Color: amber yeallow
Protein: 0-150mg/24 hr, 0-18mg/dl
Clucose, Ketones, Bilirubin: none
Specific gravity: 1.003-1.030
Osmolality: 300-1300 mOsm/Kg
pH: 4.0-8.0 (avg 6.0)
BUN (Blood Urea Nitrogen)
8-20 mg/dL, Reflects glomerular filtration rate (GFR); the ability to filter/excrete end products of metabolism (urea). GFR is affected by CO & Fluid volume
normal 0.5-1.2mg/dl (critical above 4mg/dl). product of muscle metabolism, excreted entirely by the kidney. not affected by diet or fluid volume. Levels rise after 50% of kidney function lost
24 Hr Creatinine clearance
An excellent diagnostic indicatior of renal function. The most sensitive test of early renal disease. Decrease renal function. Provides an estimate of GFR
UTI (Urinary Tract Infections)
Most common cause, bacteria ascending from the external urethra.
A chronic inflammation of the entire lower urinary tract, not related to infection can lead to pyelonephritis and sepsis
An infection that spreads from the urinary tract to the bloodstream.
UTI (risk factors)
Structural or functional abnormalities, indwelling catheters, sexual intercourse, diaphragm, and pregnancy, prostate disease, Age/gender
Bladder inflammation. Frequency, dysuria, and urgency. Other: hesitancy, retention, low back pain, suprapubic tenderness. Older adults; often report vague symptoms, risk for urosepsis.
Infection: bacteria, fungal, viral and parasitic. Noninfectious:chemicals, radiation, autoimmune
Cystitis (Laboratory and diagnostics)
Urinalysis. +leukocyte esterase, nitrates, 100,000 colonies/ml, > 3 WBCs/RBCs. >20 epithelia cells on high power suggest contamination. Specimine collection, urine culture. Other:CBC, ultrasound, CT, cystoscopy
Urinary antiseptics, antifungals
Development of stones (calculi) in the urinary tract.
Risks: UTIs, low fluid intake, sluggish flow of urine, urine pH, altered metabolism, genetics. Substances in urine--formation of crystals
High fluid intake, UTI prevention, change urine pH is a preventitive measure for_________?
Personal and FH, diet, fluid intake, Manifestations: 'renal colic', N/V, Pale, diaphoresis, altered urine output
BUN/Creatinine, UA, Ultrasound, IVP, KUB, CT
Urolithiasis (Collaborative care)
Pain relief measures: drug therapy
Other:Strain all urine; primary purpose is for analysis.
Diet/drug therapy: Calcium oxalate: decrease oxalate foods and sodium.
Calcium phosphate; decrease animal protein/dairy (+/-) & sodium
Struvite; limit high phosphate foods
Uric acid; decrease purine sources
Cystine; limit protein
Procedures: lithotripsy, stent placement. Retrograde ureteroscopy
Urothelial Cancer (Bladder)
Painless gross hematuria, chronic or intermittent. Bladder frequency, urgency, dysuria
Diagnostics: UA (cytology), cytoscopy
Collaborative care: Radiation & Chemotherapy
Urothelial Cancer (Renal)
No characteristic early symptoms. Weight loss, weakness, anemia. Gross hematuria, flank pain, palpable mass.
Collaborative care: nephrectomy & radiation; no effective chemotherapy
Bacterial infection in the kidney and renal pelvis (upper urinary tract) inflammation of renal parenchyma and collection system.
Cause: INfection, ie, Ecoli, Proteus, Klebsiella, Enterobacter. Lower tract-ureters-renal medulla-cortex.
Acute: fatigue, chills/fever, N?V, malaise, flank pain, CVA tenderness, +/- urinary symptoms.
Chronic: HTN, inability to conserve sodium, decreased urine concentrating ability, hyperkalemia and acidosis
Urinalysis: Pyuria, bacteriuria, hematuria, & WBC casts. Urine for culture and sensitivity. CBC w/ differential:leukocytosis, increase in immature bands, Blood culture; if present, , close observation, VS.
C-reactive protein, ESR
Pyelonephritis (Collaborative care)
Severe infection: hospitalize, IV antibiotics, antipyretics, analgesics
Relapses: 6 weeks of antibiotics, follow-up urine C&S, imaging
Reinfections: tx as individual episodes or long-term therapy
Inflammation of renal pelvis and glomerulus. Often post infection, AG-AB complexes accumulate-alter permeability or related to other systemic diseases
Acute Glomerulonephritis (Diagnostics)
Urinalysis: RBCs, casts, albumin/protein
Other: CBC, BUN/Creatinine, Antistreptolysin O titers, complement levels, renal biopsy
Acute Glomerulonephritis (Management)
Balance rest and activity
Dietary/Fluid restrictions: low Na, K+, protein; Hich carbs
Medication therapy: Diuretics-don't give K+ sparing. ACE and ARBS= bad if K+ creeps up
End stage of glomerular inflammatory disease, i.e., glomerlonephritis and nephrotic syndrome.
Slow progression--scarring--kidneys atrophy-- renal failure--dialysis.
Chronic Glomerulonephritis (Manifestations)
Ofetn found coincidentally second to abnormal urinalysis or elevated BP, eventual manifestations
Chronic Glomerulonephritis (Management)
Symptomatic relief, aggressive treatement of infections and HTN, Diet; phosphate and protein restriction, Fluid intake adjustment. End stage; dialysis, transplant
Follows conditions that seriously decrease glomerular function & increase permeability to protein, i.e., glomerular disease, cancer.
Frost on skin appearance
Nephrotic Syndrome (manifestations)
Hyperlipidemia (increase in total cholesterol). Extensive proteinuria-- decrease serum albumin, total protein--decrease oncotic pressure.
Severe edema, ascites, anasarca, increase clotting factors, blood hypercoaguable
Nephrotic Syndrome (Collaborative care)
Fluid: assess edema, I/O, daily weight, measure girth/extremities.
Diet: low-moderate protein, low sodium; small frequent meals
Encourage rest and provide skin care
Medications: diuretics, vitamins, antibiotics, corticosteroids, heparin, immunosuppressive agents. Considerations: ACE inhibitors and NSAIDS
AFR (Acute Renal Failure)
An acute decrease in renal function--high serum levels of nitrogen, creatinine, olguria
Pre-Renal: decrease renal blood flow-- glomerular perfusion & filtration. Most common cause 60-70%.
Intra-Renal: direct damage to renal tissue-- malfunctioning nephrons.
Glomeruli- decreased filtering
Post-Renal: Acute process obstructs urine flow; wastes accumulate.
Initiating phase (ARF)
Insult until s/sx present.
Lasts hrs to days. Immediate intervention may result in reversal
Oliguria Phase <400cc/24hr (ARF)
Fluid retention (Edema, HTN< CHF)
Electrolyte imbalances (K+, BUN/Creatinine & P increase, Na+ & Ca+ decrease)
Anemia & platelet abnormalities, Neurological changes.
UA: hematuria w/ casts, RBCs, WBCs, SG, 1.01; osmolality, 300 osm/L (Same as SG plasma)
Onset w/i 1-7 days of the event
Duration: 1-3 weeks
The longer the phase, the poorer the prognosis
Diuretic Phase (ARF)
2-6 weeks after oliguric stage. May last 1-3wks.
Gradual increase in urine output may reack 10L/day. Tubular patency restored; nephrons unable to concentrate urine. Hypovolemia, hypotensive, hypokalemia, dehydration. Uremia may be severe Increse in BUN/Creatinine.
Client remains biochemically imbalanced.
Recovery Phase (ARF)
GFR increases. Serum BUN/Creatinine levels stabilize & decrease.
Improvement; recovery may take >1year.
Healthy living-best treatment.
ARF (diagnostic Studies)
H&P; important to determine the cause.
Serum creatinine/BUN, electrolytes. Urine osmolality, NA, SG
Urinalysis (sediment, casts, RBCs, WBCs, and crystals)
Retrograde pyelogram, renal scan, ultrasound, CT or MRI