After a kidney transplant from a living donor, what is the typical pattern of urine output?

• A. It may be large and dilute.
• B. It will be absent for several days.
• C. It should be minimized to protect the graft.
• D. It is always highly concentrated.

Answer: (A)

After a living-donor kidney transplant, the transplanted kidney often produces a period of diuresis. This occurs because the graft has good perfusion and filters a large volume of fluid right away, while its tubular concentrating ability is not yet fully established in the immediate postoperative period. As a result, the urine output can be substantial and the urine tends to be dilute, since the kidney may not concentrate solutes effectively at first.

This pattern is expected and monitored closely. Adequate urine output is a positive sign of graft perfusion and function, but the high volume and dilute concentration also mean you need to ensure enough IV fluids to replace losses and prevent dehydration or electrolyte disturbances. If urine output were absent or severely reduced, that would raise concern for graft dysfunction or obstruction, and different management would be needed. Early concentrated urine is less typical because the concentrating mechanisms haven’t recovered yet.