2. OUTLINES
Anatomy & physiology overview of gus
Subjective data /History taking
Objective data /Physical Examination
DIAGNOSTIC STUDIES OF THE US
Cystoscopy
Radiologic Examination
Reference
3. ANATOMY & PHYSIOLOGY OVER VIEW
Anatomy of the kidney & Urinary System
Include:-
Kidneys
Ureters
Bladder &
Urethra
Urine is formed in the kidney and flows through
other structures to be eliminated from the body.
4. Kidneys
Are pairs of bean- shaped
Brownish red- structure
Located retroperitoneally-behind & outside
the peritoneal cavity
Vertically found b/n T12- L3 in the adult.
Average weight-113 to 170g
Length-10 to 12cm long
6cm wide & 2.5 cm thick
5. Kidneys…
The right kidney is slightly lower than the left
due to the location of the liver.
Kidneys are supported by two major layers of
tissues.
A) Externally:- Renal fascia, perirenal fat capsule
and renal capsule
B) Internally:-Renal cortex, medulla and renal
pelvis.
6. Nephrons
Are functional and structural units of the kidney.
Each kidney is made up of about 1 million nephrons
Each nephron has two major components
A glomerulus
Renal tubule
Two types
1) Cortical nephrons
Makes up 80% -85% of total number.
Located in the outermost part of the cortex
Blood supply from peritubular capillaries
7. 2)Juxtamedullary Nephrons
Make up 15% to 20%.
Located deeper in the cortex.
Vasa recta
This nephron:-
Maintains osmolality
Filters blood &
Maintains acid-base balance
8. BLOOD SUPPLY TO THE KIDNEY
Renal arteries which are the direct branches of abdominal
aorta supply the kidney.
Afferent arteriole
Brings blood into the glomerular capillary.
Efferent arteriole
Takes blood from the glomerulus to peritubular capillary
& vasa recta.
Then to the renal veins, ends in inferior vena cava.
Large blood flow goes to the kidneys
Ap. ¼ th (1200 ml) of blood flows from the heart to the kidneys
each minute.
That is, approximately 20-25% of the total CO.
9. Accessory Excretory structures
1) URETERS
The ureters are urine-bearing tubes that exit the
kidney and empty into the urinary bladder.
2) BLADDER
Smooth, collapsible, muscular sac that temporarily
stores urine.
Accumulates 300 to 400 ml but as high as 1.5 L of
urine.
As urine accumulates, the bladder expands without
significant rise in internal pressure.
10. 3) Urethra
• Muscular tube that drains urine from the bladder and
moves it out of the body.
• Propels semen (in males)
• It is 4 cm in female and 12 cm in males.
• The urethra has two syphincters
• Internal sphincter – involuntary urethral sphincter
• External sphincter – voluntary urethral sphincter
• Levator ani muscle – voluntary urethral sphincter
• NB The genito-urinary system also includes M & F
genitalia
14. Sub...
Signs and symptoms involving the urinary
tract may be due to disorders of
The kidneys
Ureters, or
Bladder
Surrounding structures, or
Disorders of other body systems
15. Past Health History
Obtaining urologic health history requires excellent
communication skills.
B/c many pts are uncomfortable talking about
genitourinary symptoms.
Use language the pt can understand
Avoid jargon
Review risk factors ( high risk pts).
16. …
Ask consciously about the presence or history of
diseases that are related to renal or other urologic
problems.
Some of these diseases are
• Hypertension
• Diabetes mellitus
• Metabolic problems
19. Medications
current and past use of medications
Over-the-counter drugs
Prescribed medications
Herbs.
Drugs affect the urinary tract in several ways.
Many drugs are known to be nephrotoxic.
Certain drugs may alter the quantity and
character of urine output (e.g. diuretics ).
20. Example
1.Phenazopyridine (Pyridium )-analgesics
Dark orange color or dark red color of urine.
2.Nitrofurantoin ( Macrodantin)-antibiotic for UTI
Change the color of urine.
3. Anticoagulants -may cause hematuria (heparin &
warfarin).
Many antidepressants
21. …
Calcium channel blockers
oNifedipine-edema of the ankle
Antihistamines &
Drugs used for neurologic &
Musculoskeletal disorders affect the ability of the
bladder or sphincter to contract or relax normally
22. Surgery or Other Treatments
Ask previous hospitalizations related to:
o Renal or urologic diseases
Past surgeries ( particularly pelvic surgeries )
Urinary tract instrumentation –ascending
infection.
Any radiation or chemotherapy treatment for
cancer
23. …
All urinary problems during past pregnancies
o Duration
o Severity
Its treatment &
Patient's perception of any problem
24. Functional Health Patterns
Health Perception–Health mgt Pattern.
Ask general health-particularily w/n d/se affecting kidney is
suspected.
Feeling tired all of the time
Changes in weight or
Appetite
Excess thirst
Fluid retention
25. Complaints of :
Headache,
Pruritus, or
Blurred vision may be r/t abnormal kidney function.
The elderly patient may report
Malaise and
Non-localized abdominal discomfort as the only symptoms of
UTI
26. History of Occupation
Exposure to chemicals can affect the kidneys and UTS
Phenol and ethylene glycol are nephrotoxic chemicals.
Aromatic amines and certain organic chemicals may
increase the risk of bladder cancers.
Textile workers, painters, hairdressers, and industrial
workers have a high incidence of bladder tumors.
27. History of Smoking
Cigarette smoking is a major risk for
bladder cancer.
Tumors occur 4 times more
frequently in cigarette smokers than
in non smokers.
28. Family History
The presence of certain renal or urologic problem is r/t
genetic in origin-familial.
Ask family members if they may have the ff d/ses in he
past time
Polycystic renal disease&
Congenital urinary tract abnormalities
congenital nephritis
29. Nutritional-Metabolic Pattern
Quantity and types of fluid taken is important information
related to UTD.
Dehydration (Metabolic alkalosis ) may contribute to:
Urinary infections
Calculi formation &
Renal failure
Large intake dairy product foods or foods high in proteins
may also lead to calculi formation.
30. Nutrition…
o Caffeine
o Alcohol
o Carbonated beverages or
o Spicy foods often aggravate urinary inflammatory diseases.
Many herbal teas also cause diuresis (excess urine).
An unexplained weight gain may be the result of fluid
retention secondary to a renal problem.
32. ELIMINATION
Asking about urine elimination patterns are the
cornerstone of the health history in the patient with a
LUT disorder.
The majority eliminate urine by spontaneous voiding
Asked about daytime (diurnal) voiding frequency –
Under normal condition 6-8 times a day.
The frequency of night time (nocturia)
33. …
• Pelvic organ prolapse
• Particularly advanced anterior vaginal prolapse
• May cause suprapubic pressure
Frequency
Urgency &
Incontinence secondary to urinary retention.
Ask the patients about some other lower urinary tract
symptoms
o Urgency
o Incontinence ( Inability to control urine)
o Urinary retention
34. …
• Change in color
• If normal-clear, pale to deep yellow
• Appearance of urine
• Blood in urine
• Bowel function
• Problems with fecal incontinence may signal
neurologic causes for bladder problems
• Because of shared nerve pathways.
35. Constipation and Fecal Impaction
Obstruct the urethra causing
Inadequate bladder emptying
Overflow incontinence &
Infection
36. Activity
• Assess pt’s activity
• A sedentary lifestyle causes stasis (loss of tone ) of urine
Predispose to infection &
Calculi
• Demineralization(loss of minerals) of bones in a person
with limited physical activity can cause increased urine
calcium precipitation.
37. Increasing activity
May aggravate the urinary problem.
Pt with prostate surgery (weakened pelvic floor
muscles ) may leak urine when running.
Chronic inflammatory prostatitis or epididymitis
after heavy lifting or long-distance driving.
38. Sleep &Rest
• Nocturia
• Is a common
• Is lower urinary tract symptom that often leads to
o Sleep deprivation
o Daytime sleepiness &
o Fatigue.
39. …
Occurs in multiple disorders affecting the
lower urinary tract
Urinary incontinence
Urinary retention &
Interstitial cystitis
40. …
Up to one episode of nocturia is considered
normal in younger adults
Up to two episodes are acceptable among
adults age 65 years or older.
Sleep problems associated with a urinary
disorder should be documented.
42. Self-Perception , Self-Concept
Problems r/t urinary system may lead to anemia
Result in loss of self-esteem and a negative body image.
Ask systematically to elicit cues to problems
Role-Relationship Pattern
U/P can affect many aspects of a person's life
Including the ability to work and relationships with
others.
43. Sexuality-Reproductive Pattern
Ask the pt about the effect of renal or urologic problem on
her or his sexual patterns and satisfaction.
Problems related to personal hygiene and fatigue can
seriously affect a sexual relationship.
Urinary incontinence is not directly associated with sexual
dysfunction
It has a devastating effect on self-esteem, social and
intimate relationships.
44. Symptoms R/t Irritation of the LUT
Dysuria
pain or difficult urination.
Frequency
voiding occurs more commonly than usual
Increasing frequency can result from a variety of conditions such as
Infection &
UTD
Metabolic disease
Hypertension
Medications (diuretics)
45. Urgency
Strong desire to urinate that is difficult to postpone.
Causes
Inflammatory conditions of the bladder , prostate, or urethra
Acute or chronic bacterial infections
Neurogenic voiding dysfunctions
Chronic prostatitis or bladder outlet obstruction in men
Urogenital atrophy in postmenopausal women.
46. Strangury
Slow and painful urination
Only small amounts of urine voided
Blood staining may be noted.
Seen in severe cystitis and interstitial cystitis
It is also called as bladder pain syndrome
47. …
Is a chronic health issue of bladder
Feeling of pain and pressure in the bladder area.
Pain along with the lower urinary tract symptoms
May last up to 6wks without having an infection
48. Nocturia
Excessive urination at night which interrupts sleep.
Urologic conditions
Poor bladder emptying
Bladder outlet obstruction
Overactive bladder
Metabolic causes
Decreased renal concentrating ability
Diabetes mellitus
Increased urine production at rest that occurs with aging.
49. Symptoms R/t Obstruction of LUT
Weak Stream
Decreased force of stream when compared to usual stream of urine when
voiding
Hesitancy- Pause
Undue delay and difficulty in initiating voiding.
May indicate :-
Compression of urethra,
Outlet obstruction,
Neurogenic bladder (dysfunction of bladder by neurologic damage).
50. Terminal dribbling-To cut off little by little
Urine from the meatus after urination is complete.
May be caused by bladder outlet obstruction.
Incomplete emptying
Feeling that the bladder is still full even after urination.
Indicates either urinary retention or a condition that
prevents the bladder from emptying well
Leads to infection.
52. Urinary Tract Pain
GU Pain
Is not always present in renal disease,
but is generally seen in the more acute conditions of US.
Kidney pain
Felt as a dull ache in CVA
Or may be sharp & colicky pain felt in the flank area
Radiates to the groin or testicle
Due to distension of the renal capsule
53. Ureteral pain
Pain felt in the back
Radiates to the groin or scrotum - upper ureter is the
source,
Radiates to the suprapubic area, penis, and urethra-lower
ureter is the source.
Bladder pain –LAP-Suprapubic Pain
May be due to bladder infection or over distension
54. Urethral pain
Irritation of bladder neck
Foreign body in canal
Urethritis
Pain increases when voiding
Pain in Scrotal Area
B/c of inflammatory swelling of epididymis or testicle, or
torsion of the testicle.
55. Testicular Pain
Due to injury, orchitis( Painful) , torsion of spermatic cord
Perineal or rectal discomfort
Due to acute prostatitis, prostatic abscess.
Back and leg pain
Due to cancer of prostate with metastases to bone.
Pain in glans penis
Usually from prostatitis
Penile shaft pain is from urethral problems
56. Related Symptoms
GI symptoms related to urologic conditions include:-
Nausea
Vomiting
Diarrhea
Abdominal discomfort
Paralytic ileus and
GI hemorrhage with uremia
57. …
These two systems have common autonomic &
sensory innervations &
Because of renointestinal reflexes
Fever and chills may also occur with infectious
processes
61. Weight
Weight gain secondary to edema
Weight loss & muscle wasting - renal failure
General state of health
Fatigue
Lethargy &
Diminished alertness
62. ii) Palpation
A landmark useful in locating the kidneys is the costo
-vertebral angle (CVA)
Formed by the 12th rib & the vertebral column.
The normal-sized left kidney is rarely palpable because
the spleen lies directly on top of it.
Occasionally the lower pole of the right kidney is
palpable.
63. A landmark to Locate Kidney -CVA
A landmark useful in locating
the kidneys is the costo -
vertebral angle (CVA)
Formed by the 12th rib & the
vertebral column.
The normal-sized left kidney is
rarely palpable because the
spleen lies directly on top of it.
Occasionally the lower pole of
the right kidney is palpable.
CVA-B/n 12th rib & spine.
64. …
To palpate the right kidney, the examiner's left hand
is placed behind and
Supports the patient's right side between the rib cage
and the iliac crest .
The right flank is elevated with the left hand, and the
right hand is used to palpate deeply for the right
kidney.
65. …
The lower pole of the right kidney may be felt as
a smooth, rounded mass that descends on
inspiration.
If kidney is palpable, its size, contour, and
tenderness should be noted.
Enlarged kidney-suggests of neoplasm or other
pathologic conditions.
66. …
Urinary bladder is normally not palpable
unless - distended with urine.
Full bladder- felt as a smooth, round, firm
and sensible to palpation.
68. iii) Percussion
o Tenderness may be detected in the flank area .
o Performed by striking the fist of one hand against the
dorsal surface of the other hand
o Which is placed flat along the posterior CVA margin.
o Normally a firm blow in the flank area should’t elicit
pain.
69. …
If CVA tenderness and pain are
present-indicate a kidney infection or
polycystic kidney disease.
Bladder is not percussible until it
contains 150 ml of urine.
Full bladder-dullness is heard above
the symphysis pubis.
A distended bladder may be
percussed as high as the umbilicus.
Percussion of CVA
70. IV) Auscultation
Use the bell of stethoscope to auscultate over
both CVAs and in the UAQ.
With this technique, the abdominal aorta and
renal arteries are auscultated for a bruit (murmur)
Which indicates impaired blood flow to the
kidneys.
71. 3) DIAGNOSTIC STUDIES OF THE URINARY SYSTEM
I. Urine Studies
Urinalysis
U/A is a general examination of urine
Establish baseline information
Provide data to establish a tentative diagnosis
Determine whether further studies are to be ordered
72. U/A…
Try to obtain first urinated morning specimen.
Ensure that specimen is examined within 1 hr
of urination
Wash perineal area if soiled with menses or
fecal material.
73. Creatinine Clearance
Creatinine
Waste product of protein breakdown- muscle mass
The first-line test in the diagnosis of renal failure.
Approximates GFR.
Collect 24-hr urine specimen ( full 24hrs period).
Normal finding: 85-135 ml/min
74. Composite Urine Collection
The purpose is to examine or measure specific components such as
Electrolytes
Glucose
Protein
Creatinine &
Minerals
Composite urine specimens are collected over a period that may range
from 2-24 hr.
75. …
Discard this first urine specimen.
Ask the patient to urinate and add the urine to the container.
Reminding the patient to save all urine during the study
period is critical.
Specimens may be refrigerated, or preservatives may be
added to the container used for collecting urine.
76. Urine culture
Done to confirm suspected urinary tract
infection
identify causative organisms
Use sterile container for collection of urine.
Touch only outside of container.
77. …
For women, separate labia with one hand &
Clean meatus with other hand, using at least
three sponges in a front-to-back motion.
For men, retract foreskin (if present) and
cleanse glans with at least three cleansing
sponges.
78. …
After cleaning, instruct the patient to void in sterile
container.
The initial voided urine flushes out most contaminants in
the urethra and perineal area.
Catheterization - If unable to cooperate with the
procedure.
Normally, bladder is sterile, but urethra contains bacteria
and a few WBCs.
79. If properly collected, stored, and handled
<10,000 organisms/ml usually indicates no
infection
10,000-100,000/ml is usually not diagnostic,
and test may have to be repeated
>100,000/ml indicates infection.
80. Concentration Test
Study evaluates renal concentration ability.
Concentration is measured by specific gravity readings.
Instruct patient to fast after given time in evening (in
usual procedure).
Collect three urine specimens at hourly intervals in
morning.
Normal finding: 1.020-1.035
81. Residual Urine
Study determines amount of urine left in bladder after urination.
Finding may be abnormal with bladder innervation, sphincter
impairment, BPH, or urethral strictures
If residual urine test is ordered, catheterize patient immediately after
urinating or use bladder ultrasound equipment.
If a large amount of residual urine is obtained, health care provider
may want catheter left in bladder.
Normal finding: 50 ml urine (increases with age)
82. Protein Determination
Dipstick (Albustix, Combistix)
Dipstick test detects protein (primarily albumin) in urine.
Dip end of stick in urine and read result by comparison with color
chart on label as directed.
Grading is from 0 to 4.
Interpret with caution.
A positive result may not indicate significant proteinuria
some medications may give false-positive readings.
Normal finding: 0-trace
83. Quantitative Test for Protein
A 12- or 24-hr collection gives a more accurate
indication of the amount of protein in urine.
Persistent proteinuria usually indicates glomerular
renal disease.
Perform 12- or 24-hr urine collection.
Normal finding: <150 mg/24 hr (<0.15 g/24 hr)
Consisting mainly of albumin
84. Urine cytology-Study of Cells
Is the standard non invasive method for diagnosis in detection
of bladder carcinoma.
Cytology is used to assess morphologic changes in intact cells
The test may also detect cancers of the kidney , ureters,
prostate & urethra.
Urine can be analyzed to identify abnormal cellular structures
with bladder cancer and follow the progress of bladder cancer.
85. …
Specimens may be obtained by voiding or catheterization
The first morning's voided specimen should not be used
Because epithelial cells may change in appearance in urine
held in the bladder overnight.
As with urinalysis, the specimen should be fresh or brought
to the lab within a hour.
An alcohol based fixative is then added to preserve the
cellular structure.
86. II. Blood Chemistries
BUN( Blood Urea Nitrogen)
Urea concentration of blood is often expressed in terms-BUN
BUN is most commonly used to identify presence of renal
problems.
Concentration of urea in blood is regulated by rate at which
kidney excretes urea
Sample: serum , plasma and urine
When interpreting BUN, non renal factors may cause .ed.
87. …
e.g. Rapid cell destruction from infections
Fever
GI bleeding
Trauma,
Athletic activity - excessive muscle breakdown
Corticosteroid therapy
Normal finding: 10-30 mg/dl (1.8-7.1 mmol/L)
88. Creatinine
Is a substance derived from creatine & creatine
phosphate.
Is a product of protein metabolism
Not significantly reabsorbed or secreted by tubules
Creatinine is more reliable than BUN
Good test for GFR
As it is determinant of renal function
89. …
Creatinine is end product of muscle and
protein metabolism
Is liberated at a constant rate.
Sample - serum, plasma, urine
Normal finding: 0.5-1.5 mg/dl (44-133
μmol/L).
90. Uric acid
This test measures uric acid levels in blood or urine
Uric acid urine test is used to dx the cause of recurrent kidney stone &
Gout for stone formation
Uric acid blood test ordered when a high uric level is suspected.
Is made during the normal break down of cells & in the digestion of certain
food.
Uric acid study is used as a screening test primarily for disorders of purine
metabolism
But can indicate kidney disease as well
91. …
If increased in blood gout, kidney stone, bone, joint &
tissue damage
Values depend on renal function rate of purine
metabolism and dietary intake of food rich in purine
Sample : Serum, plasma urine
Not a good test for GFR
Normal finding: Women--2.5-5.5 mg/dl (149-327 mol/L)
Men--4.5-6.5 mg/dl (268-387 mol/L)
92. Sodium (Na+)
Na+ is main extracellular electrolyte
determining blood volume.
Usually, values stay within normal range until
late stages of renal failure.
Normal finding: 135-145 mEq/L (135-145 mmol/L)
93. Potassium (K+)
• Kidneys are responsible for excreting majority of body's K+
• In renal disease, K+ determinations are critical
• Because K+ is one of the first electrolytes to become
abnormal.
• Elevated K+ levels of >6 mEq/L can lead to muscle
weakness and cardiac dysrhythmias.
• Normal finding: 3.5-5.0 mEq/L (3.5-5.0 mmol/L)
94. Calcium (Ca2+)
Ca2+ is main mineral in bone
Aids in muscle contraction, neurotransmission, and clotting.
In renal disease, decreased reabsorption of Ca2+ leads to
renal osteodystrophy
Bone d/s that occurs when kidney fails to maintain proper
calcium level
Normal finding: 9-11 mg/dl
Or 4.5-5.5 mEq/L, 2.25-2.74 mmol/L
95. Phosphorus
In renal disease, phosphorus levels are elevated
Because the kidney is the primary excretory organ.
Normal finding: 2.8-4.5 mg/dl (0.95-1.45 mmol/L)
Bicarbonate (HCO3
−)
Most patients in renal failure have metabolic acidosis
- low serum HCO3
− levels.
Normal finding: 22-26 mEq/L (22-26 mmol/L)
96. RFT (Renal Function Test)
Is a profile of biochemistry blood tests that are useful
to assess renal function.
Is used to evaluate the severity of kidney disease &
To follow the patient's clinical progress.
This test also give information concerning the kidneys
effectiveness in caring out their execratory function
Serum creatinine (NR:0.5 - 1.5 mg/dl)
97. 4) Cystoscopy
Cystoscopey is the endoscopy of the urinary bladder
via the urethra.
Is carried out with a cystoscope which has lenses like
telescope or microscope.
Cystoscopy (cystourethroscopy) is a diagnostic
procedure that uses an endoscope especially designed
for examination of the bladder, lower urinary tract,
and prostate gland.
98. …
The cystoscope is inserted through the urethra into the bladder
Which has a self-contained optical lens system that provides a
magnified, illuminated view of the bladder.
The cystoscope allows complete visualization of the urethra
, bladder ,ureteral orifices and prostatic urethra.
It can also be used to collect urine samples, perform biopsies,
and remove small stones.
A cystoscopy typically lasts from 10 to 40 minutes.
99. Main purpose of cystoscopy
To inspect the interior of the bladder with a tubular lighted
scope (cystoscope).
Used to insert ureteral catheters, remove calculi, obtain
biopsy specimens of bladder lesions, and treat bleeding
lesions.
Lithotomy position is used.
Local or general anesthesia my be used depending on needs
and condition of patient.
101. Professional Responsibilities
Before: give IV fluids if general anesthesia is to be used.
Ensure consent form is signed.
Explain procedure to patient.
Give preoperative medication.
After: Explain that burning on urination, pink-tinged urine, and urinary
frequency are expected effects.
Observe for bright red bleeding, which is not normal.
Do not let patient walk alone immediately after procedure because orthostatic
hypotension may occur.
Offer warm sitz baths, heat, and mild analgesics to relieve discomfort.
103. 5) Radiologic Studies Of GUS
a) X-Ray
An x-ray study of the abdomen or kidneys ,
ureters and bladder may be performed to
delinature
The size,
Shape, &
Position of the kidneys &
To reveal urinary system abnormalities
104. b) General Ultrasonography
I s a non- invasive procedure that uses sound
waves passed into the body through a transducer
to detect abnormalities of internal tissues &
organs.
Can identify abnormalities such as fluid
accumulation, masses, congenital malformation,
changes in organ size & obstruction.
Requires a full bladder , therefore fluid intake is
encouraged before the procedure.
105. c) Bladder Ultrasonography
Is a non invasive method of measuring urine volume in the
bladder.
Indication
o Urine frequency
o Inability to void after removal of catheter
o To measure post voiding residual urine volume
o Inability to void postoperatively
Portable, battery operated devices are available for bed
side use.
The scan head is placed on the pt’s abdomen& directed
toward the bladder
The device automatically calculates & display urine volume.
106. d) CT & MRI
Computed tomography ( CT) & magnetic resonance
imaging ( MRI) are non invasive techniques
That provide excellent cross- sectional views of the
anatomy of the kidneys and urinary tract.
Used to evaluate genitourinary masses,
nephrolithiasis, chronic renal infection, renal or
urinary tract trauma , metastatic disease, and soft
tissue abnormalities.
Occasionally, an oral or IV radiopaque contrast
agent is used in CT scanning to enhance
visualization.
107. E) Biopsy
Renal & Urethral Brush Biopsy
Bush biopsy techniques provide specific information
when abnormal x-ray findings of the ureters or
renal pelvis raise questions about whether a
defect is a tumor , stone, blood clot, or artifact.
1st Cystoscopic examination is conducted
Then, ureteral catheter is introduced followed by a
biopsy brush that is passed through the catheter.
The suspected lesion is brushed back & forth to
obtain cells & surface tissue fragments for
histological analysis.
108. f) Kidney Biopsy
Used to help diagnose & evaluate the extent
of kidney disease.
Indication of kidney biopsy include:
Unexplained acute renal failure
Persistent proteinuria or hematuria
Transplant rejection
Glomerulopathies-
109. Contraindication of Kidney Biopsy
Bleeding
Uncontrolled HTN
A solitary kidney-single
Morbid obesity
Before the biopsy is carried out, coagulation
studies are conducted to identify any risk of
postbiopsy bleeding.
110. …
Fasting 6 to 8hrs before the test
IV line is established
Urine specimen is obtained
Saved to compare with the postbiopsy specimen
If needle-pt breaths in & hold that breath.
Is to prevent kidney from moving while the
needle is inserted
Place sedated pt in prone position with a sand
bag under the abdomen
111. …
Local anesthesia is used to infiltrate the skin
The biopsy needle is introduced inside the
renal capsule of the kidney.
The location is confirmed with fluoroscopy or
ultrasound- special probe is used.
With open biopsy-Small incision is made over
the kidney, allowing direct visualization
Preparation for an open biopsy is similar to
that for major abdominal surgery.
112. Nursing Responsibilities
Administer IV fluid
Monitor vital sign
Monitor input output
Follow signs of infection
-Fever
-Bleeding
urine may contain blood ( 24-48hrs) from
oozing at the site.
