Report anuria or sharply decreasing urine output, especially with a solitary or bilaterally obstructed kidney.
Before you read
Test yourself first: 1 question
Question 1 of 1
A client with benign prostatic hyperplasia (BPH) reports difficulty starting urination, a weak stream, and a sensation of incomplete emptying. The nurse recognizes the client is at increased risk for which complication?
Answer: A. BPH obstructs the bladder outlet, causing urinary retention. Retained, stagnant urine promotes bacterial growth and urinary tract infection, and back-pressure can lead to hydronephrosis and renal impairment over time. The presentation does not indicate dehydration, diabetes insipidus, or hyperkalemia from the obstruction itself.
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What is hydronephrosis?
Causes include kidney stones, strictures, tumors, an enlarged prostate (BPH), and congenital anomalies. Relieving the obstruction promptly is essential to preserve kidney function.
Key points to remember
- It results from an obstruction anywhere along the urinary tract that backs urine up into the kidney.
- Presentation depends on the cause and acuity: flank pain, decreased urine output, signs of UTI, or it may be silent and found on imaging.
- Bilateral obstruction or obstruction of a solitary kidney can cause acute kidney injury and rising BUN/creatinine.
- Treatment is aimed at relieving the obstruction (stent, nephrostomy tube, stone removal, treating BPH) before permanent damage occurs.
- Prolonged or unrelieved obstruction leads to irreversible kidney parenchymal damage and loss of function.
- After obstruction is relieved, a postobstructive diuresis can occur, requiring close fluid and electrolyte monitoring.
Common causes
- Stones, BPH, tumor, stricture
Signs & symptoms
- Flank pain, ↓urine output
- ↑BUN/creatinine, hematuria
Nursing priorities
- Monitor urine output strictly and assess for decreasing output or anuria.
- Monitor renal function (BUN, creatinine) and fluid/electrolyte balance.
- Assess and manage pain and prepare the patient for procedures to relieve obstruction (stent, nephrostomy).
- Maintain patency of any urinary drainage device (catheter, nephrostomy tube, stent) and record drainage.
- After relief of obstruction, monitor for postobstructive diuresis and replace fluids/electrolytes as ordered.
Labs & values
Patient teaching
- Report decreased urination, flank pain, or fever promptly, since relieving the blockage protects the kidney.
- If you have a nephrostomy tube or stent, keep it secure and report leaking, blockage, or no drainage.
- Stay hydrated as directed and complete any treatment for the underlying cause (stones, prostate, infection).
- Keep follow-up appointments to confirm the obstruction has resolved.
Red flags: report now
- Report anuria or sharply decreasing urine output, especially with a solitary or bilaterally obstructed kidney.
- Report rising creatinine/BUN, severe flank pain, or fever with obstruction (obstructed infected system is an emergency).
- Report a blocked or non-draining nephrostomy tube or catheter immediately.
References
Clinical references for this topic
