Urinary assessment and tests Flashcards
What is a normal GFR?
125 ml/min
This is the amount of blood filtered in one minute by kidneys
Where does filtration take place?
Glomerulus
Where does the bulk of reabsorption take place?
Proximal tubule
What is relationship between kidneys and erythropoietin?
Erythropoietin is a hormone made by kidneys. Stimulates the production of RBCs in bone marrow.
What is the term for pain from kidney stone?
Renal colic
What is normal urine output for adult daily?
1500 ml
What are some health issues that deplete kidney function?
HTN
Diabetes
Gout
Connective tissue disease like SLE
HIV
Infection
Neuro problems (CVA, neuro injury)
What is daytime voiding called?
Nightime voiding?
Diurnal voiding
Nocturia
What are some commonly used meds that are nephrotoxic?
–6–
Vanc (and many other ABx)
NSAIDS
ACE inhibitors
Captopril
Lithium
Statin drugs
What are some health hx info questions to ask for in urinary system problems?
Energy levels
Vision changes
Weight changes
Fluid intake habits
Skin itchiness
Urination habits
Family history of kidney disease
Surgical Hx
GI health
What is excoriation?
Skin picking (can be a sign of poor kidney function)
What is the significance of the CVA (costovertebral angle)?
Good location to check for kidney tenderness.
Can do a fist percussion test
What qualifies as anuria?
No urine (less than 100 mL in 24 hrs)
What is enuresis?
Bed wetting
What is considered oliguria?
100—400 mL of urine within 24 hours
What does the presence of bilirubin in urinalysis indicate?
Liver disease or injury
What does the presence of glucose in urine indicate? (glycosuria)
Diabetes
What does presence of ketones in urine indicate?
Diabetes
Starvation
Dehydration
Severe vomiting/diarrhea
What does presence of proteins in urine indicate? (proteinuria)
Kidney disease
Heart failure
What is a normal B-U-N level?
10—-20 mg/dL
Too high may be from:
Kidney disease
Infection
Fever
GI bleeding
Trauma
Excessive exercise
Muscle breakdown
What is best time to obtain a urinalysis?
First void of morning
How soon must a urinalysis be examined after collection?
1 hour
–can refrigerate if need–
What does creatinine clearance measure?
It tells us how well kidneys are removing creatinine (a waste product) from the body
Creatinine clearance is the most accurate indicator of kidney function.
What is difference between creatinine clearance test and serum creatinine test?
Creatinine clearance test compares the difference between 2 things: creatinine in urine (for 24 hours) and creatinine in blood. This reveals how much creatinine kidneys are eliminating. These are not commonly done in hospital.
Serum creatinine is just a blood test to measure amount of creatinine in blood. This is used to measure kidney function. It is the blood test to determine AKI. Common.
What is a cystoscopy?
Lighted scope in bladder
What is a cystogram?
Contrast in bladder»then visualizes bladder for abnormalities (usually with cystoscope)
–A urethrogram is similar–
What is KUB?
X-ray of:
Kidneys
Ureters
Bladder
What is a nephrostogram?
Contrast in kidneys»Then visualization
What is a renal scan?
Evaluation of anatomy, blood flow and function by injecting radioactive isotopes then scanning.
What are some of the functions of the kidneys?
Excretes wastes
Controls volume and composition of ECF
Controls BP
Makes erythropoietin
Activates Vit D
Regulates acid/base balance
What is the kidney hilus?
Medial sides of kidneys
Place where arteries/veins/ureter enter and exit kidney
What is the Bowman’s capsule?
The surrounding wrapping of the glomerulus. When filtration happens, the filtrate is housed in the Bowman’s capsule. Leaves Bowmans and goes to proximal convoluted tube.
What is urine NOT supposed to contain?
Blood
Platelets
Large plasma proteins
What does aldosterone do?
Hangs onto Na+ and water
Kicks out K+
Comes from adrenal cortex
What role does the right atrium play in fluid balance?
Detects volume overload
Secretes ANP (atrial natriuretic peptide)
ANP excretes Na+ and water
Works in opposition to ADH and renin
What is the UPJ?
Ureter Pelvic Junction
Where kidney and ureter meet. Valve that keeps reflux
Sometimes calculi get stuck here because narrower
What is the UVJ?
Ureter Vesical Junction
Where ureter and bladder meet
Valve that keeps reflux
Sometimes calculi get stuck here because narrower
What is role of hypothalamus in fluid balance?
Osmorecetors in the hypothalamus are activated by an increase in plasma osmolarity or water deficit. This is the chain that follows:
Increase salt or decrease body water….
Hypothalamus alarms….
Thirst kicks in…
Pituitary sends out ADH (vasopressin) to kidneys….
Kidneys hang onto water
This combo of increased thirst and conservation of water restores balance
What does the RAAS system do?
Manages drops in BP by activating Angiotensin 2 and aldosterone to increase BP
What are normal changes to urinary system in geri population?
Kidneys slow down=Decreased GFR, Increased BUN
Muscle weakness and decreased tone=
Urinary retention
Stress incontinence
Overactive bladder
Prostate enlargement
What is a composite urine collection test?
Urine specimens collected over time period (usually 24 hours)
What is a creatinine clearance test?
Tests how much waste product of protein breakdown is happening.
24 hour urine specimen
What is a residual urine test?
Bladder scan (right after pt urinates)
Or Cath patient right after urinate
What is a urine cytologic study?
Urine sample for identifying abnormal cells-used to detect bladder cancer cells
What is VCUG?
Voiding cystourethrogram
Voiding study of bladder opening and urethra. Bladder filled with contrast. Films taken of journey of urine in bladder and urethra. Looking for structural problems
What is an IVP?
IV pyelogram
IV injection of contrast. Evaluates size and shape or GU
Pts with decreased renal function should not get this.
Many times must give enema before.
What is a renal arteriogram?
Looks at renal blood vessels
Goes into femoral artery
May need enema before
What is a retrograde pyelogram?
Cystoscope inserted and ureteral catheters inserted into kidneys then contrast given into kidneys
Xray then taken to watch journey of contrast
What type of bowel prep is contraindicated in kidney failure?
Fleet enema
Magnesium citrate (oral drink)
What is caution with contrast in kidney disease?
Iodine based contrast hard on kidneys
Can create further damage called contrast induced kidney injury (CIN)
Keep patient well hydrated and give N-acetylcysteine
What is VUR?
This is a condition not a test
Vesicoureteral Reflux
–Backflow of urine from bladder up into ureter–
Can be a congenital anomaly in kids
What are some s/sx of UTI in infants?
Fever
Hypothermia (in Neonate)
Crying
Urine color/odor
Poor weight gain
Feeding poorly
What are some s/sx of UTI in children?
Abdominal pain or suprapubic pain
Voiding frequency/urgency
Dysuria
New enuresis
Fever
What is a cystometrogram?
Catheter inserted, water instilled in bladder. Ballon on catheter measures the bladder’s capacity to contract and expel urine.
What does a radionuclide cystography measure?
Detects and grades vesicoureteral reflux
A radioisotope tracer is put into bladder.
What is hypospadias? Epispadias? Which is more common?
Hypo-below its normal opening
Epi-Above its normal opening
Hypo much more common.
What is a urine flow study? (also called a uroflow)
Measures urine volume in single voiding
What is a Whitaker study?
Looking for ureteral obstruction
Catheter inserted into kidney and bladder. Fluid infused and measures pressure differential between kidney and bladder.
What is a normal serum creatinine in men? Women?
Men: 53—106
Women: 49—97
