Method and investigation of kidney function

2. :-METHODS AND
INVESTIGATION OF
KIDNEY
FUNCTION:-
2

3. KIDNEY DIAGNOSTIC
TESTS:-
1. Laboratory studies.
2. Radiology & Imagine.
3. Other tests.
3

4. 1. LABORATARY
STUDIES:-
a) Tests On Kidney Function.
b) Prostate-specific antigen
(PSA)
c) Urinalysis.
4

5. a) TESTS ON KIDNEY FUNCTION
 Kidney function tests are used to determine
effectiveness of the kidneys' excretory
functioning, to evaluate the severity of
kidney disease, and to follow the patient's
progress.
 There is no single test of Kidney function; best
results are obtained by combining a
number of clinical tests.
 Kidney function is variable from time to time.
5

6. WHAT ARE THE TESTS ON
KIDNEY FUNCTION ? ? ?
1.Kidney concentration test.
 Specific gravity
 Osmolality of urine
2. Creatinine clearance.
3. Serum creatinine.
4. Serum urea nitrogen (Blood urea nitrogen [BUN]).
5. Protein.
6. Microalbumin/Creatinine ratio.
7. Urine casts. 6

7. 1. LABORATARY
STUDIES:-
a) Tests On Kidney Function.
b) Prostate-specific antigen
(PSA)
c) Urinalysis.
7

8. b) PROSTATE-SPECIFIC ANTIGEN
(PSA)
 An amino acid glycoprotein that is measured in the
serum by a simple blood test.
 An elevated PSA indicates the presence of prostate
disease, but is not exclusive to prostate cancer.
 Level rises continuously with the growth of prostate
cancer.
 Normal serum PSA level is less than 4 ng/mL.
Levels less than 10 ng/mL may be indicative of
benign prostatic hyperplasia (BPH) and not
necessarily prostate cancer.
 Patients who have undergone treatment for prostate
cancer are monitored periodically with PSA levels for
recurrence
 No patient preparation is necessary. 8

9. 1. LABORATARY
STUDIES:-
a) Tests On Kidney Function.
b) Prostate-specific antigen
(PSA)
c) Urinalysis.
9

10. c) KIDNEYANALYSIS
Involves examination of the urine for overall
characteristics, including appearance, pH, specific
gravity, and osmolality as well as microscopic
evaluation for the presence of normal and abnormal
cells.
 Appearance - normal urine is clear
 Odour - normal urine has a faint aromatic odor
 Colour - Normal urine is clear yellow or amber
 pH of urine - Normal pH is around 6 (acid); may
normally vary from 4.6 to 7.5.
 Specific gravity - Normal specific gravity ranges
from 1.005 to 1.025
 Osmolality - Average value is 300 to 1,090 mOsm/ kg
for females; 390 to 1,090 mOsm/kg for males.
10

11. KIDNEYANALYSIS : NURSING
AND PATIENT CARE CONSIDERATIONS
 Freshly voided urine provides the best results for
routine urinalysis; some tests may require first
morning specimen.
 Obtain sample of about 30 mL.
 Urine culture and sensitivity tests are typically
performed using the same specimen obtained for
urinalysis; therefore, use clean-catch or
catheterization techniques.
 Patients with urinary diversions, especially ileal
conduit diversions, require special techniques to
obtain urine that is not contaminated with
bacteria from the intestinal diversion. 11

12. TECHNIQUE FOR OBTAINING CLEAN-CATCH MIDSTREAM
VOIDED SPECIMEN EQUIPMENT FROM MALE
PATIENT
 Instruct the patient to expose glans and cleanse
area around meatus. Wash area with mild
antiseptic solution or liquid soap. Rinse
thoroughly.
 Allow the initial urinary flow to escape.
 Collect the midstream urine specimen in a sterile
container.
 Avoid collecting the last few drops of urine.
12

13. TECHNIQUE FOR OBTAINING CLEAN-
CATCH MIDSTREAM VOIDED SPECIMEN
EQUIPMENT FROM FEMALE PATIENT
 Ask the patient to separate her labia to expose the
urethral orifice. If no one is available to assist the
patient, she may sit backward on the toilet seat facing
the water tank or sit on (straddle) the wide part of the
bedpan.
 Clean the area around the urinary meatus with pads
soaked with antiseptic/soap solution. Rinse
thoroughly.
 While the patient keeps the labia separated (see
accompanying figure), instruct her to void forcibly.
 Allow initial urinary flow to drain into bedpan (toilet)
and then catch the midstream specimen in a sterile
container, making sure that the container does not
come in contact with the genitalia. 13

14. KIDNEY DIAGNOSTIC
TESTS:-
1. Laboratory studies.
2. Radiology & Imagine.
3. Other tests.
14

15. 2. RADIOLOGY & IMAGINE.
a) X-ray of Kidneys, Ureters, and Bladder
b) Intravenous Pyelogram (Intravenous Urogram)
c) Retrograde Pyelography
d) Renal Angiography
e) Renal Scans
f) Ultrasound
g) Computed Tomography Scanning (CTS) and
Magnetic Resonance Imaging (MRI)
15

16. a) X-RAY OF KIDNEYS, URETERS, AND
BLADDER
o Bowel preparation is recommended.
Clear liquids only the day before the examination.
Cathartics/laxatives are given the evening before the
examination.
Nothing by mouth (NPO) after midnight the day of the
examination (if scheduled for afternoon, clear liquids only
in the morning).
 Usually done before other testing.
 Patient will be asked to wear a gown
and remove all metal from the
X-ray field
16

17. b) INTRAVENOUS PYELOGRAM
(INTRAVENOUS UROGRAM)
 I.V. introduction of a radiopaque contrast
medium that concentrates in the urine and
thus facilitates visualization of the kidneys,
ureter, and bladder.
 The contrast medium is cleared from the
bloodstream by renal excretion.
 Contraindicated in patients with renal
failure, uncontrolled diabetes, or multiple
myeloma.
 Contraindicated in patients receiving drug
therapy for chronic bronchitis, emphysema,
or asthma and in patients taking metformin
(Glucophage). 17

18.  Patients with known iodine/contrast material
allergy must have steroid/antihistamine
preparation; in some cases, an anesthesiologist
must be available.
 Bowel preparation is necessary:
 Clear liquids only the day before the examination.
 Cathartics/laxatives are given the evening before
the examination.
 Nothing by mouth (NPO) after midnight the day of
the examination (if scheduled for afternoon, clear
liquids only in the morning).
18

19. d) RENAL ANGIOGRAPHY
 I.V. catheter is threaded through the femoral
and iliac arteries into the aorta or renal
artery.Contrast material is injected to visualize
the renal arterial supply.
 Evaluates blood flow dynamics, demonstrates
abnormal vasculature, and differentiates renal cysts
from renal tumors.
 May be done to embolize a kidney before
nephrectomy for renal tumor.
 Clear liquids only after midnight before the
examination; adequate hydration is essential.
 Continue oral medications (special orders
needed for diabetic patients). 19

20.  I.V. required.
 May not be done on the same day as other
studies requiring barium or contrast material.
 Maintain bed rest for 8 hours after the
examination, with the leg kept straight on the
side used for groin access.
 Observe frequently for hematoma or bleeding at
access site. Keep sandbag at bedside for use if
bleeding occurs.
20

21. f) ULTRASOUND
 Uses high-frequency sound waves passed into
the body and reflected back in varying
frequencies based on the composition of soft
tissues. Organs in the urinary system create
characteristic ultrasonic images that are
electronically processed and displayed as an
image.
 Abnormalities, such as masses, malformations, or
obstructions, can be identified; useful in
differentiating between solid and fluid-filled masses.
 A noninvasive technique.
21

22.  Ultrasound examination of the prostate is
performed using a rectal probe. A Fleet enema
may be ordered just within hours of the
examination.
 Ultrasound examination of the bladder
requires that the bladder be full.
 Patient should not have had any studies
using barium for 2 days before ultrasound
of the kidney or bladder.
22

23. KIDNEY DIAGNOSTIC
TESTS:-
1. Laboratory studies.
2. Radiology & Imagine.
3. Other tests.
23

24. CYSTOSCOPY
24

25. CYSTOSCOPY
 Cystoscopy is a method of direct visualization of the
urethra and bladder by means of a cystoscope that is
inserted through the urethra into the bladder. It has a
self-contained optical lens system that provides a
magnified, illuminated view of the bladder.
 Nursing interventions after cystoscopic examination:
 Monitor for complications: urinary retention, urinary
tract hemorrhage, infection within prostate or bladder.
 Expect the patient to have some burning on voiding,
blood-tinged urine, and urinary frequency from trauma
to mucous membrane of the urethra.
 Administer or teach self-administration of antibiotics
prophylactically as ordered to prevent UTI.
 Advise warm sitz baths or analgesics, such as ibuprofen
or acetaminophen, to relieve discomfort after
cystoscopy. Increase hydration.
 Provide routine catheter care if urine retention persists
and an indwelling catheter is ordered.
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26. TESTS FOR RENAL TUBULAR
FUNCTION:-
 Measurement of Urine Volume
 Urine is collected separately during day and
during night (6 AM to 6 PM & 6 PM to 6 AM)
 Normally night volume is only 50% of day
volume
 ↑ excretion of urine in night (nocturia) →
tubular dysfunction
 Measurement of Osmolality
 Instrument: ‘Osmometer’
 Urine Osmolality: 60 to 1200 milliosmol/kg
 Plasma Osmolality: 285 to 300 milliosmol/kg
 Osmolality of urine/plasma: 3 to 4.5
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27. NEEDLE BIOPSY OF KIDNEY
 Performed by percutaneous needle biopsy
through renal tissue with ultrasound guidance or
by open biopsy through a small flank incision;
useful in securing specimens for electron and
immunofluorescent microscopy to determine
diagnosis, treatment, and prognosis of renal
disease.
27

28. NURSING AND PATIENT CARE
CONSIDERATIONS
 Prebiopsy nursing management
 Ensure that coagulation studies are carried out to identify
the patient at risk for postbiopsy bleeding and that serum
creatinine, urinalysis, and urine culture are done.
 Ensure that patient fasts for several hours before the
procedure, as ordered.
 Establish an I.V. line, as ordered.
 Describe the procedure to the patient, including holding
breath (to prevent movement of the thorax) during during
insertion of the biopsy needle.
o Postbiopsy nursing management.
• Place the patient in a prone position immediately after
biopsy and on bed rest for 8 to 24 hours to minimize
bleeding.
 Take vital signs every 5 to 15 minutes for the first hour
and then with decreasing frequency if stable to assess for
hemorrhage, which is a major complication.
 Watch for rise or fall in blood pressure, anorexia, vomiting,
or development of a dull, aching discomfort in abdomen.
 Assess for flank pain.
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29. TESTS FOR RENAL TUBULAR
FUNCTION
 Dilution tests
 Subject is not allowed to drink water after
midnight
 Morning after emptying bladder, water load of
1200ml is given for about 30 min
 Hourly urine samples is collected seperately for
next 4 hours
 Each sample: Volume, specific gravity and
osmolality is measured
29

30. TESTS FOR RENAL TUBULAR
FUNCTION:
 Dilution tests…
 Normal response: Almost all water load is
excreted by 4 hours
- One of the 4 samples shows specific
gravity falling to 1.003 and osmolality to 50
milliosmol/kg
 Advantage:
- More sensitive test
- Feasible
- Less harmful than concentration test
30

31. TESTS FOR RENAL TUBULAR
FUNCTION
 Specific gravity
 Instrument: ‘Urinometer’
 earliest manifestation of renal disease →
difficulty in concentrating the urine →
alterations in specific gravity
 Concentration test
 Subject is not allowed to consume food or water
after 6 PM till next day 7 AM, when the bladder
is emptied
 A second specimen is collected one hour later
and specific gravity is measured
 > 1.022 indicates adequate renal function
31

32. KIDNEY DIAGNOSTIC
TESTS
1. Laboratory studies.
2. Radiology & Imagine.
3. Other tests.
32

33. KIDNEY FUNCTION TEST -
SUMMARY
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Measurement of GFR Clearance tests
Endogenous substance used for
clearance tests
Creatinine
Exogenous substance used for clearance
testes
Inulin
Volume, Appearance, Colour, Odour,
Specific gravity
Physical Characteristics
Measurement of specific gravity Urinometer
Reducing substance, Ketone bodies,
Proteins, Blood, Bile salts and Bile
pigments
Abnormal chemical
constituents
Early detection of Diabetic and
hypertensive nephropathy
Microalbumin
Specific gravity, Concentration test,
Urine volume, Osmolality, Dilution
test, Acidification
Renal tubular function

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