.org/splash/toc.shtml -- kidney school! this is an online resource for patients to learn everything they ever wanted to know about kidney disease. each link goes to a self-learning module explaining such things as how the kidneys work, how they fail, treatment options and much much more. there are 16 modules you can access.
  • http://www.renalinfo.com/us/en/display/how-kidneys-work-and-fail -- what is kidney failure? a online informational resource from baxter. it is written for patient education, but has nice explanations of what is happening when the kidneys fail. has some animated pictures with sound on how the kidneys work.

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in esrd the kidneys are not making urine. the fluid builds up in the person's system. they are often on a fluid restriction. fluid is removed during hemodialysis. the patient will be weighed before and after dialysis to help determine how much water weight was dialyzed off.

  • http://www.kidneyschool.org/splash/toc.shtml -- kidney school! this is an online resource for patients to learn everything they ever wanted to know about kidney disease. each link goes to a self-learning module explaining such things as how the kidneys work, how they fail, treatment options and much much more. there are 16 modules you can access.
  • http://www.renalinfo.com/us/en/display/how-kidneys-work-and-fail -- what is kidney failure? a online informational resource from baxter. it is written for patient education, but has nice explanations of what is happening when the kidneys fail. has some animated pictures with sound on how the kidneys work.

kidney school is such an excellent resource!!! i had my community nursing clinical in a dialysis center and i found this site when getting information for my inservice. i ordered the postcards for the facility and they were pretty excited about it too! so valuable!

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she is not making urine probably. Fluids can be excreted thru the kidney or bowel, so I believe she is either excreting them thru the bowel or retaining them. Solids are not affected - they are excreted thru the bowel of course. She is retaining the toxins and waste that normally is excreted thru the urine which will put her in grave danger when the toxin level exceeds the body's ability to deal with it.

As Daytonite said - fluids and wastes are removed through dialysis. It is important to remember that is possible to remove just the waste or just the fluids, depending on the pt's wt prior to dialysis and on what their weekly labs are showing.

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I understand that there is no urine being produced - but just wasn't sure about the fluids building up in the person's system. I also thought the same thing about the fluid restriction for this reason and asked the nurse but when she told me no shes not on any restrictions, I thought maybe I'm missing something here. And being the patient is only going for dialysis 3 days a week what happens the other 4 days?? I don't know just rambling on....

Thanks for the sites Daytonite! Very informative!!

Thanks again!

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Specializes in Rehab, Med Surg, Home Care.

It's pretty common for patients undergoing hemodialysis to not void, although there seems to be a lot of variation from one individual to another. I never assume anymore, I just ask the patient what is normal for them so I can know what to expect (and prepare the oncoming nurse when they see there's no urine for the last shift/ last day!). When the pt is done with dialysis part of the dialysis nurse's report will be how many liters of fluid they removed from the pt in the session. My dialysis pts seem to be pretty tired and often thirsty after dialysis earlier in the day. They usually feel pretty good for the next day or so but then often feel increasingly unwell as the time passes until they are next dialysed.

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Hey, thanks for the last piece of my information...

It was a change for me, I had my patient on a Friday - she was voiding freely... And then Monday when I got to floor the nurse in charge was giving me morning report and announced the anuria situation which like I said I had never even heard of before so it kinda threw me off. Unfortunately, my patient is unable to verbalize with you... She has dementia and is very confused. She is on restraints because she keeps tryin to pull her permacath out. It kills me to have to put the restraints on her because she's such a pleasant lady but just doesn't understand not to scratch at the permacath. Oh boy - I know I have to harden up a bit... My professor tells me I'm too nice half the time : )

Next time I go in though - which unfortunately won't be for another two weeks - I'm definitely gonna try and check up on the dialysis reports and try to familiarize myself for future patients. I'm hoping I still have this patient when I return because I really grew attached to her - I've had her for three weeks!

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ESRD and dialysis are very interesting 'worlds'. I found it fasinating when doing my clinicals in dialysis! I really learned a lot from my mentor. Read up on it because each pt has such varying degrees of symptoms and needs for dialysis. It truely is amazing when you really get down to the nitty-gritty of it all. Definately check out the Kidney School website - absolutely a great rescource!

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Specializes in Medical.

It is unusual that she's not fluid restricted, though. Generally haemodialysis patients where I work are restricted to 500ml/day plus urine output because - as described above - their only way of losing fluid is through the gut, sweat and respiration (insensible fluid loss).

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I know it is unusual - but I specifically asked the first time I was assigned to her because she asked for water to drink, and everytime I have had her since I ask the nurse before I go into her room and I check her chart and it hasn't said anywhere that she is on restriction. She is on a Renal diet, that's about it.. but can have water when she's thirsty!

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Specializes in Medical.

Sorry if that sounded like I was questioning you - I was just remarking :)

It's unusual because the more fluid she has in the more needs to be taken off during dialysis, which worsen the side effects of haemo (like dizziness, nausea, light-headedness) and increases the risk of hypotension and myocardial infarction. If the fluid isn't taken off she's more prone to hypertension, congestive cardiac failure and acute pulmonary oedema.

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