assessment of the urinary system
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| Anatomy | 2 kidneys behind the peritoneum, on either side of the spinal cavity. Left Kidney is slightly longer and narrower than right. Right is lower than left.
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| blood through kidneys | Blood: afferent arteriole-glomerulus-efferent arteriole-proximal convoluted tubule-descending loop of Henle-Ascending Loop of Henle-Distal convoluted tubule-collecting duct
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| Renin | a hormone that helps regulates blood flow, glomerular filtration rate (GFR) and blood pressure. Secreted when sensing cells in DCT sense change in blood volume and pressure.
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| Aldosterone | a mineral that increases reabsorption of Na and is K+ secretion in DCT and CD; water and chloride follow sodium movement
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| Glomerular filtration | rate of 125 mL/min. GFR controlled by BP and blood flow. Larger particles;blood cells, albumin are too large to filter through the glomerular capillary walls. Therefore these substances are not normally present in the filtrate or in the final urine
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| Proximal Convoluted tubule | site for reabsorption of Na, Cl, water, glucose, amino acids, K+, Bicarbonate, Ph, urea
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| Renal Threshold | the limit to how much glucose the kidney can reabsorb: 220 mg/dL. A BG level of 220 or less, all glucose is reabsorbed & returned to the blood with no glucose in urine. When BGL are >220, some glucose stays in the filtrate and will be excreted in urine
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| Aging | tubular changes dec ability to concentrate urine:nocturnal polyuria. Inc risk of dehydration/hypernatremia.detrusor muscle elasticity leads to dec bladder capacity & ability to retain urine. Weakened urinary sphincter muscles & shortened urethra in women.
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| Erythroprotein (RBC) | sensitive to decreased oxygen in blood
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| Nitrogen in body | can change taste of food. This is a sign of renal failure. Ask about changes in appetite
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| meds | explore past and current use of OTC drugs, dietary supplements, vitamins & minerals, herbal agents, laxatives, analgesics, acetaminophen, NSAIDS. High doses of NDAIDS or aspirin can seriously reduce renal function: hypertension, hematuria or protein-uria
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| Assessment | Inspect abdomen & flank both supine and sitting. Listen for a bruit (audible swish)over each renal artery. Renal palpation: by a Dr, ask for tenderness & discomfort. If tumor or aneurysm is suspected, palpation may harm the pt.
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| Psychosocial assessment | concerns may evoke dear, anger, embarrassment, anxiety, guilt or sadness in the pt. urologic disorders may bring up forgotten memories of difficult toilet training.
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| Lab test | creatinine produced when protein or muscle breaks down,Filtered by the kidneys & excreted in urine, good indicator of kidney function. BUN measures excretion of urea nitrogen, by-product of protein breakdown in liver. Not a good indicator of function
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| BUN to creatinine ratio | when blood volume is deficient (dehydrated) or BP is low, the BUN level rises more rapidly than creatinine level. Ratio of BUN-creatinine is increased
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| Urinalysis | part of a complete exam for kidney disorder. Specific gravity of urine is the density of urine compared with water, SG of 1,000. Inc with dehy, dec kidney flow or presence of ADH. Dec when an increase of fluid intake, diuretic drugs & diabetes insipidus
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| Ketone bodies | are formed from incomplete metabolism of fatty acids. should not be present in urine.
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| Creatinine clearance | a calculated measure of glomerular filtration rate. Best indication of overall kidney function. Creatinine- 0.8-2/24h. dec indicated a deterioration in renal function. Inc occurs with infection, exervise, diabetes and meat meals
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| Sodium, Chloride | Na-40-220mEq/24hr. Cl- 110-250 mEq/24hr
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| Calcium, Protein | Ca-100-400mg/24hr. Protein-1-14mg/dL
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| Kidney, ureter and bladder x-ray | an x-ray of the kidneys, ureters, and bladder is a plain film of the abdomen obtained without any specific patient preparation. No discomfort or risk from the procedure. Taken in supine position
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| Intravenous urography | contrast dye can be kidney-damaging. Risk for contrast-induced renal failure is greatest in pt who are older or dehy, renal insufficiency, on nephrotoxic drugs.risk for contrast-induced nephrotoxicity need add IV fluids before procedure for hydration
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| Renography (kidney scan) | a kidney scan is performed to provide general information about renal blood flow. A small amount of radioactive material, a radionuclide is used. Reassure the pt that there is no danger from the small amount of radioactive material present in the agent.
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| Renal Biopsy | pt prep-explain a biopsy can help determine a cause of unexplained problems & can help direct therapy. performed percutaneously (through skin) using ultrasound. NPO 4-6hr before. Hypertension & uremia inc risk for bleeding.
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| pt history | age, race and gener. Previous renal issues (tumor, infection, stones), diabetes, HTN. Ask if they have been told about presence of albumin or protein in their urine. Chemical exposure at work or home.
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