Assessment of the Renal System
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| Ureters | Hollow tube from each kidney. Connects to urinary bladder. Ends at the trigone.
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| Bladder Function | Temporary storage site. Provides continence. Enables voiding.
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| Urethra | Narrow tube. Purpose: elimination. Men:6-8 inches long. Women: 1-1.5 inches long.
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| Renal Changes with Age | Reduced ability to filter blood and waste. Blood flow decreases. GFR decreases. Decreased ability to concentrate urine. Less efficient ability to regulate solutes. Hormonal changes = decreased renin secrection, aldosterone, activation of Vit D.
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| Urinary Changes with Aging | Decreased bladder capacity. Reduced ability to urinate, trouble starting stream. Decreased tone of urinary sphincters (incontinence prone).
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| Patient History related to Renal | Disease hx: Neuropathy, HTN, Polycystic Kidney Disease. Symptom hx: Problems, Trouble going, UTIs, Color, Odor, Make it in time, Burning, tingling, Sexual Hx, Breif/pad “just in case”. Occupation, hobbies: Nursing (hold it), Hairdressers, Truckers.
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| Daily Fluid Intake Should be | 3L/day
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| Physical Assessment for Renal | General appearance, Skin color, rashes, bruising, edema (pedial, pretibial, sacral, orbital), Ausculation of lungs, fluid backup, Wt (fluid gain), BP, LOC, any cognitive changes
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| Kidney, Ureters, and Bladder Assessment | Inspection: Asymmetry, discoloration. Ausculation: Bruit at renal arteries. Palpate: Light only. Percussion: Bladder=dull, Flank.
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| Urethra Assessment | Discharge. Lesions, rashes of genital area. Urethrial irritation. Anatomical abnormalities. Hygiene.
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| Serum Creatinine | (0.5-1.5mg/dL), Measures breakdown of muscle, High – kidney damage (nephron), 50% lost before ever shown, Low is also damage, but mostly seen high.
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| BUN | (5-25 mg/dL), Elevation suggests renal disease. Low BP or Dehydration will show elevation also.
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| BUN to Creatinine ratio | 10:1. Ratio off = usually other problems. Ratio same, but levels high = kidney issues.
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| GFR (glomerulor function ratio) | 90-120 mL/min. Detects changes in kidney function.
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| Urinalysis | Color, Odor, Turbidity (Cloudy/thick/syrupy), Specific gravity (Low – Diluted, High – Concentrated). pH 4.5 – 8. Glucose Should be Negative.
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| UA cont | Ketones (Protein and fat breakdown normally not in urine, but may be in high protein diet, High exercise, Diabetic Ketoacidosis). Protein elevated during stress, toxemia, excessive exercise. Bilirubin should be negative, hepatic disease or renal failure.
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| UA cont | RBCs Rare. WBC 3-4, Infection/inflammatory. Cast occasional, fever, Kidney stone, Heart Failure. Crystals occasional, specimen is old or Gout. Bacteria > 1000/ml indicates UA culture. Parasites microscopic.
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| UA cont | Leukoesterase on UA, increasing WBC in urine, will be + or - . Nitrites on UA, indicates E. Coli, will be + or -. Culture and sensitivity (C & S), take before antibiotics, another 7 days post treatment.
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| UA cont | Composite Urine collection, 24hr urine, dispose of first void then start time, on ice if indicated. Creatinine clearance. Urine electrolytes mostly checking sodium. Urine Osmolarity.
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| Bladder scan | Looking for bladder distention, Palpate instead. Not use on pregnant women, displaced bladder, will show inaccurate.
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| X-rays (KUB) | Location and size, Supine Position
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| IV pyelogram (IVP) | Inject dye, take serial x-rays as dye passes through, May use laxative to keep picture clear, Assess for allergies, Increase fluids after
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| Renal Imaging | CT. Ultrasonography: Bladder should be full.
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| Renal Arteriography | Not used much, replaced by cystoscopy, Dye injected to femoral artery
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| Cystoscopy | Cystourethroscopy dye goes straight into bladder, retrograde procedures, catheter, visual scope.
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| Urodynamic Studies | Cystometrogram (CMG). Urine stream testing. Looks at muscles, how long does it take to stop urine flow.
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| Renal biopsy | Prone. Apply pressure. Watch urine output. Percutaneous (NPO, Risk of bleeding, Prone position during procedure, Apply pressure x 20 minutes, Monitor dressing site, s/s bleeding, VS, UO, Internal bleed-flank pain, decreased BP, UO, signs of hypovolemia.
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