Renal
Kidney Function
• Excrete urine
• Provide bicarb to balance pH
• Erythropoietin stimulates RBC
• Homeostasis – water balance
• Calcium & phosphorus balance
• Synthesizes vitamin D
• BP – renin & aldosterone
Diagnostic
• Serum Creatinine (0.6-1.2)
o Better indicator of kidney function
o Caused by protein & muscle breakdown
o Kidney disease only condition that increases levels (>50% kidney function loss)
o Elderly – serum level remains constant unless kidney disease noted
• BUN (10-20)
o Can change w/ different factors (chemo, liver problems)
o Breakdown of protein in liver creates byproduct urea nitrogen which is excreted
by kidneys
o Levels affected by: dehydration, infection, chemotherapy, steroids, reabsorption
of blood in liver from tissue damage
o Elevated levels = kidney disease
• Urinalysis Culture 24 hr collection (4.5-7.2 pH)
o Evaluated waste produces from kidney & detects urologic disorders
o First void in morning, more concentrated
o Assess color, clarity, concentration/dilution, acidity/alkalinity & presence of drug
metabolites, glucose, ketones, protein (including leukocyte esterase & nitrates)
o glucose, ketones, protein (including leukocyte esterase & nitrates) are not
normally found in urine & can indicate diabetes, fat metabolism, infection, or
cancer
o urine culture & sensitivity identifies bacteria & determines antibiotic to
adequately treat infection
o 24 hr urine measures various substances including creatinine clearance which
measures GFR for pts who have impaired kidney function (GFR 90-130)
• X-ray
o KUB
o Shows structure, calculi, strictures, calcium deposits, obstructions
• CT
o 3D image (dye enhances image)
o Images renal/urinary system
o Shows cysts/masses, obstructions, kidney size
• MRI
o Same as CT scan
, o Useful for staging cancer
o Must lie still
• Ultrasound
o Assess kidney size, ureters & bladder for masses, cysts, calculi & obstructions of
lower urinary tract
• Cystography, cystourethrography, voiding cystourethrogram (VCUG)
o Uses contrast dye (detects injury to bladder or urethra)
o VCUG detects reflux of urine during voiding via X-ray
o Encourage increased fluid intake to dilute urine after procedure to minimize
burning on urination
• Kidney Biopsy
o Removal of tissue sample by excision or needle aspiration for cytological exam
o Pt is sedated
o Complications: hemorrhage, infection, urgency, urine + for leukocytes esterase &
nitrates., sediment & RBCs
• Cystoscopy, cystourethroscopy
o Detects abnormalities of bladder wall and/or occlusions of ureter or urethra
o Pt receives anesthesia for procedures
o Pt in lithotomy position
o Monitor VS & urine output
o Urine may be pink tinged
o May irrigate catheter w/ NS if blood clots present or urine output is
decreased/absent
o Encourage pt to increase fluid intake
o Complications: UTI, cloudy foul-smelling urine, urgency, urine + for leukocytes
esterase, nitrites, sediment, RBCs
• Retrograde pyelogram, cystogram, urethrogram
o Identifies structural issues or obstructions of ureters & renal pelvis
o Identifies fistulas, diverticula, & tumors in bladder & urethra
o Nursing care & complications are the same as cystoscopy
• Renal scan
o Assesses renal blood flow & GFR after injection of radioactive dye to produce
scanned image of kidney
o Monitor BP frequently as pts receive captopril to change renal blood flow
• Excretory urography
o Detects obstruction & parenchymal masses & size of kidney
o Iodine-based dye is used
o Prep may include bowel cleansing to allow better visualization
Kidney Function
• Excrete urine
• Provide bicarb to balance pH
• Erythropoietin stimulates RBC
• Homeostasis – water balance
• Calcium & phosphorus balance
• Synthesizes vitamin D
• BP – renin & aldosterone
Diagnostic
• Serum Creatinine (0.6-1.2)
o Better indicator of kidney function
o Caused by protein & muscle breakdown
o Kidney disease only condition that increases levels (>50% kidney function loss)
o Elderly – serum level remains constant unless kidney disease noted
• BUN (10-20)
o Can change w/ different factors (chemo, liver problems)
o Breakdown of protein in liver creates byproduct urea nitrogen which is excreted
by kidneys
o Levels affected by: dehydration, infection, chemotherapy, steroids, reabsorption
of blood in liver from tissue damage
o Elevated levels = kidney disease
• Urinalysis Culture 24 hr collection (4.5-7.2 pH)
o Evaluated waste produces from kidney & detects urologic disorders
o First void in morning, more concentrated
o Assess color, clarity, concentration/dilution, acidity/alkalinity & presence of drug
metabolites, glucose, ketones, protein (including leukocyte esterase & nitrates)
o glucose, ketones, protein (including leukocyte esterase & nitrates) are not
normally found in urine & can indicate diabetes, fat metabolism, infection, or
cancer
o urine culture & sensitivity identifies bacteria & determines antibiotic to
adequately treat infection
o 24 hr urine measures various substances including creatinine clearance which
measures GFR for pts who have impaired kidney function (GFR 90-130)
• X-ray
o KUB
o Shows structure, calculi, strictures, calcium deposits, obstructions
• CT
o 3D image (dye enhances image)
o Images renal/urinary system
o Shows cysts/masses, obstructions, kidney size
• MRI
o Same as CT scan
, o Useful for staging cancer
o Must lie still
• Ultrasound
o Assess kidney size, ureters & bladder for masses, cysts, calculi & obstructions of
lower urinary tract
• Cystography, cystourethrography, voiding cystourethrogram (VCUG)
o Uses contrast dye (detects injury to bladder or urethra)
o VCUG detects reflux of urine during voiding via X-ray
o Encourage increased fluid intake to dilute urine after procedure to minimize
burning on urination
• Kidney Biopsy
o Removal of tissue sample by excision or needle aspiration for cytological exam
o Pt is sedated
o Complications: hemorrhage, infection, urgency, urine + for leukocytes esterase &
nitrates., sediment & RBCs
• Cystoscopy, cystourethroscopy
o Detects abnormalities of bladder wall and/or occlusions of ureter or urethra
o Pt receives anesthesia for procedures
o Pt in lithotomy position
o Monitor VS & urine output
o Urine may be pink tinged
o May irrigate catheter w/ NS if blood clots present or urine output is
decreased/absent
o Encourage pt to increase fluid intake
o Complications: UTI, cloudy foul-smelling urine, urgency, urine + for leukocytes
esterase, nitrites, sediment, RBCs
• Retrograde pyelogram, cystogram, urethrogram
o Identifies structural issues or obstructions of ureters & renal pelvis
o Identifies fistulas, diverticula, & tumors in bladder & urethra
o Nursing care & complications are the same as cystoscopy
• Renal scan
o Assesses renal blood flow & GFR after injection of radioactive dye to produce
scanned image of kidney
o Monitor BP frequently as pts receive captopril to change renal blood flow
• Excretory urography
o Detects obstruction & parenchymal masses & size of kidney
o Iodine-based dye is used
o Prep may include bowel cleansing to allow better visualization
