urinary labs

Question 1

dark yellow + amber or honey urine

Answer 1

dark yellow - normal, probably drink some water
amber/honey - not enough water, drink now

Question 2

syrup/brown ale urine

Answer 2

possibility of liver disease OR severe dehydration
*drink water + see HCP if persist

Question 3

pink to reddish urine

Answer 3

beets, blueberries, rhubarb may change color

possibly blood
sign of kidney disease, tumors, UTI, prostate problems
possible if lead or mercury poisoning

contact HCP

Question 4

orange urine

Answer 4

not drinking enough water
liver or bile duct condition
could be food dye
contact HCP

Question 5

how is turbidity evaluated?

Answer 5

holding the specimen in front of a line of printed material –> urine is graded as clear, slightly cloudy, cloudy, or turbid (very cloudy)

Question 6

urinary: blood studies

Answer 6

Cr
BUN
K
Ca (total)
Phosphorus

Question 7

creatinine

Answer 7

normal: 0.5-1.2 mg/dL

specific to kidneys - more reliable indicator of renal fxn than BUN
breakdown of muscle and protein metabolism and is released at a consistent rate

<0.5: muscle atrophy
>1.2: impaired renal fxn

Question 8

BUN

Answer 8

normal: 10-20 mg/dL

non renal factors: (increase BUN, no inc/dec for Cr)
-high nitrogen TFs or high PRO diet
-GI bleed
-hydration status

Question 9

potassium

Answer 9

normal: 3.5-5
kidneys excrete majority of K+

kidney disease –> K+ is one of the first electrolytes to become abnormal

> 6.0 = cardiac dysrhythmias + muscle weakness

Question 10

calcium (total)

Answer 10

normal: 9-10.5

kidney disease –> decrease reabsorption of Ca leads to “renal osteodystrophy” (weakened bones)

Question 11

phosphorus

Answer 11

normal: 3-4.5

inversely r/t Ca

kidney disease –> typically high bc kidney is primary excretory muscle

Question 12

magnesium

Answer 12

normal: 1.3-2.1

increase with kidney disease because excreted by kidney

Question 13

urinalysis includes (10)

Answer 13

bilirubin, color, glucose, ketones, odor, pH, protein, RBCs, specific gravity, WBCs

Question 14

considerations of a urinalysis

Answer 14

first morning best
analyze within 1 hour

Question 15

normal findings on an urinalysis

Answer 15

1. bilirubin: none
2. color: amber yellow
3. glucose: none
4. ketones: none
5. odor: aromatic/none
6. pH: 4.6-6
7. protein: zero to trace
8. RBCs: 0-4
9. specific gravity: 1.010 - 1.030
10. WBCs: 0-5

Question 16

diagnostic studies

Answer 16

1. creatinine clearance
2. eGFR
3. bladder scan
4. urine culture - clean catch
5. cystoscopy
6. kidney, ureter, bladder (KUB)
7. intravenous pyelogram (IVP)
8. retrograde pyelogram
9. renal biopsy
10. non-contrast spiral CT

Question 17

creatinine clearance

Answer 17

approximates GFR
24-hr urine collection
discard first urine when begin testing
save all subsequent urine for 24 hours
have patient urinate at end of 24 hours and add to collection
measure serum Cr during 24-hr period

Question 18

considerations with 24-hour urine container

Answer 18

keep cold/refrigerated

Question 19

GFR

Answer 19

glomerular filtration rate - amount of blood filtered per minute by glomeruli

Question 20

estimated GFR (eGFR)

Answer 20

calculation that takes into consideration the patient’s age, sex, weight, ethnicity

Question 21

considerations with 24-hour urine container

Answer 21

keep cold/refrigerated

Question 22

bladder scan

Answer 22

done at bedside w/ water soluble gel
calculates presence of residual urine

Question 23

clean-catch urine

Answer 23

confirms suspected UTI & identifies causative agents
sterile container
cleanse meatus (bladder is sterile; urethra is not)
collect specific 1-2 seconds after voiding starts

Question 24

cystoscopy

Answer 24

main goal: inspect interior of bladder wall
lithotomy position
consent form

Question 25

post-cystoscopy procedure

Answer 25

expected findings: burning, pink-tinged urine & frequency NOT normal: bright red blood

Question 26

kidneys, ureter, bladder (KUB)

Answer 26

Xray of abd & pelvis bowel prep delineates size, shape, and position of kidneys + radiopaque stones (struvite)

Question 27

intravenous pyelogram (IVP)

Answer 27

requires bowel prep check iodine sensitivity (avoid anaphylaxis --> uses contrast) expect flushed feeling with injection force fluids afterwards consider alternative if Cr elevated *dye injected and kidneys uptake it

Question 28

retrograde pyelogram

Answer 28

done if: -IVP doesn't visualize good -pt is allergic to contrast medium -pt has decreased renal fxn *cystoscope and urethral catheters are used *prep same as IVP; complications same as cystoscopy *dye doesnt get in blood so OK if you have an iodine allergy

Question 29

pyelogram indicates for which part of the body

Answer 29

renal pelvis

Question 30

renal biopsy

Answer 30

assess coag hx (PT, INR, platelets) sign consent form pt not taking ASA or warfarin (thins blood) performed on the kidney - backside below bottom ribs

Question 31

post-renal biopsy procedure

Answer 31

apply pressure dressing keep on affected side 30-60 minutes bedrest 24 hours (minimize movement + bleeding) VS q 5-10 min for 1 hour assess for flank pain or signs of bleeding no heavy lifting x7 days