Chapter 53 Renal Assessment

Question 0

What questions are asked about health history?

Answer 0

• Major illnesses
• Recurrent minor illnesses
•Accidents or injuries
• Surgical procedures, and
allergies
• Related disorders such as
hypertension
• Have you ever had a urinary infection?
• Are you taking herbal medications or prescription, over-the-counter, or recreational drugs?
• Do you have pain or burning on urination?
• Is initiating urination difficult?
• What color is your urine?
• Are you allergic to drugs, foods, or other products? If yes, describe the reaction you experienced.
• Have you ever had a sexually transmitted disease (STD)?

Question 1

What is part of the assessment for chief complaint?

Answer 1

• urinary frequency and urgency
• difficulty urinating
• pain on urination
• flank pain

Question 2

What questions should be asked regarding family history?

Answer 2

Ask if blood relatives have ever been
treated for renal or cardiovascular disorders, diabetes, cancer, or
other chronic illness.

Question 3

What are the components of urinalysis and urine culture?

Answer 3

• Urine color
• Urine clarity and odor
• Urine pH and specific gravity
• Tests to detect protein, glucose, and ketone bodies in the urine (proteinuria, renal glycosuria, and ketonuria, respectively)
• Microscopic examination of the urine sediment after centrifugation to detect RBCs (hematuria), white blood cells (pyuria), casts (cylindruria), crystals (crystalluria), and bacteria (bacteriuria)

Question 4

What is specific gravity?

Answer 4

An expression of the degree of concentration of the urine that measures the density of a solution compared to the density of water (1.000)

Question 5

What does osmolality measure?

Answer 5

Urine osmolality evaluates the diluting and concentrating ability
of the kidneys. It may aid in the differential diagnosis of polyuria,
oliguria, or syndrome of inappropriate antidiuretic hormone secre-
tion.

Question 6

What are renal function tests and what do they measure?

Answer 6

Renal concentration tests, creatinine clearance and serum creatinine and blood urea nitrogen. Renal function tests are used to evaluate the severity of kidney disease and to assess the status of the patient’s kidney function.

Question 7

What are renal radiological imaging tests?

Answer 7

Radiologic and imaging studies help screen for renal and urologic
abnormalities. These studies include computed tomography (CT)
scan, excretory urography, kidney-ureter-bladder (KUB) radiogra-
phy, magnetic resonance imaging (MRI), radionuclide renal scans,
renal angiography, ultrasonography, and voiding cystourethrography.

Question 8

What are renal CT scans used for?

Answer 8

In a renal CT scan, the image’s density reflects the amount of radiation absorbed by renal tissue, thus permitting identification of masses and other lesions.

Question 9

What is excretory urography?

Answer 9

After I.V. administration of a contrast medium, this common pro-
cedure (also known as I.V. pyelography) allows visualization of
the renal parenchyma, calyces, pelvises, ureters, bladder and, in
some cases, the urethra.

Question 10

What is KUB radiography?

Answer 10

The KUB study, consisting of plain, contrast-free X-rays,
shows kidney size, position, and structure as well as calculi and
other lesions.

Question 11

What is renal MRI used for?

Answer 11

MRI can provide precise images of anatomic detail and important biochemical information about the tissue examined and can efficiently visualize and stage kidney, bladder,
and prostate tumors.

Question 12

What is a radionuclide renal scan?

Answer 12

I.V. injection of a radionuclide, followed by scintiphotography. Observation of the uptake concentration and radionuclide transit during the procedure allows assessment of renal blood flow, nephron and collecting system function, and renal structure.

Question 13

What is renal ultrasonography used for?

Answer 13

The pulse-echo transmission technique of this test determines the kidney’s size, shape, and position. It also reveals internal structures and perirenal tissue and helps the practitioner
diagnose complications after kidney transplantation.

Question 14

What are CT and MRI used for in the renal patient?

Answer 14

They provide excellent cross=sectional views of the anatomy of the kidney and urinary tract. They are used to evaluate genitourinary masses, nephrolithiasis, chronic renal infections, renal or urinary tract trauma, metastatic disease, and soft tissue abnormalities.

Question 15

What is retrograde pyelography and why is it used?

Answer 15

Catheters are advanced through the ureters if IV urography provides inadequate visualization.

Question 16

What is cystography used for?

Answer 16

Evaluating urine backflow into the ureters.

Question 17

What is voiding cystourethrography?

Answer 17

In voiding cystourethrography, a urinary catheter inserted into the
bladder allows instillation of a contrast medium by gentle syringe pressure or gravity. Fluoroscopic films or overhead radiographs demonstrate bladder filling and then show excretion of the con-
trast medium as the patient voids.

Question 18

What is renal angiography?

Answer 18

It provides an image of the renal arteries.

Question 19

What is a MAG3 Renogram?

Answer 19

A relatively new scan to further evaluate renal function.

Question 20

What is a urologic endoscopic procedure?

Answer 20

Endourology is used to directly visualize the urethra and bladder. The cystoscope is inserted through the urethra into the bladder, providing a magnified, illuminated view of the bladder.

Question 21

What is a brush biopsy?

Answer 21

Using a cystoscope, a brush is passed over abnormal cells to obtain a very small sample for analysis.

Question 22

What is a kidney biopsy used for?

Answer 22

Diagnosis and evaluation of the extent of kidney disease.