Assessment of Renal and Urinary Tract Function

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Assessment of Renal and Urinary Tract Function
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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)

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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.

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Regulatory Functions

• Water balance
• Includes fluid and electrolyte balance
• Acid-base balance
• Auto-regulation of Blood Pressure

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Regulatory Functions

• Waste product formation and elimination
• Glomerular filtration
• Tubular reabsorption
• Tubular secretion
• Renal Clearance

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Hormonal Influences

• ADH
• Renin
• Erythropoetin
• Prostaglandins
• Bradykinin
• Vitamin D Synthesis and activation

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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

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Diagnostic Tests

• Blood Tests
• Serum Creatinine (0.5 1.2 mg/dl)
• Blood Urea Nitrogen (10-20 mg/dl)
• BUN/Creatinine Ratio (121 to 201 mass)
• Urine Tests
• Urinalysis
• Urine for CS
• Composite (e.g., 24hr) urine collections
• Creatinine Clearance Test
• Urine Electrolytes
• Osmolality (plasma urine)

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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

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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

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Biopsy

• Renal and Ureteral Brush Biopsy
• Kidney Biopsey
• Needle biopsy
• Open biopsy

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Diagnostic Testing Nursing Implications

• Anticipate anxiety, discomfort and embarrassment
• Promote relaxation, comfort and privacy as able
• Provide teaching