Renal Diagnostic Tests PDF

Responses to Altered Elimination: Diagnostic Alexis Luigi Lorenzo C. Cresencia, RN, MD Examinations Role of Nurses Educate (prior to testing) Purpose What to expect Possible side effects Note trends in results Help relax Privacy Renal Function Tests ...

Responses to Altered Elimination: Diagnostic Alexis Luigi Lorenzo C. Cresencia, RN, MD Examinations Role of Nurses Educate (prior to testing) Purpose What to expect Possible side effects Note trends in results Help relax Privacy Renal Function Tests  Serum Serum Creatinine - end product of muscle metabolism - N: 0.6 – 1.2 mg/dl (50-110 mmol/L) BUN (Blood Urea Nitrogen) - measures renal excretion of urea - N: 10 – 25 mg/dl BUN-to-Creatinine Ratio - Hydration status - N: 10:1 NC: Avoid excessive exercise for 8 HRS Avoid red meat for 24 HRS  Urinalysis Urine Culture & Sensitivity Kidney function Bacterial presence Helps diagnose other (strains & concentration) diseases (e.g. Antimicrobial therapy Diabetes) Includes the following: Color Clarity and Odor pH & Specific Gravity Protein, Glucose and Ketone Bodies RBC, WBC, Casts, Crystals and Bacteria  Urinalysis RBC  N: 0-3/hpf  Hematuria: > 3/hpf F > M Protein  N: 150mg/day  Dipstick Examination (30-1000 mg/dL)  Proteinuria (>1+)  Microalbuminuria (20-200 mg/dL) – Diabetic nephropathy  Renal Concentration Tests Specific Gravity Osmolality Measure of the degree of Most accurate measurement concentration of the urine of the kidney’s ability to Depends largely on hydration dilute and concentrate urine status Measures number of solute Normal: Decrease OFI, specific gravity increases & vice-versa particles in a kilogram of Kidney Disease: Does not vary water with fluid intake; fixed specific Normal Values: gravity Serum: 280 to 300 mOsm/kg; N: 1.010-1.025 Urine: 200 to 800 mOsm/kg; Methods for determination 24 hr urine: 300 to 900 Multiple-test Dipstick (most mOsm/kg common) Urinometer (least accurate) Refractometer (most accurate)  Urine Collection Voided Urine Specimen Collect early morning / 1st voided specimen Place it in a CLEAN container Send to the laboratory immediately Clean Catch Specimen Instruct client to self-clean before voiding Collect midstream specimen Place it in a STERILE container Send to the laboratory immediately  Urine Collection Catheter Specimen Apply clamp to drainage tubing, distal to the injection port Clean injection port with antiseptic Use 5cc syringe to collect specimen Place it in a sterile container Send to the laboratory immediately  24-Hour Urine 24-Hour Urine Specimen Place sign appropriately Discard first voided urine and note the time Container must be kept cool Collect urine over the next 24 hours Creatinine Clearance Best indicator of overall kidney function Calculated measure of GFR  Diagnostic Imaging Kidney, Ureter, Bladder Studies Size Shape Position Abnormalities  Intravenous Urography Injection of radiopaque dye to outline the kidneys, ureter and bladder via x-ray imaging NC: Perform bowel preparation Assess for allergy Place client in supine position Monitor renal function Increase fluid intake  Cystograp hy Voiding Evaluates Vesicoureteral reflux Cystourethrography Fluoroscopy to visualize lower urinary tract Bladder Injury Assess urine storage Can also be performed with simultaneous pressure recordings  Nursing Interventions Post-procedure Pre-procedure Vital signs Relieve any discomfort Explain Moist heat to the Procedure lower abdomen Warm sitz bath NPO Antispasmodic (especially if (Flavoxate) Intermittent upper catheterization cystoscopy) Monitor for infection  Renal Angiography/Arteriography Renal arteries Renal blood flow Renal trauma Cysts vs Tumors Preop for renal transplantation Femoral artery (usual site)  Nursing Interventions Pre-procedure Explain Procedure Assess for allergy Inform sensations that the patient may experience Bowel Preparation Injection site may be shaved Post-procedure Vital signs Examine injection site Peripheral pulses Color and temperature of involved extremity Cold Compress Increase OFI  Renal Biopsy Diagnose & evaluate extent of kidney disease Indications:  Unexplained acute kidney injury  Persistent proteinuria or hematuria  Transplant rejection  Glomerulopathies Small section of renal cortex is obtained (percutaneously or open) CI:  Bleeding  Uncontrolled Hypertension  Sepsis  Solitary Kidney  Large Polycystic Kidneys  Neoplasm  UTI  Nursing Interventions NPO post-midnight OR 6 to 8 hours prior Coagulation studies Urine specimen before and after procedure Instruct to breath in and hold breath (while needle is inserted) If sedated, prone position with sandbag under abdomen Monitor vital signs Monitor for signs of bleeding IV fluids Hematuria (clears within 24 to 48 hours) Bed rest for 8 hours Pressure dressing Analgesics as needed  Renography (Kidney Scan) IV injection of radioisotope for visual imaging of renal blood flow and kidney function Technetium scan – kidney perfusion 123I-Hippurate Renal Scan – kidney function (GFR) Scintillation camera placed behind kidney NC: Assess for allergy Remain motionless during procedure Instruct client that urine is not radioactive Increase OFI