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Assessment of Renal and Urinary Tract Function

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Assessment of Renal and Urinary Tract Function

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    1. Assessment of Renal and Urinary Tract Function

    2. A & P Review Review normal anatomy and physiology on your own. Helpful illustrations: Anatomical location of kidneys (fig. 43-1) Bisection of kidneys (fig. 43-1) Anatomy of Nephron (fig. 43-2)

    3. Things to note: The nephron is the functional unit of the kidney The chief physiologic functions of the kidneys are regulatory and hormonal The function of the renal system as a whole is to maintain homeostasis.

    4. Regulatory Functions Water balance Includes fluid and electrolyte balance Acid-base balance Auto-regulation of Blood Pressure

    5. Regulatory Functions Waste product formation and elimination Glomerular filtration Tubular reabsorption Tubular secretion Renal Clearance

    6. Hormonal Influences ADH Renin Erythropoetin Prostaglandins Bradykinin Vitamin D Synthesis and activation

    7. Renal/Urinary System Changes Associated with Aging Reduced renal blood flow Thickened glomerular and tubular basement membrane Decreased tubule length Decreased GFR Nocturnal polyuria and risk for dehydration

    8. Diagnostic Tests Blood Tests Serum Creatinine (0.5 – 1.2 mg/dl) Blood Urea Nitrogen (10-20 mg/dl) BUN/Creatinine Ratio (12:1 to 20:1 mass) Urine Tests Urinalysis Urine for C&S Composite (e.g., 24hr) urine collections Creatinine Clearance Test Urine Electrolytes Osmolality (plasma; urine)

    9. Diagnostic Tests (cont) Bedside sonography; Bladder scanners Radiographic Examinations Kidneys, Ureter, and Bladder X-ray Intravenous Urography Computed Tomography Cystography and Cystourethrography Other Renal Diagnostic Tests Renal Arteriography (Angiography) Renal Biopsy Renography (Kidney Scan) Ultrasonography

    10. Diagnostic Tests (cont) Other Urinary Tract Diagnostic Tests Cystoscopy and Cystourethroscopy Retrograde Procedures Retrograde Pylogram Cystogram Urethrogram Urodynamic Studies Cystometrography Urethral Pressure Profile Electromyography Urine Stream Test

    11. Biopsy Renal and Ureteral Brush Biopsy Kidney Biopsey Needle biopsy Open biopsy

    12. Diagnostic Testing: Nursing Implications Anticipate anxiety, discomfort and embarrassment Promote relaxation, comfort and privacy as able Provide teaching

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