BUN (serum)? Range?
- Blood urea nitrogen level
- Adult: 8-21 mg/dL
- Approximately two thirds of renal function must be lost before a significant rise in the BUN level occurs.
dehydration, prerenal failure or renal failure, GI bleeding. They will usually check a serum creatinine level to determine if the high BUN is renal or due to dehydration. Also indicative of BPH
: overhydration (hypervolemia), severe liver damage, low protein diet, malnutrition
- 10:1 -20:1 (BUN:creatinine)
- Average is 15:1
- High value indicative of renal disease, inadequate renal perfusion, shock, dehydration.
- Low value indicative of liver disease, malnutrition, low protein diet, overhydration
Creatinine (serum)? range?
- Adult: Male: 0.6-1.2, Female: 0.5-1.1 mg/dL, 45-132.3 umol/L. Creatinine value of 10mg/dl: 90% of kidney function has been lost
- Females may have a slightly lower value due to less muscle mass.
- Creatinine, a by product of muscle catabolism (creatine phosphate). Considered a more sensitive test for renal failure. It's not as easily influenced by diet or fluid intake.
- High value: acute and chronic renal failure, shock, systemic lupus erythematosus, cancers, HF. Drug influence: amphotericin (antifungal), cephalosporins(cefazolin), aminoglycosides (gentamicin), lithium, ketone bodies.
- Low value: pregnancy, eclampsia.
Creatinine clearance (urine)? range?
- 85-135 mL/min. females may have somewhat lower values.
- Urine creatinine: 1-2g/24h
- Considered reliable test for estimating GFR.
- High value: hypothyroidism, hypertension, exercise. Drug influence: ascorbic acid, steroids, levodopa.
- Low value: mild to severe renal impairment, hyperthyroidism, progressive muscular dystrophy, amylotrophic lateral sclerosis. Drug influence:phenacetin steroids (anabolid), thiazides.
- Normal = less than 1000 colonies/mL
- Clean catch for specimen. Nitrites found in urine may indicate need for a culture due to nitrite forming bacteria.
- Antibiotics and sulfonamides may cause false negative results.
- Color: light straw to dark amber
- Appearance: clear
- Odor: aromatic
- PH: 4.5-8.0 average 6
- Specific gravity: 1.005-1.030
- protein: (2-8 mg/dL negative reagent strip test)
- Glucose: negative
- Ketones: negative
- Blood: negative
- Microscopic examination
- RBC: 0-2 per High power field
- WBC: M: 0-3, F: 0-5 HPF
- Casts: occasional hyaline
Normal components of urine?
Should not be found in urine?
red or red-brown urine?
- Kidney diseases (glomerular diseases specifically for blood)
- menstrual contamination
- drug influence-sulfisoxazole, phenytoin (Dilantin), chlorpromazine (Thorazine), Doxidan, Ex-Lax.
- Foods: beets, rhubarb, food coloring
overhydration, diabetes insipidus, chronic kidney disease, alcohol ingestion, nervousness...
Blue or green urine?
- pseudomonas toxemia
- drug influence: methylene blue, vitamin B complex, yeast concentrate, amitriptyline (Elavil)
Brown or black urine?
- lysol poisoning, melanin, bilirubin, methemoglobin, porphyrin,
- Drug influence: cascara, chloroquine (Aralen), Iron injectable compounds.
Bacteria, pus, tissue, RBC, WBC, phosphates, prostatic fluid, spermatozoa, uric acids.
PH of urine?
- <4.0: acidosis, starvation, diarrhea, high protein diet.
- >8.0: bacteriuria, UTI, Certain antibiotics, excessive salicylates (aspirin),
reasons for proteinuria?
for testing purpose Protein should be 0
8mg/dL or greater than 80mg/24h
exercise, severe stress, cold baths, fever, acute infectious diseases, renal diseases, leukemia, materials( arsenic, mercury, lead, carbon tetrachloride), drug influences: neomycin, massive doses of penicillin, sulfonamides, barbiturates.
reasons for glucose in urine?
For testing purpose glucose should be 0
- Greater than 15 mg/dL (random) or +3
DM, CNS disorders, meningitis, cushings syndrome, anesthesia, glucose infusions, severe stress, infections. Drug influence: False positive results: ascorbic acid, aspirin, cephalothin, streptomycin, epinephrine.
Reason for RBC and RBC casts in urine?
Greater than 2 per High power field
- renal disease(pyelonephritis, glomerulonephritis, hydronephrosis)
- renal calculi
- lupus nephritis
- aspirins (excess)
- menstrual contamination
reasons for WBC in urine?
- WBC and WBC casts greater than 0-5 per High power field
- strenuous exercise
- lupus nephritis
- renal diseases
Reason for a low specific gravity?
- renal diseases: low fixed SG can indicate kidney disease because of inability to concentrate urine.
- diabetes inspidus
Reason for a high specific gravity?
- > 1.026
- IV dextran/albumin
- x-ray contrast media
Foul/putrid urine smell?
Mousey urine smell?
Phenylketonuria-A birth defect that causes an amino acid called phenylalanine to build up in the body.
ammonia urine smell?
urea breakdown by bacteria
sweet or fruity urine smell?
starvation or DKA
CT scan for kidney?
checking for renal lesions, tumors, calculi, cysts, congenital anomalies, perirenal hematomas and abscesses.
- Direct visualization of the bladder wall and urethra
- useful for removal of renal calculi, tissue biopsy, detection of tumors or to determine cause of hematuria. In addition retrograde pyelography (injection of contrast dye through the catheter into the ureters and renal pelvis)
IVP -Pyelography? info?
- Called excretory urography, because it visualizes the entire urinary tract and not just the kidney pelvis. Renografin-60D is injected and a series of x-rays are taken. Diagnostic test to aid in identifying abnormal size shape, and functioning of kidneys. (renal calculi, neoplasms, and kidney diseases)
- Anaphylaxis may occur due to Dye.
Ultrasound?- detects what in Kidneys?
Ultrasound can detect tissue abnormalities ( masses, cysts, edema, stones) Most ultrasound studies (gallstones) do not need other modalities for confirmation; however they may use CT, MRI, to confirm other potential complications.
cysts are echo free, tumors and renal calculi record multiple echoes.
X-ray (KUB)? info?
- Kidney, ureter, and bladder.
- diagnostic test for abnormal size and structure of KUB. Should be done before intravenous pyelogram or GI studies.
Threshold for glucose in urine?
Blood sugar > 180
Most common infection in community acquired infection?
- Kidney infection- Upper UTI-bacteria from bladder migrate to kidneys.
- fever, chills, flank pain.
uristat? what is it for?
Treating symptoms of kidney pain/GU pain. May mask symptoms of genuine UTI.
- Urethral blockage?
- Bladder unable to empty properly
- relaxed pelvic floor
- increased abdominal pressure
- Bladder oversensitivity from infection
- neurologic disorders
- Dementia/ ETOH-intoxication.
- People are unaware full bladder and that they need to go. x
Enlarged prostate can lead to?
Kidney failure of both kidneys
Post-ARF-acute renal failure
Is incontinence a normal part of aging or child birth?
- No it's not, but you can have some lasting physiologic changes.
- 4 types
- Overflow-urethral blockage
- Stress-increased abdominal pressure/relaxed pelvic floor
- Urge-oversensitive bladder
Average volume of bladder?
causes of Stress incontinence?
- Lifting, laughing, jogging, coughing, sneezing
- weakening of bladder neck due to CHILD BIRTH?
- congential defects
- damage to sphincter during surgery or trauma
Treatment: kegel exercise, nutritional therapy, exercise-weight loss
Causes of Urge incontinence?
- Overactive bladder
- involuntary loss of urine associated with strong desire to urinate. May be a sign of UTI or enlarged prostate
- main cause unknown, however it can be aggrivated by artifical sweetners, caffeine, alcohol, citric intake.
- stroke, parkinsons, MS, spinal tumors
Treatment: space fluids out, decrease caffeine, certain anticholinergics-relax smooth muscle (Ditropan & Detrol)
Causes of Overflow incontinence?
- Detrusor muscle fails-
- Enlarged prostate, Large genital prolapse Female, diabetic neuropathy, spinal cord problems
Treatments: surgery, self cath,short term drug use to increase bladder pressure (urecholine)
Causes of Functional incontinence?
- Dementia, alcohol? cognitive decline.
- Unaware of full bladder or when to go-doesn't respond to urge or has no urge
- Enlarged prostate can lead to kidney failure, urinary retension-stress/overflow
- dysuria, nocuria, diminished force of urine.
- Treatment: Microwave therapy, Laser ablation, Electrocautery, Transurethral Needle ablation (TUNA), TURP-transurethral resection of the prostate
- Meds: flomax, proscar
- Most common invasive cancer among men
- slow growing-confirmed with biopsy
- Prostate specific antigen-PSA
- digital rectal exam-DRE
- treatments: radiation, meds, surgery
Post op care forTUNA/TURP
continuous bladder irrigation (CBI)- 5-10 days, 30 cc balloon
- Monitor for bleeding
- small clots can make bag bloody-
- arterial- ketchup
- venous- burgandy
Erectile dysfunction? ED
- Organic (surgery, diseases, diet, drugs, alcohol)
- treatments-penile implants, drugs, Austin powers pump!!!
Kidney stones-crystals in urine-leads to blockages-damage, blood in urine.
Normal urine output?
Lower UTI of bladder-inflammation of bladder
formed in the liver from amonia as an end product of protein metabolism-diffuses into intra and extra fluid. excreted by kidneys.
Peak and trough levels?
- Peak: highest level of drug in plasma=too high lower dose
- Trough: lowest level of drug in plasma=too high-lengthen dosing
Some drugs that require peak and trough levels? those that are nephrotoxic or have a narrow therapeutic index
- Amphotericin-systemic antifungals
- Ace inhibitors
- cyclosporine for immunesuppression
- Radiographic contrast agents
A radiopaque dye is injected intravenously. The dye circulates into the kidney blood vessels and excreted in the urine. A series of x-rays are taken at various times after the injection. Helps evaluate kidney function, renal calculi, and trauma.
Quantitative analysis of a composite urine sample for levels of creatinine, urea nitrogen, sodium, chloride, calcium or catecholamine.
24 hour urine collections
X-ray of the kidneys, ureters, and bladder to screen for presence of 2 kidneys, measure kidney size, and to detect gross obstruction.
Uses sound waves to identify the size of the kidneys, obstruction, tumor, or cysts. Minimal risk to the client
Blood tests that provides information about renal impairment.
Performed under general anesthesia or local anesthesia with sedation. Scope goes through the urethra and into the bladder to examine for trauma, obstruction, tumor, or enlarged prostate gland.
The catheter in inserted into the femoral artery and threaded into the renal arteries. Radiopaque dye is injected into vessel and x-rays taken to determine areas of narrowing or obstruction. Bleeding from the insertion site is the most common complication.
Provides information on components present in urine sample. Abnormal results include blood, protein, glucose, white blood cells.
Analyzes presence of bacteria and determines which drugs are effective at killing or stopping growth of the bacteria.
C & S
A decrease in this occurs with increased fluid intake, diuretic administration, and diabetes inspidus. An increase occurs with dehydration, ADH, and decreased renal perfusion.
Provides 3-dimentional information about the kidneys, ureters, bladder, and surrounding tissues. May be performed with contrast medium.