urinary labs Flashcards
dark yellow + amber or honey urine
dark yellow - normal, probably drink some water
amber/honey - not enough water, drink now
syrup/brown ale urine
possibility of liver disease OR severe dehydration
*drink water + see HCP if persist
pink to reddish urine
beets, blueberries, rhubarb may change color
possibly blood
sign of kidney disease, tumors, UTI, prostate problems
possible if lead or mercury poisoning
contact HCP
orange urine
not drinking enough water
liver or bile duct condition
could be food dye
contact HCP
how is turbidity evaluated?
holding the specimen in front of a line of printed material –> urine is graded as clear, slightly cloudy, cloudy, or turbid (very cloudy)
urinary: blood studies
Cr
BUN
K
Ca (total)
Phosphorus
creatinine
normal: 0.5-1.2 mg/dL
specific to kidneys - more reliable indicator of renal fxn than BUN
breakdown of muscle and protein metabolism and is released at a consistent rate
<0.5: muscle atrophy
>1.2: impaired renal fxn
BUN
normal: 10-20 mg/dL
non renal factors: (increase BUN, no inc/dec for Cr)
-high nitrogen TFs or high PRO diet
-GI bleed
-hydration status
potassium
normal: 3.5-5
kidneys excrete majority of K+
kidney disease –> K+ is one of the first electrolytes to become abnormal
> 6.0 = cardiac dysrhythmias + muscle weakness
calcium (total)
normal: 9-10.5
kidney disease –> decrease reabsorption of Ca leads to “renal osteodystrophy” (weakened bones)
phosphorus
normal: 3-4.5
inversely r/t Ca
kidney disease –> typically high bc kidney is primary excretory muscle
magnesium
normal: 1.3-2.1
increase with kidney disease because excreted by kidney
urinalysis includes (10)
bilirubin, color, glucose, ketones, odor, pH, protein, RBCs, specific gravity, WBCs
considerations of a urinalysis
first morning best
analyze within 1 hour
normal findings on an urinalysis
- bilirubin: none
- color: amber yellow
- glucose: none
- ketones: none
- odor: aromatic/none
- pH: 4.6-6
- protein: zero to trace
- RBCs: 0-4
- specific gravity: 1.010 - 1.030
- WBCs: 0-5
diagnostic studies
- creatinine clearance
- eGFR
- bladder scan
- urine culture - clean catch
- cystoscopy
- kidney, ureter, bladder (KUB)
- intravenous pyelogram (IVP)
- retrograde pyelogram
- renal biopsy
- non-contrast spiral CT
creatinine clearance
approximates GFR
24-hr urine collection
discard first urine when begin testing
save all subsequent urine for 24 hours
have patient urinate at end of 24 hours and add to collection
measure serum Cr during 24-hr period
considerations with 24-hour urine container
keep cold/refrigerated
GFR
glomerular filtration rate - amount of blood filtered per minute by glomeruli
estimated GFR (eGFR)
calculation that takes into consideration the patient’s age, sex, weight, ethnicity
considerations with 24-hour urine container
keep cold/refrigerated
bladder scan
done at bedside w/ water soluble gel
calculates presence of residual urine
clean-catch urine
confirms suspected UTI & identifies causative agents
sterile container
cleanse meatus (bladder is sterile; urethra is not)
collect specific 1-2 seconds after voiding starts
cystoscopy
main goal: inspect interior of bladder wall
lithotomy position
consent form
post-cystoscopy procedure
expected findings: burning, pink-tinged urine & frequency
NOT normal: bright red blood
kidneys, ureter, bladder (KUB)
Xray of abd & pelvis
bowel prep
delineates size, shape, and position of kidneys + radiopaque stones (struvite)
intravenous pyelogram (IVP)
requires bowel prep
check iodine sensitivity (avoid anaphylaxis –> uses contrast)
expect flushed feeling with injection
force fluids afterwards
consider alternative if Cr elevated
*dye injected and kidneys uptake it
retrograde pyelogram
done if:
-IVP doesn’t visualize good
-pt is allergic to contrast medium
-pt has decreased renal fxn
*cystoscope and urethral catheters are used
*prep same as IVP; complications same as cystoscopy
*dye doesnt get in blood so OK if you have an iodine allergy
pyelogram indicates for which part of the body
renal pelvis
renal biopsy
assess coag hx (PT, INR, platelets)
sign consent form
pt not taking ASA or warfarin (thins blood)
performed on the kidney - backside below bottom ribs
post-renal biopsy procedure
apply pressure dressing
keep on affected side 30-60 minutes
bedrest 24 hours (minimize movement + bleeding)
VS q 5-10 min for 1 hour
assess for flank pain or signs of bleeding
no heavy lifting x7 days
