Assessing decreased urine output.

Decreased urine output may indicate that your patient has acute renal failure. Do not assume that your patient is simply dehydrated, instead, look for risk factors of renal dysfunction.

Now this is a decision you have to make when you are looking at a patient with decreased urine output. It could be one of two major things that are happening now to cause the decrease: it could be he is dehydrated or needs fluid volume, or it could be a sign of early renal dysfunction.

***Renal function can be estimated using an estimated creatinine clearance or by glomerular filtration rate, in addition to the 24-hour urine.***

Look for risk factors such as hypertension and diabetes. Patients with hypertension and diabetes have ten times the risk of renal dysfunction over patients who do not. Look for a recent urinary tract infection, also for decreased blood pressure or maybe the presence of nephrotoxic drugs. All of these things can decrease renal function and lead to acute renal dysfunction and renal failure. When you are assessing your patient, look at his creatinine clearance (24-hour urine). Creatinine clearance gives you an indication of renal function, whereas the BUN and creatinine are only going to give you an indication of renal failure.

Make a "Hit List"

--Age

--Shock

--Sepsis

--Nephrotoxic drugs

Look at decreased urine output as a multi-factoral event.

Is it dehydration or could it be acute renal dysfunction? Observation: decreased urine output. Question: is it dehydration or acute renal dysfunction?

David W. Woodruff, MSN, RN, CNS, CEN, www. Ed4Nurses.com reprinted with permission.