Genitourinary System

I.
Anatomy and Physiology of the Genitourinary System
GENITOURINARY SYSTEM
The renal system consists of all the organs involved in the formation and release
of urine. It includes the kidneys, ureters, bladder and urethra.
The kidneys are bean-shaped organs which help the body produce urine to get
rid of unwanted waste substances. When urine is formed, tubes called ureters transport
it to the urinary bladder, where it is stored and excreted via the urethra. The kidneys are
also important in controlling our blood pressure and producing red blood cells.
Components of the renal system
 Kidneys and ureters
The kidneys are large, bean-shaped organs towards the back of the abdomen
(belly). They lie behind a protective sheet of tissue within the abdomen. The kidneys
perform many vital functions which are important in everyday life. For example, they
help us get rid of waste products by making urine and excreting it from the body. A
special system of tubes within the kidneys allow substances such as sodium (salt) and
chloride to be filtered.
The kidneys regulate the amount of water in the body. Humans produce about
1.5 litres of urine a day. However, if we drink more water, we may produce more urine.
On hot days, if we get dehydrated and sweat more, we may produce less urine. This is
why it's very important to drink lots of water on hot summer days.
The kidneys also produce renin (a hormone important in regulating blood

pressure) and erythropoietin (helps produce red blood cells).
Located in the lower part of our bellies, the right kidney is slightly lower in
position than the left, allowing room for the liver. The kidneys are reddish brown in
colour and measure about 10 cm in length, 5 cm width and 2.5 cm thick. On the side of
the kidney with the smaller curve is an opening called the hilum, where blood vessels,
nerves, and the ureters enter the kidney. On one end of the ureters is a funnel-shaped
expansion, called the renal pelvis, where urine collects. The ureters carry urine to the
bladder; they are 25–30 cm long tubes lined with smooth muscle. The muscular tissue
helps force urine downwards. The ureters enter the bladder at an angle, so urine
doesn't flow up the wrong way.
The kidney can be divided into two distinct regions. There is an outer red-brown
part (cortex) and inner lighter coloured part (medulla). The cortex is made up of special
units called corpuscles, nephrons, and a system of straight and curvy collecting tubules
supplied by many blood vessels. In the outer part of the kidney, there are many
nephrons which act as filtering units. Each nephron is supplied by a ball of small blood
vessels, called glomeruli. A diagram of a single glomerulus is seen below. Blood is
filtered through the small blood vessels to produce a mixture that is the precursor of
urine. This mixture then passes through more tubules, where water, salt and nutrients
are reabsorbed.
The inner part of the kidney (the medulla) is a continuation of the specialized
nephrons in the kidney. A small blood vessel network called the vasa recta supplies the
medulla. Each kidney is supplied by the renal arteries, which give off many smaller
branches to the surrounding parts of the kidneys. Renal veins drain the kidney.
 Bladder
The bladder is a pyramid-shaped organ which sits in the pelvis (the bony
structure which helps form the hips). The main function of the bladder is to store urine
and, under the appropriate signals, release it into a tube which carries the urine out of
the body. Normally, the bladder can hold up to 500 mL of urine. The bladder has three
openings: two for the ureters and one for the urethra (tube carrying urine out of the
body).
The bladder consists of smooth muscles. The main muscle of the bladder is
called the detrusor muscle. Muscle fibres around the opening of the urethra forms a
ring-like muscle that controls the passage of urine. When we want to urinate, stretch
receptors in the bladder are activated, which send signals to our brain and tell us that
the bladder is full. The ring-like muscle relaxes and the detrusor muscle contracts,
allowing urine to flow.
The blood supply of the bladder is from many blood vessels. Some of these
blood vessels are named: the vesical arteries, the obturator, uterine, gluteal and vaginal
arteries. In females, a venous network drains blood from the bladder arteries into the
internal iliac vein. Nervous control of the bladder involves centres located in the brain
and spinal cord.
 Urethra
The male urethra is 18–20 cm long, running from the bladder to the tip of the
penis. The male urethra is supplied by the inferior vesical and middle rectal arteries. The
veins follow these blood vessels. The nerve supply is via the pudendal nerve.
The female urethra is 4–6 cm long and 6 mm wide. It is a tube running from the
bladder neck and opening into an external hole located at the top of the vaginal
opening. As the female urethra is shorter than the male urethra, it is more likely to get
infections from bacteria in the vagina. The female urethra is supplied by the internal
pudendal and vaginal arteries.
II.Diagnostic Tests and Table of Laboratory Values

• Serum Creatinine
Measures effectiveness of renal function. Creatinine is end product of muscle

energy metabolism. In normal function, level of creatinine, which is regulated and
excreted by the kidneys, remains fairly constant in the body.
Normal Value: 0.6 – 1.2 mg/dl (50 – 110 µmol/dL
How the test is performed
o Blood is drawn from a vein, usually from the inside of the elbow or the back of the
hand. The site is cleaned with germ-killing medicine (antiseptic). The health care
provider wraps an elastic band around the upper arm to apply pressure to the area
and make the vein swell with blood.
o Next, the health care provider gently inserts a needle into the vein. The blood
collects into an airtight vial or tube attached to the needle. The elastic band is
removed from your arm.
o Once the blood has been collected, the needle is removed, and the puncture site is
covered to stop any bleeding.
o In infants or young children, a sharp tool called a lancet may be used to puncture
the skin and make it bleed. The blood collects into a small glass tube called a
pipette, or onto a slide or test strip. A bandage may be placed over the area if there
is any bleeding.
How to prepare for the test
The health care provider may tell you to stop taking certain drugs that may affect the
test. Such drugs include:
• Aminoglycosides (for example, gentamicin)

• Bactrim
• Cimetidine
• Heavy metal chemotherapy drugs (for example, Cisplatin)
• Nephrotoxic drugs such as cephalosporins (for example, cefoxitin)
• Blood Urea Nitrogen (BUN)
Serves as index of renal function. Urea is nitrogenous end product of protein

metabolism. Test values are affected by protein intake, tissue breakdown, and fluid
volume changes.
Normal Value: 7-18 mg/dl, patients over 60 years: 8-20 mg/dL
hand. The puncture site is cleaned with antiseptic, and a tourniquet is placed
around the upper arm to apply pressure and restrict blood flow through the vein.
This causes veins below the tourniquet to fill with blood.
o A needle is inserted into the vein, and the blood is collected in an airtight vial or a
syringe. During the procedure, the tourniquet is removed to restore circulation.
Once the blood has been collected, the needle is removed, and the puncture site
is covered to stop any bleeding.
o In infants and young children, the area is cleaned with antiseptic and punctured
with a sharp needle or a lancet. The blood may be collected in a pipette (small
glass tube), on a slide, onto a test strip, or into a small container. A bandage may
be applied to the puncture site if there is any continued bleeding.
Some drugs affect BUN levels. Before having this test, make sure the health care
provider knows which medications you are taking.
Drugs that can increase BUN measurements include:
• Allopurinol • Guanethidine
• Aminoglycosides • High-dose aspirin
• Amphotericin B • Indomethacin
• Bacitracin • Methicillin
• Carbamazepine • Methotrexate
• Cephalosporins • Methyldopa
• Chloral hydrate • Neomycin
• Cisplatin • Penicillamine
• Colistin • Polymyxin B
• Furosemide • Probenecid
• Gentamicin • Propranolol
• Rifampin • Thiazide diuretics
• Spironolactone • Triamterene
• Tetracyclines • Vancomycin
Drugs that can decrease BUN measurements include:
• Chloramphenicol
• Streptomycin
• Urinalysis and Urine Culture
Urinalysis
The urinalysis provides important clinical information on kidney function and

helps diagnose other diseases, such as diabetes.
Specific Gravity
Evaluates ability of kidneys to concentrate solutes in urine.
Normal value: 1.010 – 1.025
o The test requires a clean-catch urine sample.

o To obtain a clean-catch sample, men or boys should clean the head of the penis.
o Women or girls need to wash the area between the lips of the vagina with soapy
water and rinse well.
o As you start to urinate, allow a small amount to fall into the toilet bowl to clear the
urethra of contaminants. Then, put a clean container under your urine stream and
catch 1 to 2 ounces of urine. Remove the container from the urine stream. Cap
and mark the container and give it to the health care provider or assistant.
o For infants, thoroughly wash the area around the urethra. Open a urine collection
bag (a plastic bag with an adhesive paper on one end), and place it on the infant.
For boys, the entire penis can be placed in the bag and the adhesive attached to
the skin. For girls, the bag is placed over the labia. Diaper as usual over the
secured bag. This procedure may take a couple of attempts -- lively infants can
displace the bag. The infant should be checked frequently and the bag changed
after the infant has urinated into the bag. The urine is drained into the container
for transport to the laboratory.
• Your health care provider will instruct you, if necessary, to discontinue drugs that
may interfere with the test. Drugs that can increase specific gravity
measurements include dextran and sucrose. Receiving intravenous dye
(contrast medium) for an x-ray exam up to 3 days before the test can also
interfere with results.
• Eat a normal, balanced diet for several days before the test.
Urine culture and Sensitivity
The urine culture determines if bacteria are present in the urine, as well as their
strains and concentration.
Urine examination includes:
• Urine color
• Urine clarity and odor
• Urine pH and specific gravity
• Test to detect protein, glucose, and ketone bodies in the urine (proteinuria,
glycosuria, and ketonuria)
• Microscopic examination of urine sediment after centrifuging to detect RBCs

(hematuria), WBCs, casts (cylindruria), crystals (crystalluria), pus (pyuria), and
bacteria (bacteriuria)
• Creatinine Clearance
Description:
• This test is the most accurate measurement of renal function that does not
require the injection of dye or radiologic testing. It determines the glomerular
filtration rete and tubular exrection ability of the kidney.
How is it used?
• A creatinine clearance test is used to help evaluate the rate and efficiency of
kidney filtration. It is used to help detect kidney dysfunction and/or the presence
of decreased blood flow to the kidneys. In patients with chronic kidney disease or
congestive heart failure (which decreases the rate of blood flow), the creatinine
clearance test may be ordered to help monitor the progress of the disease and
evaluate its severity.
When is it ordered?
• The creatinine clearance test may be ordered whenever a doctor wants to

evaluate the filtration ability of the kidneys. It may be ordered when a patient has
increased blood creatinine concentrations, a known or suspected kidney
disorder, or decreased blood flow to the kidneys due to a condition such as
congestive heart failure.
Procedure:
o Urine is taken from the patient ;The normal value is 90-110 ml/min and declines with
age.
o A 24-hour urine sample generally required. Occasionally, 6- or 12-hour urine

collections can be done alternatively. The health care provider will instruct you, if
necessary, to discontinue drugs that may interfere with the test.
• On day 1, urinate into the toilet when you get up in the morning.
• Afterwards, collect all urine in a special container for the next 24 hours.
• On day 2, urinate into the container when you get up in the morning.
• Cap the container. Keep it in the refrigerator or a cool place during the collection
period. Label the container with your name, the date, the time of completion, and
return it as instructed.
For an infant:
o Thoroughly wash the area around the urethra. Open a urine collection bag (a
plastic bag with an adhesive paper on one end), and place it on the infant. For
boys, the entire penis can be placed in the bag and the adhesive attached to the
skin. For girls, the bag is placed over the labia. Diaper as usual over the secured
bag.
o This procedure may take a couple of attempts -- lively infants can displace the
bag. The infant should be checked frequently and the bag changed after the
infant has urinated into the bag. The urine is drained into the container for
transport to the laboratory.
o Deliver it to the laboratory or your health care provider as soon as possible upon
completion.
For an adult or child:
hand. The puncture site is cleaned with antiseptic. An elastic band is placed
around the upper arm to apply pressure and cause the vein to swell with blood.
o A needle is inserted into the vein, and the blood is collected in an air-tight vial or
a syringe. During the procedure, the band is removed to restore circulation. Once
the blood has been collected, the needle is removed, and the puncture site is
For an infant or young child:
o The area is cleansed with antiseptic and punctured with a sharp needle or a
lancet. The blood may be collected in a pipette (small glass tube), on a slide,
onto a test strip, or into a small container. A bandage may be applied to the
puncture site if there is any bleeding.
o Both the blood and urine will be tested in a laboratory.
Nsg. responsibility
• The nurse should collect the urine specimen 12 or 24 hours as ordered.
• Vanillylmandelic acid test:
Description:
• A test for catecholamine-secreting tumors (pheochromocytoma and

neuroblastoma)
Procedure:
• Performed on a 24-hour urine specimen; it is based on the finding that

vanillylmandelic acid is the major urinary metabolite of norepinephrine and
epinephrine.
Nsg. responsibility
 The nurse should tell the patient to catch the midstream flow of his/her urine
• KUB (kidney, ureter, bladder)
Description:
A KUB is a plain frontal supine radiograph of the abdomen. It is often

supplemented by an upright PA view of the chest (to rule out air under the diaphragm or
thoracic etiologies presenting as abdominal complaints) and a standing view of the
abdomen (to differentiate obstruction from ileus by examining gastrointestinal air/water
levels).
Despite its name, a KUB is not typically used to investigate pathology of the
kidneys, ureters, or bladder, since these structures are difficult to assess (for example,
the kidneys may not be visible due to overlying bowel gas.) In order to assess these
structures with X-ray, a technique called an intravenous pyelogram is utilized.
KUB is typically used to investigate gastrointestinal conditions such as a bowel

obstruction and gallstones, and can detect the presence of kidney stones. The KUB is
often used to diagnose constipation as stool can be seen readily. The KUB is also used
to assess positioning of indwelling devices such as ureteric stents and nasogastric
tubes. KUB is also a routine projection done as a scout film for other procedures such
as barium enemas. Actually, the KUB should be called a KUBU, the last U standing for
"Urethra". Commonly, it is still referred to as KUB only.
It should include on the upright projections both right and left visualizations of the
diaphragm. In at least one projection, the symphysis pubis must be present as the lower
end of the area of interest. If the patient is large, more than one film loaded in the Bucky
in a "landscape" direction may be used for each projection. This is done to ensure that
the majority of bowel can be reviewed.
• Demonstrates the size of kidney, ureter, and bladder for presence of cysts,
tumors, and displacement or obstruction.
Procedure:
• X-Ray the kidney, ureter and bladder
Nsg. responsibility
 Establish/maintain fluid and electrolyte balance

 Prevent complication
 Provide emotional support
 Provide information about s\disease
Uric acid:
Description:
 It is the increased urate excreation, fluid depletion and a low urinary pH.
How is it used?
The uric acid test is used to learn whether the body might be breaking down cells
too quickly or not getting rid of uric acid quickly enough. The test also is used to monitor
levels of uric acid when a patient has had chemotherapy or radiation treatments.
What does the test result mean?
Higher than normal uric acid levels mean that the body is not handling the
breakdown of purines well. The doctor will have to learn whether the cause is the over-
production of uric acid, or if the body is unable to clear away the uric acid.
Increased concentrations of uric acid can cause crystals to form in the joints,
which leads to the joint inflammation and pain characteristic of gout. Uric acid can also
form crystals or kidney stones that can damage the kidneys. Low levels of uric acid in
the blood are seen much less commonly than high levels and are seldom considered
cause for concern. Although low values can be associated with some kinds of liver or
kidney diseases, exposure to toxic compounds, and rarely as the result of an inherited
metabolic defect, these conditions are typically identified by other tests and symptoms
and not by an isolated low uric acid result.
Procedure:
Urine is taken from the patient.
Nsg. responsibility
 The nurse should tell the patient to catch the midstream flow of his/her urine
• Bladder scanning:
Description:
• This procedure is to inspect the bladder for any obstruction, tumor etc.
Procedure:
• The patient is scanned with the ultrasonography machine
Nsg. responsibility
• The nurse should tell the patient to empty bladder first before the procedure
• Computed Tomography Scan
A computerized axial tomography scan is an x-ray procedure that combines many x-

ray images with the aid of a computer to generate cross-sectional views and, if needed,
three-dimensional images of the internal organs and structures of the body.
Computerized axial tomography is more commonly known by its abbreviated names, CT
scan or CAT scan. A CT scan is used to define normal and abnormal structures in the
body and/or assist in procedures by helping to accurately guide the placement of
instruments or treatments.
A large donut-shaped x-ray machine takes x-ray images at many different angles
around the body. These images are processed by a computer to produce cross-
sectional pictures of the body. In each of these pictures the body is seen as an x-ray
"slice" of the body, which is recorded on a film. This recorded image is called a
tomogram. "Computerized Axial Tomography" refers to the recorded tomogram
"sections" at different levels of the body.
Procedure:
o All metallic materials and certain clothing around the body are removed because
they can interfere with the clarity of the images.
o Patients are placed on a movable table, and the table is slipped into the center of a
large donut-shaped machine which takes the x-ray images around the body.
o The actual procedure can take from a half an hour to an hour and a half.
o If specific tests, biopsies, or intervention are performed by the radiologist during CT
scanning, additional time and monitoring may be required.
o It is important during the CT scan procedure that the patient minimizes any body
movement by remaining as still and quiet as is possible. This significantly
increases the clarity of the x-ray images.
o The CT scan technologist tells the patient when to breathe or hold his/her breath
during scans of the chest and abdomen.
o If any problems are experienced during the CT scan, the technologist should be
informed immediately.
o The technologist directly watches the patient through an observation window
during the procedure, and there is an intercom system in the room for added
patient safety.
Nursing responsibilities:
 Promote / maintain the client’s dignity

 Maintain the client’s sense of control
 Assist the client to become comfortable in a new environment
• Magnetic Resonance Imaging

An MRI (or magnetic resonance imaging) scan is a radiology technique that uses
magnetism, radio waves, and a computer to produce images of body structures. The
MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a
moveable bed that is inserted into the magnet. The magnet creates a strong magnetic
field that aligns the protons of hydrogen atoms, which are then exposed to a beam of
radio waves. This spins the various protons of the body, and they produce a faint signal
that is detected by the receiver portion of the MRI scanner. The receiver information is
processed by a computer, and an image is produced.
Procedure:
o All metallic objects on the body are removed prior to obtaining an MRI scan.
o Occasionally, patients will be given a sedative medication to decrease anxiety
and relax the patient during the MRI scan.
o MRI scanning requires that the patient lie still for best accuracy.
o Patients lie within a closed environment inside the magnetic machine.
o Relaxation is important during the procedure and patients are asked to breathe
normally. Interaction with the MRI technologist is maintained throughout the test.
o There are loud, repetitive clicking noises which occur during the test as the
scanning proceeds.
o Occasionally, patients require injections of liquid intravenously to enhance the
images which are obtained.
o The MRI scanning time depends on the exact area of the body studied, but
ranges from half an hour to an hour and a half.
Nursing responsibilities:
• Supply the MRI Medical History Questionnaire (S/N 1384) to the patient
forcompletion if the patient is coherent and an accurate historian. Notify MRI
personnel if the patient is unconscious, unresponsive, can not provide reliable
history and there is no family that can provide information.
• The nursing staff is responsible for placement of an IV lock and assuring that
theMRI
• Medical History Questionnaire is complete prior to transporting the patient to
MRI.
• Nursing staff shall also key the order into the Invision system following computer
prompts.
• Intravenous Pyelogram (IVP)
An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and

urinary bladder that uses iodinated contrast material injected into veins.
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose
and treat medical conditions. Imaging with x-rays involves exposing a part of the body to
a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays
are the oldest and most frequently used form of medical imaging.
When a contrast material is injected into a vein in the patient's arm, it travels through
the blood stream and collects in the kidneys and urinary tract, turning these areas bright
white. An IVP allows the radiologist to view and assess the anatomy and function of the
kidneys, ureters and the bladder.
Procedure:
o This examination is usually done on an outpatient basis.

o The patient is positioned on the table and still x-ray images are taken. The
contrast material is then injected, usually in a vein in the patient's arm, followed by
additional still images.
o You must hold very still and may be asked to keep from breathing for a few
seconds while the x-ray picture is taken to reduce the possibility of a blurred
image. The technologist will walk behind a wall or into the next room to activate
the x-ray machine.
o As the contrast material is processed by the kidneys a series of images is taken to
determine the actual size of the kidneys and to capture the urinary tract in action
as it begins to empty. The technologist may apply a compression band around the
body to better visualize the urinary structures leading from the kidney.
o When the examination is complete, you will be asked to wait until the radiologist
determines that all the necessary images have been obtained.
o An IVP study is usually completed within an hour. However, because some
kidneys empty at a slower rate the exam may last up to four hours.
• Renal Angiography
Angiography is the use of an x-ray to look at arteries in order to detect blockage or

narrowing of the vessels. In many cases, the interventional radiologist can treat the
blockages such as those occurring in the arteries of the kidney by inserting a small
stent which inflates and opens the vessel. This procedure is called angioplasty.
For diagnosis and treatment of renal (kidney) vascular hypertension and renal
insufficiency, CO² angiography is available to minimize contrast load in patients with
preexisting renal insufficiency.
How it works
A contrast dye injected via a catheter threaded into the blood vessels of the kidneys
makes them visible on a x-ray, allowing detection of any abnormalities affecting the
blood supply to the kidneys.
• Preparation
Clear liquids for 12 hours before the procedure. You may take your medicines.
Test procedure
• Local anesthesia is injected into your skin near an artery in your arm or leg.
• When the site is numbed, a catheter is inserted into the artery and threaded up
through the aorta and into the renal artery.
• Dye is injected through the catheter, and a series of X-rays is taken. During the
X-rays, you must remain absolutely still.
After the test
• The catheter is removed, and pressure is applied to the catheter site to stop any
bleeding.
• You will go to a recovery room for a short while so your vital signs can be
checked. You may receive pain medication if the catheter insertion site is sore.
• You should restrict your activities and remain relatively quiet during the next 24
hours, after which you can resume normal activities.
• You must check the incision and report any excessive bleeding, soreness, or
swelling to your doctor.
Nursing Responsibilities:
1.See all patients the day/night before their procedure and review chart, check
labs* and EKG, obtain consent, write preprocedure note and place orders.
2.See all same day admit patients and out patients for workup as above (in
conjunction with NPs).
3.CTA/MRA protocol first thing after conference when assigned to imaging.
4.Residents should arrive by 7:30 AM if not at conference or case review. Be

ready to perform cases by 8:00.
5.Scheduling of cases, or add-on cases, should be referred to Fellows.
6.When preparting to do a case, make a treatment plan based on old studies and
present it to an attending.
7.Perform procedures with supervision by Fellow/Attending.
8.A physician or nurse must be present in the procedure room at all times.
9.Fill post note at completion of procedure and call admitting resident.

10.Review your cases with an attending prior to dictation.
11.See in-house patients after all diagnostic procedures for follow up and write
note in chart later that same day.
12.Attend all AM conferences.
13.Complete 2 angio teaching files per rotation and review them with an
attending.
*If labs are pending the evening before the procedure, find the results before
8:00 a.m. the day of the procedure.
• Renal Scanning
A renal scan is a nuclear medicine exam in which a small amount of radioactive

material (radioisotope) is used to measure the function of the kidneys.
The specific type of scan may vary, depending on the patient's specific needs. This
article provides a general overview.
A renal scan is similar to a renal perfusion scintiscan. It may be done along with that
test.
o You will be asked to lie on the scanner table. The health care provider will place a
tourniquet or blood pressure cuff to the upper arm, which creates pressure and
enlarges your arm veins. The inner elbow is scrubbed with numbing medicine
(antiseptic) and a small amount of radioisotope is injected into a vein. The
specific radioisotope used may vary, depending on the kidney function that is
being studied.
o The pressure on the upper arm is released, which allows the radioactive material
to travel through the bloodstream. The kidneys are scanned a short time later.
Several images are taken, each lasting 1 or 2 seconds. The total scan time takes
about 30 minutes to 1 hour.
o A computer analyzes the images and provides detailed information about
particular kidney functions (such as how much blood the kidney filters over time).
After the scan, no recovery time is required. You may be asked to drink plenty of fluids
and urinate frequently to help remove the radioactive material from the body.
DESCRIPTION
• Cystoscopy is a
test that looks at
the inner lining of
the bladder and the tube from the bladder to the outside of the body (urethra). The
cystoscope is a thin, lighted viewing tool that is put into the urethra and moved into
the bladder.I t is performed by a urologist, with one or more assistants. The test is
done in a special testing room in a hospital or the doctor's office.
PROCEDURE
o You should empty your bladder just before the test. You may be given medicine
to prevent a urinary tract infection that could be caused by the test.
o You will need to take off all or most of your clothes, and you will be given a cloth
or paper covering to use during the test.
o About an hour before the test, you may be given a sedative to help you relax. An
intravenous (IV) needle may be placed in a vein in your arm to give you other
medicines and fluids. You will lie on your back on a special table with your knees
bent, legs apart, and your feet or thighs may be supported by stirrups. Your
genital area is cleaned with an antiseptic solution, and your abdomen and thighs
are covered with sterile cloths.
o If a local anesthetic is used, the anesthetic solution or jelly is inserted in your
urethra.
o If a general anesthetic is used, you will be put to sleep either with a medicine
given through an IV or by inhaling gases through a mask, or both methods may
be used.
o If a spinal anesthetic is used, the area on the back where the needle will be
inserted is first numbed with a local anesthetic, then the needle is guided into the
spinal canal and the anesthetic is injected. A spinal anesthetic may prevent
movement of the legs until the anesthetic wears off.
o After the anesthetic takes effect, a well-lubricated cystoscope is inserted into
your urethra and slowly advanced into your bladder. If your urethra has a spot
that is too narrow to allow the scope to pass, other smaller instruments are
inserted first to gradually enlarge the opening.
o After the cystoscope is inside your bladder, either sterile water or saline is
injected through the scope to help expand your bladder and to create a clear
view. A medicine may also be injected through the scope to reduce chances of
infection. Tiny instruments may be inserted through the scope to collect tissue
samples for biopsy; the tissue samples then are sent to the laboratory for
analysis.
o The cystoscope is usually in your bladder for only 2 to 10 minutes. But the entire
test may take up to 45 minutes or longer if other X-ray tests are done at the same
time.
o If a local anesthetic is used, you may be able to get up immediately after the test.
If a general anesthetic is used, you will stay in the recovery room until you are
awake and able to walk (usually an hour or less). You can eat and drink as soon
as you are fully awake and can swallow without choking. If a spinal anesthetic
was used, you will stay in the recovery room until sensation and movement
below your chest returns (usually about an hour).
RESULTS
Normal
 The urethra, bladder, and ureters are normal.
 There are no polyps or other abnormal tissues, swelling, bleeding, narrow areas
(strictures), or structural abnormalities.
Abnormal
 There is welling or narrowing of the urethra because of previous infections or an
enlarged prostate gland.
 There are bladder tumors (cancerous or benign), polyps, ulcers, urinary stones,
or inflammation of the bladder walls.
 Abnormalities in the structure of the urinary tract present since birth (congenital)
are seen.
 Pelvic organ prolapse is present in a woman.
IMPORTANCE
A cystoscopy can check for stones, tumors, bleeding, and infection. Cystoscopy can see
areas of the bladder and urethra that usually do not show up well on X-rays. Tiny
surgical instruments can be put through the cystoscope to remove samples of tissue
(biopsy) or samples of urine.
Cystoscopy also can be used to treat some bladder problems, such as removing small
bladder stones and some small growths.
• Kidney Biopsy
DESCRIPTION
A kidney biopsy is done using a long thin needle put through the back (flank) into
the kidney. This is called a percutaneous kidney biopsy. A tissue sample is taken and
sent to a lab. It is look at under a microscope. The sample can help your doctor see how
healthy your kidney is and look for any problems.
A kidney biopsy may be done to check for kidney problems. It may also be done
after other tests for kidney disease, such as blood and urine tests, ultrasound, or a
computed tomography (CT) scan, show a kidney problem. If kidney cancer is
suspected, a biopsy may not be done because of the chance of spreading the cancer.
Biopsy results are ready in 2 to 4 days. If tests are done to find infections, it may
take several weeks for the results to be ready.
PROCEDURE
o A kidney biopsy is done by a urologist, nephrologist, or a radiologist in a clinic or

a hospital. A kidney biopsy is often done by a radiologist using ultrasound,
fluoroscopy, a CT scan, or magnetic resonance imaging (MRI) to help guide the
biopsy needle.
o You will need to take off all or most of your clothes. You will wear a gown. Before
the biopsy, you may be given a sedative through an intravenous (IV) line in a vein
in your arm. The sedative will help you relax and lie still during the biopsy.
o You will be asked to lie facedown on an examination table. A sandbag, a firm
pillow, or a rolled towel will be placed under your body to support your belly. It is
very important that you follow your doctor's directions about breathing, holding
your breath, and lying still while the biopsy is being done.
o Your doctor will examine your back and may mark the biopsy site by making a
slight dent in your skin with a pencil or tool. The biopsy may be done on either
the right or the left kidney. The site will be cleaned with a special soap. Your
doctor then gives you local anesthetic to numb the area where the biopsy needle
will be inserted.
o Your doctor puts the biopsy needle through the skin while looking at your kidney
with ultrasound. You will be asked to hold your breath and stay very still while the
needle is put into the kidney.
o The needle is removed after the tissue sample is taken. Pressure is put on the
biopsy site for several minutes to stop the bleeding. Then a bandage is put on
the site. The biopsy takes 15 to 30 minutes.
o After the biopsy, you will rest in bed for 6 to 24 hours. Your pulse, blood pressure,
and temperature will be checked often after the biopsy.
o If no problems develop, you can go home. To prevent bleeding at the biopsy site,
lie flat on your back for the next 12 to 24 hours. You may eat your normal diet. Do
not take aspirin or anti-inflammatory medicines for a week after the biopsy. You
may do your regular activities, but do not do strenuous activities, such as heavy
lifting, hard running, motorcycle riding, contact sports, or other activities that
might jar or jolt your kidney, for 2 weeks after the biopsy. Also, drink more fluids
so you will not be dehydrated.
RESULTS
Normal
The structure and cells of the kidney look normal. There are no signs of
inflammation, scar tissue, infection, or cancer.
Abnormal
The sample may show signs of scarring due to infection, poor blood flow,
glomerulonephritis, a kidney infection (pyelonephritis), or signs of other diseases that
affect the body, such as systemic lupus erythematosus.
Kidney tissue may show tumors that were not expected, such as Wilms' tumor (which
occurs in early childhood) and renal cell cancer (which is most common after age 40).
DESCRIPTION
• Complete Blood Count (CBC) gives important information about the kinds and
numbers of cells in the blood, especially red blood cells, white blood cells, and
platelets. A CBC helps your health professional check any symptoms, such as
weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose
conditions, such as anemia, infection, and many other disorders.
A CBC test usually includes:
 White blood cell (WBC, leukocyte) count. White blood cells protect the body
against infection. If an infection develops, white blood cells attack and destroy
the bacteria, virus, or other organism causing it. White blood cells are bigger than
red blood cells but fewer in number. When a person has a bacterial infection, the
number of white cells rises very quickly. The number of white blood cells is
sometimes used to find an infection or to see how the body is dealing with cancer
treatment.
 White blood cell types (WBC differential). The major types of white blood cells
are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Immature
neutrophils, called band neutrophils, are also part of this test. Each type of cell
plays a different role in protecting the body. The numbers of each one of these
types of white blood cells give important information about the immune system.
Too many or too few of the different types of white blood cells can help find an
infection, an allergic or toxic reaction to medicines or chemicals, and many
conditions, such as leukemia.
 Red blood cell (RBC) count. Red blood cells carry oxygen from the lungs to the
rest of the body. They also carry carbon dioxide back to the lungs so it can be
exhaled. If the RBC count is low (anemia), the body may not be getting the
oxygen it needs. If the count is too high (a condition called polycythemia), there is
a chance that the red blood cells will clump together and block tiny blood vessels
(capillaries). This also makes it hard for your red blood cells to carry oxygen.
 Hematocrit (HCT, packed cell volume, PCV). This test measures the amount of
space (volume) red blood cells take up in the blood. The value is given as a
percentage of red blood cells in a volume of blood. For example, a hematocrit of
38 means that 38% of the blood's volume is made of red blood cells. Hematocrit
and hemoglobin values are the two major tests that show if anemia or
polycythemia is present.
 Hemoglobin (Hgb). The hemoglobin molecule fills up the red blood cells. It
carries oxygen and gives the blood cell its red color. The hemoglobin test
measures the amount of hemoglobin in blood and is a good measure of the
blood's ability to carry oxygen throughout the body.
PROCEDURE
Your health professional drawing blood will:
 Wrap an elastic band around your upper arm to stop the flow of blood. This
makes the veins below the band larger so it is easier to put a needle into the
vein.
 Clean the needle site with alcohol.
 Put the needle into the vein. More than one needle stick may be needed.
 Attach a tube to the needle to fill it with blood.
 Remove the band from your arm when enough blood is collected.
 Put a gauze pad or cotton ball over the needle site as the needle is removed.
 Put pressure to the site and then a bandage.
 If this blood test is done on a baby, a heel stick will be done instead of a blood
draw from a vein.
RESULTS
White blood cell (WBC, leukocyte) count
Men and nonpregnant women 4,500–11,000/mcL3 or 4.5–11.0 x 109/liter (SI units)

Pregnant women
1st trimester: 6,600–14,100/mcL or 6.6–14.1 x

109/L
2nd trimester: 6,900–17,100/mcL or 6.9–17.1 x

109/L
3rd trimester: 5,900–14,700/mcL or 5.9–14.7 x

109/L
Postpartum: 9,700–25,700/mcL or 9.7–25.7 x

109/L
White blood cell types (WBC differential)
Neutrophils 50%–62%
Band neutrophils 3%–6%
Lymphocytes 25%–40%
Monocytes 3%–7%
Eosinophils 0%–3%
Basophils 0%–1%
Red blood cell (RBC) count

Men 4.7–6.1 million RBCs per microliter (mcL) or 4.7–6.1 x 1012/liter (SI units)
Women 4.2–5.4 million RBCs per mcL or 4.2–5.4 x 1012/L

Children 4.0–5.5 million RBCs per mcL or 4.6–4.8 x 1012/L
Newborn 4.8–7.1 million RBCs per mcL or 4.8–7.1 x 1012/L
Hematocrit (HCT)
Men 42%–52% or 0.42–0.52 volume fraction (SI units)

Women 37%–47% or 0.37–0.47 volume fraction
Pregnant 1st trimester: 35%–46%
women
2nd trimester: 30%–42%
3rd trimester: 34%–44%
Postpartum: 30%–44%
Children 32%–44%
Newborns 44%–64%
Hemoglobin (Hgb)
Men 14–18 grams per deciliter (g/dL) or 8.7–11.2 millimoles per liter (mmol/L)
(SI units)
Women 12–16 g/dL or 7.4–9.9 mmol/L
Pregnant 1st trimester: 11.4–15.0 g/dL or 7.1–9.3 mmol/L
women
2nd trimester: 10.0–14.3 g/dL or 6.2–8.9 mmol/L
3rd trimester: 10.2–14.4 g/dL or 6.3–8.9 mmol/L
Postpartum: 10.4–18.0 g/dL or 6.4–9.3 mmol/L

Children 9.5–15.5 g/dL
Newborns 9.5–15.5 g/dL
• HGB
Alternative Names
 Hb electrophoresis; Hgb electrophoresis
Definition
Hemoglobin electrophoresis is a test that measures the different types of the
oxygen-carrying substance (hemoglobin) in the blood.
How the Test is Performed
hand. The area is cleaned with antiseptic, and an elastic band is placed around
the upper arm to apply pressure and restrict blood flow through the vein. This
causes veins below the elastic band to fill with blood.
o A needle is inserted into the vein, and the blood is collected in an air-tight vial or
a syringe. During the procedure, the band is removed to restore circulation. Once
the blood has been collected, the needle is removed, and the puncture site is
o In an infant or young child, the area is cleansed with antiseptic and punctured
with a sharp needle or a lancet. The blood may be collected in a small glass tube
(pipette), on a slide, onto a test strip, or into a small container. Cotton or a
bandage may be applied to the puncture site if there is any continued bleeding.
How to Prepare for the Test
No special preparation is necessary for this test.
How the Test Will Feel
When the needle is inserted to draw blood, some people feel moderate pain, while
others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test is Performed
You may have this test if your health care provider suspects that you have a
disorder caused by abnormal forms of hemoglobin (hemoglobinopathy).
Many different types of hemoglobin (Hb) exist. The most common ones are HbA,
HbA2, HbF, HbS, HbC, Hgb H, and Hgb M. Healthy adults only have significant levels of
HbA and HbA2.
Some people may also have small amounts of HbF (which is the main type of
hemoglobin in an unborn baby's body). Certain diseases are associated with high HbF
levels (when HbF is more than 2% of the total hemoglobin).
HbS is an abnormal form of hemoglobin associated with sickle cell anemia. In

people with this condition, the red blood cells have a crescent or sickle shape. These
misformed cells then break down, or can block small blood vessels.
HbC is an abnormal form of hemoglobin associated with hemolytic anemia. The

symptoms are much milder than they are in sickle cell anemia.
Other, less common, abnormal Hb molecules cause anemias.
Normal Results
In adults, these hemoglobin molecules make up the following percentages of total

hemoglobin:
• Hgb A1: 95% to 98%

• Hgb A2: 2% to 3%
• Hgb F: 0.8% to 2%
• Hgb S: 0%
• Hgb C: 0%
In infants and children, these hemoglobin molecules make up the following percentages
of total hemoglobin:
• Hgb F (newborn): 50% to 80%

• Hgb F (6 months): 8%
• Hgb F (over 6 months): 1% to 2%
What Abnormal Results Mean
The presence of significant levels of abnormal hemoglobins may indicate:
• Hemoglobin C disease
• Rare hemoglobinopathy
• Sickle cell anemia
This test also may be performed if the health care provider suspects the condition
thalassemia.
Risks
• Excessive bleeding
• Fainting or feeling lightheaded
• Blood accumulating under the skin (hematoma)
• Infection
• Multiple punctures to find veins
Considerations
You may have false normal or abnormal results if you've had a blood transfusion
within the previous 12 weeks.
Veins and arteries vary in size from one patient to another, and from one side of
the body to the other. Getting a blood sample from some people may be more difficult
than from others.
• Platelet Count
Alternative Names
 Thrombocyte count
Definition
A platelet count is a test to measure how many blood cells, called platelets, you
have in your blood. Platelets help the blood clot.
o Blood is drawn from a vein, often on the inside of the elbow. The puncture site is
cleaned with antiseptic, and an elastic band is placed around the upper arm to
apply pressure and restrict blood flow through the vein. This causes veins below
the band to fill with blood.
o A needle is inserted into the vein, and the blood is collected in a vial or a syringe.
The band and needle are removed, and the puncture site is covered to stop any
bleeding.
o For infants and young children, the area is cleansed with antiseptic and
punctured with a sharp needle or a lancet. The blood may be collected in a
pipette (small glass tube), on a slide, onto a test strip, or into a small container.
Cotton or a bandage may be applied to the puncture site if there is any continued
bleeding.
No preparation is necessary.
he number of platelets in your blood can be affected by many diseases. Platelets

may be counted to monitor or diagnose diseases, or identify the cause of excess
bleeding.
Normal Results
150,000 to 400,000/mm3
If the number of platelets is below normal (thrombocytopenia), the cause may be:
• Cancer chemotherapy
• Disseminated intravascular coagulation (DIC)
• Hemolytic anemia
• Hypersplenism
• Idiopathic thrombocytopenic purpura (ITP)
• Leukemia
• Massive blood transfusion
• Prosthetic heart valve
If the number is higher than normal (thrombocytosis), the cause may be:
• Anemia
• Certain malignancies
• Early CML
• Polycythemia vera
• Post-splenectomy syndrome
• Primary thrombocytosis
A platelet count may be performed under many conditions and to assess many
diseases.
Risks
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)
• Multiple punctures to locate veins
Considerations
Drugs that can lower platelet counts include chemotherapy drugs,

chloramphenicol, colchicine, H2 blocking agents, heparin, hydralazine, indomethacin,
isoniazid, quinidine, streptomycin, sulfonamide, thiazide diuretic, and tolbutamide.
Veins and arteries vary in size from one patient to another and from one side of the
body to the other. Obtaining a blood sample from some people may be more difficult
than from others.
• Erythropoietin Test
Alternative Names
 Serum erythropoietin; EPO
Definition
The erythropoietin test measures the amount of a hormone called erythropoietin

((EPO) in blood.
The hormone acts on stem cells in the bone marrow to increase the production of
red blood cells. It is made by cells in the kidney, which release the hormone when
oxygen levels are low.
hand. The site is cleaned with germ-killing medicine (antiseptic). The health care
provider wraps an elastic band around the upper arm to apply pressure to the
area and make the vein swell with blood.
o Next, the health care provider gently inserts a needle into the vein. The blood
collects into an airtight vial or tube attached to the needle. The elastic band is
removed from your arm.
o Once the blood has been collected, the needle is removed, and the puncture site
is covered to stop any bleeding.
o In infants or young children, a sharp tool called a lancet may be used to puncture
the skin and make it bleed. The blood collects into a small glass tube called a
pipette, or onto a slide or test strip. A bandage may be placed over the area if
there is any bleeding.
No special preparation is necessary.
This test may be used to help determine the cause of anemia, polycythemia (high
red blood cells) or other bone marrow disorders.
A change in red blood cells will affect the release of EPO. For example, persons
with anemia have too few red blood cells, so more EPO is produced.
Normal Results
The normal range is 0-19 milliunits per milliliter (mU/mL).
Note: Normal value ranges may vary slightly among different laboratories. Talk to your
doctor about the meaning of your specific test results.
Increased EPO levels may be due to secondary polycythemia, an overproduction

of red blood cells that occurs in response to an event such as low blood oxygen levels.
This may happen at high altitudes or, rarely, because of a tumor that releases EPO.
Lower-than-normal EPO levels may be seen in chronic kidney failure, anemia of

chronic disease, or polycythemia vera.
Risks
Veins and arteries vary in size from one patient to another and from one side of
the body to the other. Obtaining a blood sample from some people may be more difficult
than from others.
Other risks associated with having blood drawn are slight but may include:
• CT SCAN
Alternative Names
 CAT scan; Computed axial tomography scan; Computed tomography scan
Definition
Computed tomography (CT) is an imaging method that uses x-rays to create

cross-sectional pictures of the body.

o You will be asked to lie on a narrow table that slides into the center of the CT
scanner. Depending on the study being done, you may need to lie on your
stomach, back, or side.
o Once inside the scanner, the machine's x-ray beam rotates around you. (Modern
"spiral" scanners can perform the exam in one continuous motion.)
o Small detectors inside the scanner measure the amount of x-rays that make it
through the part of the body being studied. A computer takes this information and
uses it to create several individual images, called slices. These images can be
stored, viewed on a monitor, or printed on film. Three-dimensional models of
organs can be created by stacking the individual slices together.
o You must be still during the exam, because movement causes blurred images.
You may be told to hold your breath for short periods of time.
o Generally, complete scans take only a few minutes. The newest multidetector
scanners can image your entire body, head to toe, in less than 30 seconds.
• Certain exams require a special dye, called contrast, to be delivered into the body
before the test starts. Contrast can highlight specific areas inside the body, which
creates a clearer image.
• Some people have allergies to IV contrast and may need to take medications before
their test in order to safely receive this substance.
The x-rays are painless. Some people may have discomfort from lying on the hard
table.
Contrast give through an IV may cause a slight burning sensation, a metallic taste in the
mouth, and a warm flushing of the body. These sensations are normal and usually go
away within a few seconds.
CT rapidly creates detailed pictures of the body, including the brain, chest, spine,
and abdomen. The test may be used to:
• Guide a surgeon to the right area during a biopsy

• Identify masses and tumors, including cancer
• Study blood vessels
Normal Results
Results are considered normal if the organs and structures being examined are
normal in appearance.
The significance of abnormal results depends on the part of the body being
studied and the nature of the problem. Consult your health care provider with any
questions and concerns.
Risks
CT scans and other x-rays are strictly monitored and controlled to make sure
they use the least amount of radiation. CT scans do create low levels of ionizing
radiation, which has the potential to cause cancer and other defects. However, the risk
associated with any individual scan is small. The risk increases as numerous additional
studies are performed.
In some cases, a CT scan may still be done if the benefits greatly out weigh the
risks. For example, it can be more risky not to have the exam, especially if your health
care provider thinks you might have cancer.
An abdominal CT scan is usually not recommended for pregnant women,

because it may harm the unborn child. Women who are or may be pregnant should
speak with their health care provider to determine if ultrasound can be used instead.
The most common type of contrast given into a vein contains iodine. If a person
with an iodine allergy is given this type of contrast, nausea, sneezing, vomiting, itching,
or hives may occur.
If you absolutely must be given such contrast, your doctor may choose to treat
you with antihistamines (such as Benadryl) or steroids before the test.
The kidneys help filter the iodine out of the body. Therefore, those with kidney
disease or diabetes should receive plenty of fluids after the test, and be closely
monitored for kidney problems. If you have diabetes or are on kidney dialysis, talk to
your health care provider before the test about your risks.
Rarely, the dye may cause a life-threatening allergic response called anaphylaxis
. If you have any trouble breathing during the test, you should notify the scanner
operator immediately. Scanners come with an intercom and speakers, so the operator
can hear you at all times.
• Partial thromboplastin time
Alternative Names
 APTT; PTT; Activated partial thromboplastin time
Definition
Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for
blood to clot. It can help tell if you have bleeding or clotting problems.
The health care provider uses a needle to take blood from one of your veins. The
blood collects into an air-tight container. You may be given a bandage to stop any
bleeding. If you are taking a medicine called heparin, you will be watched for signs of
bleeding.
The laboratory specialist will add chemicals to the blood sample and see how
many seconds it takes for the blood to clot.
The health care provider may tell you to stop taking certain drugs before the test.
Drugs that can affect the results of a PTT test include antihistamines, vitamin C
(ascorbic acid), aspirin, and chlorpromazine (Thorazine).
Do not stop taking any medicine without first talking to your doctor.
Your doctor may order this test if you have problems with bleeding or blood clotting. The
test may also be used to monitor patients who are taking heparin, a blood thinner.
A PTT test is usually done with other tests, such as the prothrombin test.
Normal Results
The normal value will vary between laboratories. In general, clotting should occur
between 25 to 35 seconds. If the person is taking blood thinners, clotting takes up to
two and a half times longer.
An abnormal (too long) PTT result may be due to:

• Cirrhosis
• Disseminated intravascular coagulation (DIC)
• Factor XII deficiency
• Hemophilia A
• Hemophilia B
• Hypofibrinogenemia
• Malabsorption
• Von Willebrand's disease
• Lupus anticoagulants
Risks
This test is often done on people who may have bleeding problems. The risks of
bleeding and hematoma in these patients are slightly greater than for people without
bleeding problems.
In general, risks of any blood test may include:
• Multiple punctures to locate veins
Considerations
When you bleed, the body launches a series of activities that help the blood clot. This is
called the coagulation cascade. There are three pathways to this event. The PTT test
looks at special proteins, called factors, found in two of these pathways.
• Prothrombin time
Descriptions:
Prothrombin time (PT) is a blood test that measures how long it takes blood to
clot. A prothrombin time test can be used to check for bleeding problems. PT is also
used to check whether medicine to prevent blood clots is working. The normal range is
10 – 12 sec.
Procedure
o The prothrombin time is most commonly measured using blood plasma.
o Blood is drawn into a test tube containing liquid citrate, which acts as an
anticoagulant by binding the calcium in a sample.
o The blood is mixed, then centrifuged to separate blood cells from plasma.
o The plasma is analyzed by a medical technologist on an automated instrument at

37°C,
o An excess of calcium is added (thereby reversing the effects of citrate), which

enables the blood to clot again.
o For the prothrombin time test the appropriate sample is the blue top tube, or
sodium citrate tube, which is a liquid anticoagulant.
o The prothrombin ratio is the prothrombin time for a patient, divided by the result
for control plasma.
Nursing Responsibilities
 No preparation is necessary.
 Specimen should not be obtained after meal since lipenia may interfere with
photoelectric measurements of clot formation
 check to see if the patient is taking any medications that may affect test
results.This precaution is particularly important if the patient is taking warfarin,
because there are a number of medications that can interact with warfarin to
increase or decrease the PT time
 Aftercare consists of routine care of the area around the puncture mark. Pressure
is applied for a few seconds and the wound is covered with a bandage.
III. Renal Diseases
A. UTI
Urinary tract infection, (UTI) is an infection of one or more of the structures in the
urinary tract. Most UTI’s happen from bowel organisms, (E-coli). Women are more
prone to UTI’s because of the shortness of their urethra.
CYSTITIS
Infections of the lower urinary tract are called cystitis. This is an inflammation of
the urinary bladder related to a superficial infection that doesn’t extend to the bladder
mucosa, most often caused by ascending infection from the urethra; it can also be
caused by sexual intercourse.
• Causes
o Stagnation of urine in the bladder

o Obstruction of the urethra
o Sexual intercourse
o Incorrect aseptic technique during catheterization
o Incorrect perineal care
o Kidney infection
o Radiation
o Diabetes mellitus
o Pregnancy
• Other causes
o Cystitis is usually due to a bacterial infection of the urine. Occasionally, in

children it can be caused by a virus.
o The infection is more common in women because a woman's anatomy is
designed in such a way that it makes it easier for bacteria to enter the bladder.
o Sexual intercourse, using spermicidal creams, and using diaphragms all increase
the risk of developing Bladder Infection.
o People who have a catheter in their bladder or who have to periodically
catheterize them have a higher risk of developing bladder infection.
o People with Bladder Cancers or abnormal connections between their bladder and
intestines also have a higher risk of developing Bladder Infection.
• Pathophysiology
• Bacterial infection from a second source spreads to the bladder, causing an

inflammatory response.
• Cell destruction from trauma to the bladder wall, particularly the trigone area,
initiates an acute inflammatory response.
• Complications
• Chronic cystitis (recurrent or persistent inflammation of the bladder)
• Urethritis (inflammation of the urethra)
• Pyelenophritis (Infections of the upper urinary tract)
• Clinical manifestations
Any changes in the clients voiding habits should be assessed as a possible UTI.
The most common clinical manifestation of cystitis is burning pain of urination (dysuria),
Frequency, urgency, voiding in small amount, inability to void, incomplete emptying of
the bladder, cloudy urine and hematuria ( blood in urine). Asymptomatic bacteriuria
(bacteria in urine).
• Nursing Diagnosis
Impaired Urinary Elimination. The primary diagnosis when a client is experiencing

problems related to cystitis is Impaired Urinary Elimination related to irritation of the
bladder mucosa.
Acute Pain. Another common nursing diagnosis for clients with cystitis is Acute Pain
related to irritation and inflammation of bladder and urethral mucosa.
• How to diagnose
o Often times, treatment may be based on the symptoms alone, without
additional tests.
o Urinalysis (in which the urine is tested for the presence of an infection) is the
most common method of diagnosis.
o Blood and Urine cultures may also be required.
o In women with frequent infections (more than three a year), a full
examination of the urinary tract (usually by a specialist) needs to be done.
Also, it is sometimes recommended that all men who develop any type of
urinary infection, including Bladder Infections, need to be seen by a
specialist.
• Diagnostic test findings
 Urine culture and sensitivity: positive identification of organisms (Escherichia coli,

Proteus vulgaris, Streptococcus faecalis)
 Urine chemistry: hematuria, pyuria,; increased protein, leukocytes, specific

gravity
 Cytoscopy: obstruction or deformity
• Assessment findings
 Frequency of urination
 Urgency of urination
 Burning or pain on urination
 Lower abdominal discomfort
 Dark, odoriferous urine
 Flank tenderness or suprapubic pain
 Nocturia (need to get up during the night in order to urinate, thus interrupting
sleep)
 Low-grade fever
 Urge to bear down during urination
 Dysuria (refers to painful urination)
 Dribbling
• Medical management
 Diet: acid-ash diet with increased intake of fluids and vitamin C
 Activity: as tolerated
 Monitoring: vital signs and intake and output
 Laboratory studies: specific gravity, urine culture and sensitivity
 Treatment: Sitz baths
 Antibiotics: co- trimoxizole (Bactrim), cephalexin (Keflex)
 Analgesic: oxycodone (Tylox)
 Urinary antiseptic: Phenazopyridine (Pyridium)
 Antipyretic: acetaminophen (Tylenol)
• Nursing interventions
 Maintain the patients diet
 Encourage fluids (cranberry or orange juice) to 3qt (3L)/day
 Assess renal status
 Monitor and record vital signs, I/O, and laboratory studies
 Administer medications, as prescribed
 Allay patient’s anxiety
 Maintain treatments: sitz baths, perineal care
 Encourage voiding every 2 to 3 hours
 Individualize home care instructions
o Avoid coffee, tea, alcohol and cola
o Increase fluid intake to 3 qt (3L)/ day using orange juice and cranberry
juice
o Void every 2 to 3 hours and after intercourse

o Perform perineal care correctly
o Avoid bubble baths, vaginal deodorants ant tub baths
• Evaluation
The client will have return of normal voiding habits within 3 days of starting antibiotic
treatment as evidenced by an absence of fever, pain, burning, frequency, and urgency.
The client will be able to urinate with minimal or no discomfort within 24 hours after
treatment begins and will return to normal voiding habits within 3 days, as evidenced by
an absence of pain and burning on urination.
PYELENOPHRITIS
Infections of the upper urinary tract are called pyelonephritis. This is an infection
of renal pelvis, tubules, (tubes), in the kidneys. The bacteria may enter through the
bladder via the ureters or through blood stream. Pyelonephritis describes a syndrome
caused by the inflammation (irritation, swelling, pain, damage) of the tubes (renal
tubules) that carry urine from the kidneys to the bladder (upper urinary tract) and the
renal (kidney) interstitium (tissue surrounding the renal structures).
Many times this upper UTI is caused by reflux of urine up through the ureters
from a faulty valve, that is suppose to prevent this from happening. Sign and symptoms
are chills and fever; flank pain. A urinalysis will show bacteria, pus. The s/s are pretty
much the same as for the lower UTI except the bacteria in the urine found on the
urinalysis are coated with antibodies that happens only in the renal pelvis. An upper UTI
is more serious due to the fact it can cause damage and death to tissues in the kidneys
if not treated.
Pyelonephritis can be acute (sudden) or chronic (prolonged) in nature.
Acute pyelenophritis often occurs after bacterial contamination of the urethra or after
introduction of an instrument, such as catheter or a cytoscope.
Chronic pyelenophritis is more likely to occur after chronic obstruction with reflux or
chronic disorders. It is slowly progressive and usually is associated with recurrent acute
attacks, although the client may not have a history of acute pyelenophritis.
• Causes
o Enteric bacteria
o Ureterovesical reflux
o Urinary tract obstruction
o Pregnancy
o Trauma
o UTI
o Incorrect aseptic technique
o Diabetes mellitus
o Staphylococcal or streptococcal infections
• Pathophysiology
• Bacterial infection from a second source spreads to the renal pelvis, causing an
inflammatory response.
• Cell destruction from trauma to the renal pelvis initiates an acute inflammatory
response.
• Complications
• Chronic renal failure

• Hypertension
• Septicemia
• Clinical manifestations
• Characterized by enlarged kidney, focal parenchyma abscesses and

accumulation of polymorph nuclear lymphocytes around and in the renal
tubules.
Risk for Deficient Fluid Volume. A common diagnosis is Risk for Deficient Fluid
Volume related to fever, nausea, vomiting, and possible diarrhea.
Acute Pain. Another common nursing diagnosis is acute pain related to an

inflammatory process in the kidney and possible colic.
Readiness for Enhanced Self- Care. Client teaching is important to promote self-care
and to prevent recurrent teachings. Write the diagnosis Readiness for Enhanced Self-
Care to prevent recurrent infections.
• Diagnostic test findings

 Excretory urography (which consists of imaging the kidneys and urinary tracts
before and after the administration of intravenous contrast material): atrophy,
blockage, or deformity of kidney
 Urine culture and sensitivity: bacteria
 Urine chemistry: pyuria, hematuria; leukocytes, WBCs, and casts; specific gravity
greater than 1.025; albiminuria
 Hematology( study of blood): increased WBCs
 24-hour urine collection: decrease creatinine clearance
• Assessment findings
 Elevated temperature
 Chills
 Nausea and vomiting
 Flank pain
 Chronic fatigue
 Bladder irritability
 Hypertension
 Dysuria
 Burning on urination
 Frequency of urination
 Urgency of urination
 Headache
 Anorexia
 Weight loss
 Odoriferous, concentrated urine

• Medical management
 Diet: soft, high-calorie, low protein
 IV therapy: saline lock, electrolyte and fluid replacement
 Activity: as tolerated
 Monitoring: vital signs, I/O, urine pH, and specific gravity
 Laboratory studies: WBCs, urine protein, and urine culture and sensitivity
 Treatments: warm, moist compress to flank
 Fluid intake: 3qt (3L)/day
 Analgesic: meperidine (Demerol)
 Antibiotics: cefazolin (Ancef0, cefoxitin (Mefoxin), co- trimoxizole (Bactrim)
 Urinary antiseptics: phenazopyridine (Pyridium)
 Antiemetic: prochlorperazine (Compazine)
 Alkalinizers: potassium acetate, sodium bicarbonate
 Sedative: oxazepam (Serax)
 Peritoneal dialysis and hemodialysis
• Nursing interventions
 Maintain the patient’s diet

 Encourage fluids 3qt (3L)/ day
 Assess renal status and fluid balance
 Monitor and record vital signs, I/O, laboratory studies, daily weight, specific
gravity, and urine for blood, protein, and pH
 Administer medications, as prescribed
 Allay the patient’s anxiety
 Provide hot, moist compresses and warm baths
 Prevent chilling
 Provide rest periods
 Provide skin, mouth and perineal care
 Encourage frequent voiding
 Individualize home care instructions
o Void frequently
o Return to the physician immediately if symptoms reoccur
o Take prescribed medications for entire duration of prescription
• Evaluation
The client will maintain fluid balanced intake and output, maintenance of adequate
hydration, and an absence of manifestations of dehydration.
The client will be able to report either that there is no pain or that pain is controlled.
The client will have the knowledge of the treatment regimen and understand how to
prevent recurrent infections as evidenced by the client’s statements and no recurrence
of infection.
B. Glomerulonephritis
Description of the Disease:
Glumerulonephritis is a disease that affects the glumeruli of both kidneys.

Etiologic factors are many and varied; they include immunologic reactions (lupus
erythematosus, streptococcal infection), vascular injury (hypertension), metabolic
disease (diabetes mellitus), and disseminated intravascular coagulation (DIC).
Glomerulonephritis exists in acute, latent and chronic forms.
Medical Surgical Nursing Concepts and Clinical Practice 4th Ed. By Phipps, Long,
Woods and Cassmeyer p. 1410
• Acute glomerulonephritis
Acute glomerulonephritis is inflammation of the glumerular capillary

membrane. Acute glumerulonephritis can result from systemic diseases or
primary glomerular diseases, but acute postreptococcal glomerulonephritis (also
known as acute ploriferative glomerulonephritis) is the most common form.
Medical Surgical Nursing 3rd Ed. By Priscilla Lemone and Karen Burke p. 747
• Chronic Glumerulonephritis
Chronic Glumerulonephritis is typically the end stage of other

glomerular disorders such as RGPN, lupus nephritis, or diabetic nephropathy. In
many cases, however, no previous glomerular disease has been identified.
Slow, progressive destruction of the glomeruli and a gradual

decline in renal function are characteristics of chronic glomerulonephritis. The
kidneys decrease in size symmetrically, and their surfaces become granular or
roughened. Eventually entire nephrons are lost.
Medical Surgical Nursing 3rd Ed. By Priscilla Lemone and Karen Burke p. 748
Causes or Risk Factors
• Diabetes
• Vasculitis
• High Blood Pressure
• Strep Throat
• Immune Disorders
• Genetic Disorders
• Heart Valve Disorders
• Family History of Glomerulonephritis
• Infections
• Post-streptococcal glomerulonephritis. Glomerulonephritis may
develop after a strep infection in your throat or, rarely, on your
skin (impetigo). Post-infectious glomerulonephritis is becoming
less common, most likely because of rapid and complete
antibiotic treatment of most streptococcal infections.
• Bacterial endocarditis. Bacteria can occasionally spread through
your bloodstream and lodge in your heart, causing an infection
of the valvular tissues inside the heart. Those at greatest risk are
people with a heart defect, such as a damaged or artificial heart
valve.
• Viral infections. Among the viral infections that may trigger
glomerulonephritis are the human immunodeficiency virus (HIV),
which causes AIDS, and the hepatitis B and hepatitis C viruses,
which affect the liver and can become chronic infections.
Complications:
• Nephrotic Syndrome
• Sepsis
• High Blood Pressure
• Congestive Heart Failure
• Pulmonary Edema
• Nephritic syndrome
• Malignant Hypertension
• Chronic Kidney Failure
• End Stage Kidney Disease
http://www.healthline.com/channel/urinary-tract-infections.html
Clinical Manifestations:
• Acute Glomerulonephritis:
Complaints commonly voiced by the patient include shortness of breath, mild headache,
weakness, anorexia, and flank pain. The usual signs associated with acute glumerulonephritis
are the following:
1. Proteinuria
2. Hematuria
3. Increased urine specific gravity
4. Mild generalized edema
5. Elevated antistreptolysin O titer
6. Hypertension
7. Decreased urinary output
8. Elevated serum urea nitrogen
9. Elevated serum creatinine levels
Signs and symptoms reflect damage to the glomeruli with leaking protein and red blood
cells into the urine, varying degrees of decreased glomerular filtration with retention of metabolic
waste products, and fluid overloading of varying severity.
Urinalysis provides important data such as the presence of proteinuria, hematuria and
cell debris.
Medical Surgical Nursing Concepts and Clinical Practice 4th Ed. By Phipps, Long, Woods and
Cassmeyer p. 1411
• Chronic Glumerolunephritis
Symptoms:
• Headache especially in the morning

• Dyspnea on exertion
• Blurring of vision
• Lassitude
• Cola-colored or diluted iced-tea-colored urine from red blood cells in your
urine (hematuria)
• Foam in the toilet water from protein in your urine (proteinuria)
• High blood pressure (hypertension)
• Fluid retention (edema) with swelling evident in your face, hands, feet and
abdomen
• Fatigue from anemia or kidney failure
• Less frequent urination than usual
Signs:
• Edema
• Nocturia
• Weight loss
• Urinalysis may show albumin, casts and blood, despite normal renal function
test
• Few nephrons remain intact
• Hematuria
• Proteinuria decrease
• Specific gravity of the urine becomes fixed at 1.010 (same as plasma)
• Nonprotein level in the blood increases
Cassmeyer p. 1415
Nursing Diagnosis:
Cassmeyer p. 1411
Medcal Surgical Nursing Clinical Management for Positive Outcomes 8th Ed. By Black and
Hawks p. 796
Diagnostic procedures:
Management of all types of glomerulonephritis, acute, chronic, primary and secondary,

focuses on identifying the underlying disease process and preserving kidney function. In most
glomerular disorders, there is no specific treatment to achieve a cure.
• throat or skin cultures – detect infection by group A beta hemolytic streptococci. Although
poststreptococcal glomerulonephritis typically follows the acute infection by 1 to 2
weeks, treatment to eradicate any remaining organisms is initiated to minimize antibody
production.
• Antistreptolysin O (ASO) titer and other tests detect streptococcal exoenzymes (bacterial
enzymes that stimulate the immune response in acute poststreptococcal
glomerulonephritis). Other titers such as antistreptokinase ASK) or
antideoxyribonuclease B (ADNAase B) may be obtained as well.
• Erythrocyte sedimentation rate (ESR) is a general indicator of inflammatory response. It
may be elevated in acute poststreptococcal glomerulonephritis and in lupus nephritis.
• KUB (Kidney, Ureter, Bladder) abdominal X-ray may be done to evaluate kidney size and
rule out other causes of the client’s manifestations. The kidneys may be enlarged in
acute glomerulonephritis, whereareas bilateral small kidneys are typical of late chronic
glomerulonephritis.
• Kidney Scan a nuclear medicine procdure, allows a visualization of the kidney after IV
administration of a radioisotope. In glomerular diseases, the uptake and excretion of the
radioactive material are delayed.
• Biopsy microscopic examination of kidney tissue, is the most reliable diagnostic
procedure for glomerular disorders. Biopsy helps determine the type of
glomerulonephritis, the prognosis, and appropriate treatment. Renal Biopsy is usually
done percutaneously, by inserting a biopsy needle through the skin into the kidney to
obtain a tissue sample. Open biopsy, which requires surgery, may also be done.
• Blood Urea Nitrogen (BUN) measures urea nitrogen, the end product of protein
metabolism. serves as index of renal function. Urea is nitrogenous end product of protein
metabolism. Test values are affected by protein intake, tissue breakdown and fluid
volumes chages. The BUN test is performed on a sample of the patient's blood,
withdrawn from a vein into a vacuum tube. The procedure, which is called a
venipuncture, takes about five minutes.
• Serum Creatinine Measuring serum creatinine is a useful and inexpensive method of

evaluating renal dysfunction. Creatinine is a non-protein waste product of creatine
phosphate metabolism by skeletal muscle tissue. Creatinine production is continuous
and is proportional to muscle mass.
• Urine creatinine also is an indicator of renal function and the GFR. Urine creatinine
levels decrease when renal function is impaired as it is not effectively eliminated from
the body.
• Creatinine clearance is a specific indicator of renal function used to evaluate the GFR.
The clearance, or amount of blood cleared of creatinine in 1 minute, depends on the
amount and pressure of blood being filtered and the filtering ability of the glomeruli.
Levels normally decline with aging as the GFR decreases in the older adult. Disorders
such as glomerulonephritis affect gomerular filtration, decreasing the creatinine
clearance.
• Serum electrolytes are evaluated because impaired kidney functions alters their
excretion. Monitring serum electrolytes is particularly important to prevent complications
associated with imbalances.
• Urinalysis A urinalysis is a group of manual and/or automated qualitative and semi-
quantitative tests performed on a urine sample. A routine urinalysis usually includes the
following tests: color, transparency, specific gravity, pH, protein, glucose, ketones, blood,
bilirubin, nitrite, urobilinogen, and leukocyte esterase. Some laboratories include a
microscopic examination of urinary sediment with all routine urinalysis tests. If not, it is
customary to perform the microscopic exam, if transparency, glucose, protein, blood,
nitrite, or leukocyte esterase is abnormal.
Medical Surgical Nursing 3rd Ed. By Priscilla Lemone and Karen Burke p. 749-750
Treatment, Surgery and Medications:
Treatment:
Bedrest may be ordered during the acute phase of poststreptococcal glomerulonephritis. When
the edema of nephritic syndrome is significant or the client is hypertensive, sodium intake may
be restricted.
Dietary protein may be restricted if azotemia is present. When proteins are restricted, those
included in the diet should be complete or high-value proteins. Complete protein supply the
essential amino acids required for growth and tissue maintenance. Complete and incomplete
proteins are compared in this table:
Plasma exchange therapy (plasmapharesis), a procedure to remove damaging antibodies from

the plasma, is used in conjunction with immunosuppressive therapy to treat RPGN and Good
pasture’s syndrome. Plasma and glomerular-damaging antibodies are removed using a blood
cell separator. The RBCs are then returned to the client along with albumin or human plasma
removed. This procedure is usually done in a series of treatments. Potential complications of
plasma exchange therapy include those associated with IV catheters, fluid volume shifts, and
altered coagulation.
Renal failure resulting from a glomerular disorder may necessitate dialysis to restore fluid and
electrolyte balance and remove waste products from the body.
Medications:
• Although no drugs are available to cure glomerular disorders, medications are used to
treat underlying disorder, reduce inflammation, and management symptoms.
• Antibiotics are prescribed for the client with poststreptococcal glomerulonephritis to

eradicate any remaining bacteria, removing the stimulus for antibody production.
Nephrotoxic antibiotics, such as aminoglycoside antibiotics, streptomycin and some
cephalosporins, are avoided
• Aggressive immunosuppressive therapy is used to treat acute inflammatory processes

such as rapidly progressive glumerulonephritis. When begun early, immunosuppressive
therapy significantly reduces the risk of end-stage renal disease and renal failure.
• Predinosone, a glucocorticoid, is prescribed in relatively large doses of 1 mg per kg of

body weight per day (e.g., a 160 pound man would receive 70 to 75 mg per day). Other
immunosuppressive agents such as cyclophosphamide (Cytoxan) or azathioprine
(Imuran) are prescribed in conjunction with corticosteroids. Corticosteroids use in
streptococcal glumerulonephritis may actually worsen the condition, so is avoided.
• Oral glucocorticoids such as prednisone also are used in high doses to induce remission
of nephritic syndrome. When glucocorticoids alone are ineffective, other
immunosuppressive agents such as cyclophosphamide or Clorambucil (Leukeran) may
be used to induce or maintain remission.
• ACE inhibitors may be ordered to reduce protein loss associated with nephritic
syndrome. These drugs reduce proteinuria and slow progression of renal failure. They
have a protective effect on the kidney in clients with diabetic nephropathy. Nonsteroidal
anti-inflammatory drugs (NSAIDs) also reduce proteinuria ijn some clients, but can
increase salt and water retention.
• Antihypertensives may be prescribed to maintain the blood pressure within normal

levels. BP management is important because systemic and renal hypertensions are
associated with a poorer prognosisin clients with glumerular disorders.
Surgery:
Kidney Transplantation - Kidney transplantation is a surgical procedure to remove a

healthy, functioning kidney from a living or brain-dead donor and implant it into a patient with
nonfunctioning kidneys. Purpose Kidney transplantation is performed on patients with chronic
kidney failure, or end-stage renal disease (ESRD).
Nursing Responsibilities:
• Maintain patient's diet

• Monitor blood pressure, vital signs and laboratory findings
• Provide client a rest period
• Increased fluid intake
• Assist client on cutting back on protein and potassium consumption may slow the
buildup of wastes in the client's blood.
• Teach client on how to restrict salt intake. This prevents or minimize fluid retention,
swelling and hypertension.
• If client has diabetes, nurse should take note that client should maintain a healthy weight
and control the client's blood sugar levels and blood pressure as this may help slow
kidney damage.
• Assist client in voiding.
Evaluation:
• Client will have better understanding of the disease

• Client will meet adequate nutrition regardless of present diet
• Maintenance of client's blood pressure
• Normal laboratory findings
• The client will be able to report either that there is no pain or that pain is controlled
• The client will maintain fluid balanced intake and output, maintenance of adequate
hydration, and an absence of manifestations of dehydration.
http://www.mayoclinic.com/health/glomerulonephritis
C. RENAL FAILURE
• Renal Failure is the loss of function in both kidneys.
• It has 5 stages that are based on the presence or absence of symptoms and on
progressively decreasing GFR. The stages are as follow:
o Stage 1: Kidney damage with normal or near normal glomerular filtration
rate, at or above 90mL/min
o Stage 2: Glomerular filtration rate between 60 and 89mL/min, with
evidence of kidney damage. This stage is considered one of diminished
renal reserve. Remaining nephrons are highly susceptible to failing
themselves as their load becomes overwhelming. Additional renal insults
hasten the decline.
o Stage 3: Glomerular filtration rate between 30 and 59mL/min. This stage
is considered one of renal insufficiency. Nephrons continue to die.
o Stage 4: Glomerular filtration rate between 15 and 29mL/min, with fewer
nephrons remaining.
o Stage 5: End-stage renal failure; glomerular filtration rate of less that
15mL/min. few functioning nephrons remain. Scar tissue and tubular
atrophy are present throughout the kidneys.
• Glomerular filtration rate (GFR) is a measurement of the amount of glomerular
filtrate (a substance similar to blood plasma but without proteins) formed in the
kidneys each minute. It is used to evaluate the kidneys’ ability to remove waste
products from the body.
• GFR cannot be directly measured. Instead, it is estimated from the
measurements of other body waste products. These measurements may include:
o Cystatin C test
o Serum creatinine test
o Creatinine clearance test
o Prediction equations
• Renal failure is also categorized as acute renal failure, which occurs suddenly
and is usually reversible or chronic renal failure, which is associated with
progressive, irreversible loss of renal function. Chronic renal failure usually
develops after years of renal disease or damage, but may occur rapidly in some
situations. Chronic renal failure inevitable leads to renal dialysis, transplantation
or death.
ACUTE RENAL FAILURE
• Description:
o Abrupt loss of kidney function over a period of hours to a few days.
o Characterized by oliguria (daily output of urine that between 100 and
400mL only) and anuria (urine output of less than 100mL). There is also a
decrease in GFR and elevation of the Serum Creatinine and BUN levels.
• Cause or Risk Factor:

o Causes of acute renal failure have been separated into three general
categories: prerenal, intrarenal, postrenal. Identification of the cause of
Renal Failure is important in the management of the disease. Identification
may be accomplished by a study of the patient’s history and the quantity
and quality of his/her urine.
o Prerenal Causes:
 Most common cause of acute renal failure. Prerenal failure occurs
as a result of conditions unrelated to the kidney but that damage
the kidney by affecting renal blood flow. Factors that contribute to
decreased renal blood flow are as follows:
 Circulatory Volume Depletion, as may occur with diarrhea,
vomiting, hemorrhage, excessive use of diuretics, burns,
renal salt-wasting conditions
 Volume Shifts, as from third-space sequestration of fluid,
vasodilation, or gram negative sepsis
 Decreased cardiac output as during cardiac pump failure,
pericardial tamponade, or acute pulmonary embolism.
 Decreased peripheral vascular resistance as from spinal
anesthesia, septic shock, or anaphylaxis.
 Vascular obstruction, such as bilateral renal artery occlusion
or dissecting aneurysm.
o Intrarenal Causes:
 Occurs as a result of primary damage to the kidney tissue itself. It
has many causes including glomerulonephritis, acute
pyelonephritis, and myoglobinuria.
 Kidney cell damage usually occurs with as a result of tubular
ischemic tubular necrosis. Tubular necrosis can result from a
decrease renal blood flow or a result of the direct action of
nephrotoxic drugs, such as heavy metals and organic solvents.
Aminoglycoside antibiotics such as gentamicin, are also
nephrotoxic. Radiopaque contrast media use for viewing the
cardiac chambers or the GI tract can be nephrotoxic in susceptible
individuals. Ingestion of toxic amounts of analgesic mixtures,
especially codeine and caffeine, may lead to acute tubular necrosis.
o Postrenal Cause
 Postrenal causes of ARF arise from a1n obstruction in the urinary
tract, anywhere from the tubules to the urethral meatus. Common
sources of obstruction include prostatic hypertrophy, calculi,
invading tumors, surgical accidents, ureteral or urethral strictures or
stenosis and retroperitoneal fibrosis. Spinal cord injury may lead to
decreased bladder emptying and a functional obstruction.
• Complications
o Fluid and electrolyte Imbalance
o Acidosis
o Increased susceptibility to secondary infection
o Anemia
o Platelet dysfunction
o Gastrointestinal complications
o Increase incidence of pericarditis
o Uremic encephalopathy characterized by apathy, defective recent
memory, episodic obtundation, dysarthria, tremors, convulsions and coma.
o Impaired wound healing.
• Clinical Manifestations
o Nonoliguric Renal Failure
 Urine excretion of 2L/day
 Low urine specific gravity
 Hypertension
 Tachypnea
 Dry Mucous Membranes
 Poor skin turgor
 Orthostatic Hypotension
o Oliguric Renal Failure

 Urine production of less than 400mL/day
 High urine specific gravity
 Contains hyaline and granular casts
 Edema and weight gain
 Hemoptysis resulting from elevated left ventricular end-diastolic
pressure, weakness from anemia, and hypertension.
 Anemia
 Hypertension
 High sodium concentration
 Definite proteinuria
 Hematuria, RBC and hemoglobin casts in the urine
 Elevated levels of creatinine, phosphokinase, potassium
o Deficient fluid volume related to fluid loss from a variety of causes
o Excess fluid volume related to inability of the kidneys to produce urine
secondary to ARF
o Imbalance Nutrition: Less than body requirements related to anorexia and
altered metabolic state secondary to renal failure.
o Risk for impaired skin integrity related to poor cellular nutrition and edema.
o Risk for infection related to lowered resistance
o Anxiety related to unknown outcome of disease process
• Diagnostic Procedures
o Laboratory finding of azotemia (increased nitrogenous compounds in the
blood), and elevated BUN and creatinine confirm diagnosis
o Laboratory finding of hyperkalemia (increased potassium in the blood) and
acidosis are common.
o Urinalysis shows casts
• Treatment, Surgery and Medication

o Prevention of the oliguric phase results in a better prognosis. Prevention
of oliguria involves:
 Aggressive plasma volume expansion
 Diuretics to increase urine production
 Vasodilators, especially dopamine, given to increase renal blood
flow.
 Dietary restrictions on potassium and protein are often
implemented in acute renal failure. High-carbohydrate intake
prevents the metabolism of proteins and reduces nitrogenous
waste production. Give the patient a high-calorie, low protein,
sodium, magnesium, phosphate, and potassium diet should be
given. Protein must be of high biologic value, containing essential
amino acids to reduce nitrogenous waste products.
 The patient must under go continuous renal replacement therapy
(CRRT)for:
 Continuous arteriovenous hemofiltration
 Continuous venovenous hemofiltration
 Continuous venovenous hemodialysis
 Continuous arteriovenous ultrafiltration
 Slow continuous ultra filtration
 NOTE: CCRT removes plasma water and dissolved contents
from the patient’s blood across a membrane. Slow
continuous removal of waste products and water through
CRRT is less stressful to the client than shorter, more
efficient dialysis treatment.
 Antibiotic therapy to prevent or treat infections may be necessary
because of high rate sepsis seen with acute renal failure
 Continuous peritoneal dialysis is often employed during the oliguric
stage of acute renal failure to give the kidneys time to recover.
Dialysis also prevents the build up of nitrogenous wastes, stabilizes
electrolytes, and fluid overload.
 Cautious use of diuretics such as furosemide and mannitol.
• Nursing Responsibility
o Careful maintenance of electrolyte and fluid balance
o Check vital signs, skin turgor, and mucous membranes every 4 hours
o Obtain daily weight measurements using the same scale at same time of
the day
o Monitor for abnormalities in heart sounds, cardiac output, breath sounds
and mental status
o Give sodium bicarbonate, sodium lactate or sodium acetate to correct
metabolic acidosis
o Alleviate patients thirst with careful oral hygiene, judicious use of ice chips,
lip ointments and appropriate diversionary techniques.
o Place allotted water in a spray bottle may help spread out the amount
taken
o Administer medication with meals to conserve fluid for the client
o Work with the client and dietitian to plan a diet that is acceptable. Provide
a pleasant environment at mealtime.
o Medications to alleviate the discomfort of nausea and stomatitis may be
useful.
o To prevent skin breakdown, meticulous skin care, frequent turning and
special mattresses are important.
o Teach patient range of motion exercise to facilitate movement and
increase circulation
o Monitor patient carefully for infectious processes; if these occur, they
should be treated aggressively.
o Give frequent careful explanations and provide emotional and
psychological support to the client and family to relieve anxiety.
• Evaluation
o Fluid Balance must be maintained. If fluid volume excess develops it is
managed with dialysis or CRRT to reduce body weight and to balance
intake and output.
o Intact skin should be maintained
o The client and family will be less anxious and be able to cope with the
information provided.
o Clients with ARF recover within 4 to 10 weeks of correction of the
underlying problem.
o Renal function may continue to improve for up to 12 months after the
onset of ARF. The client is particularly vulnerable to additional renal injury
during this time.
CHRONIC RENAL FAILURE

• Description
o Chronic renal failure is the irreversible and progressive reduction of
functioning renal tissue. When the remaining kidney mass can no longer
maintain the body’s internal environment renal failure is the result.
o It also known as the end stage renal disease and stage 5 CKD
o It can develop insidiously over many years or it may result from an
episode of ARF from which the client has not recovered.
• Cause or Risk Factor

o Chronic glomerulonephritis, ARF, polycystic kidney disease, obstruction,
repeated episodes of pyelonephritis and nephrotoxins.
o Systemic diseases such as diabetes mellitus, hypertension, lupus
erythematosus, polyarteritis, sickle cell disease, and amyloidosis
• Complications
o Severe azotemia and uremia are present. Metabolic acidosis worsens
which significantly stimulates respiratory rate.
o Hypertension, anemia, osteodystrophy, hyperkalemia, uremic
encephalopathy, and pruritus are common complications,
o Decreased production of erythropoietin may lead to cardiorenal anemia
syndrome, a self-perpetuating triad of anemia, cardiovascular disease and
renal disease that ultimately leads to increased morbidity and mortality.
o Congestive heart failure may develop
o Without treatment coma and death may develop
• Clinical Manifestations
o Increased BUN, serum creatinine and uric acid
o Dilute Polyuria
o Dehydration
o Hyponatremia
o Decreased Libido
o Infertility
o Delayed wound healing
o Infection
o Erratic Blood glucose levels
o Anemia, pallor
o Osteodystrophy
o Hypocalcemia
o Metabolic acidosis
o Hyperphosphatemia
o Hyperkalemia
o Hypertension
o Heart Failure
o Edema
o Peripheral Nerve Changes
o Pericarditis
o CNS changes
o Pruritus
o Bleeding tendencies
o Altered taste
o Deficient/ Excessive fluid volume related to impaired renal function, fluid
shifts between dialysate and blood, and blood loss during hemodialysis.
o Imbalance Nutrition: Less than body requirements related to anorexia and
nausea
o Constipation related to medication, fluid and dietary restrictions and
decreased activity level
o Fatigue related to anemia and altered metabolic state
o Risk for impaired skin integrity related to edema dry skin and pruritus.
o Readiness for enhanced self care related to learning to live with a chronic
illness, uncertain future, many stressors, role reversal, and effects of long
term dialysis.
• Diagnostic Procedures
o Radiographs or ultrasound will show small, atrophied kidneys
o Elevated BUN and Serum creatinine with a decreased GFR
o Reduced hematocrit and hemoglobin
o Low plasma pH
o Elevated respiratory rate indicates respiratory compensation for metabolic
acidosis.
• Treatment, Surgery and Medications

o Renal Anemia Management Period (RAMP) is defined as the following the
time following the onset of CRF when early diagnosis and treatment of
anemia will slow kidney disease progression, delay cardiovascular
complications, and improve quality of life. Treatment of anemia is by
administration of recombinant human erythropoietin. This drug improves
the quality of life and reduces the need for transfusions. It also significantly
improves cardiac function.
o Treatment is geared towards correcting fluid and electrolyte imbalances
o Treatment includes dialysis or renal transplantation
 Renal transplantation is the surgical implantation of a human
kidney from a compatible donor to a recipient.
 The kidney is surgically placed extraperitoneally in the iliac fossa.
The renal artery is anastamosed to the recipient’s hypogastric
internal or external iliac artery and the renal vein is anastamosed to
the recipient’s iliac vein.
 Selection of transplant recipients is based on careful evaluation of
the client’s medical, immunologic, and psychosocial status. A
recipient must be:
 Younger than 70 years old
 Has an estimated life expectancy of 2 years or more
 Is expected to have an improved quality of life after
transplantation
 Bilateral nephrectomy may be performed before the transplantation
procedure for persistent or active bacterial pyelonephritis,
uncontrolled, renin-mediated hypertension, polycystic kidneys or
rapidly progressive glomerulonephritis.
 The source of kidneys for transplantation is a living related donor
who matches the client closely. The donor must have compatible:
 ABO blood group
 Tissue-specific antigen
 Human leukocyte histocompatibility
 Contraindications of Renal Transplantation
 Infection
 Active malignancy
 Liver disease
 Psychological disorders
 Advance atherosclerosis
 Hypertension
 Respiratory disease
 Gastrointestinal bleeding
 Complications:
 Graft Rejection
 Spontaneous rupture of kidneys may occur
 Urinoma
 Reduced renal function
 Urinary, bladder, or pelvic leaks, obstructions, reflux and
lymphoceles
 Hypertension
 Dysrhytmias and heart Failure
 Pnuemonia, Pulmonary embolism, pulmonary edema
o Improve Renal Function by:
 Improving blood pressure by medication, weight control and diet
 Protein restriction
o Alleviate extrarenal manifestations as much as possible by:
 Applying topical emollients and lotions, taking antihistamines,
intravenous lidocaine and ultraviolet B light to alleviate pruritus.
 Treatment with epoetin alfa three times a week to stimulate the
production of RBC to treat anemia. Supplemental iron, vitamin B12
and folic acid are usually administered as well.
 Hyperlipidemia is treated with statins to minimize the risk of
myocardial infarction and stroke.
o Elemental diets, enteral feeding, or TPN may be used instead of or in
addition to regular food intake.
• Nursing Responsibilities
o Fluid Status must be known and fluid intake carefully regulated.
o Monitor fluid status by daily weight measurement, orthostatic blood
pressure, skin turgor, mucous membrane moistness, and meticulous
intake and output comparisons.
o Help the client follow the recommended fluid allowance. Relieve thirst by
moistening lips by using lip balms, performing frequent oral hygiene,
eating ice chips or using spray bottles rather than drinking.
o During dialysis monitor the client’s vital signs including postural blood
pressure, pulse rate weight and intake and output
o Help the client consume adequate nutrition while minimizing uremic
toxicity.
o Take measures to relieve nausea and vomiting, stomatitis, and other
gastrointestinal manifestations.
o Help the client select and prepare foods and learn where to obtain special
foods if necessary. Exercise also improves appetite.
o Bran which is limited in potassium or phosphorus can be used to alleviate
constipation. Stool softeners are often administered regularly can also
alleviate constipation
o Iron and erythropoietin therapy to increase energy levels. Exercise is an
important strategy to reduce fatigue and improve quality of life.
o Moisturizing oils in the bath water or applied directly to the skin help to
correct dryness. Avoid products that alcohol or perfume because they
increase dryness and pruritus.
o If edema is present avoid sustained pressure on the area
o Observe for poor circulation and areas of breakdown or infection
o Explain procedures and tests that are to be done to alleviate anxiety.
o Closely monitor patients who have undergone transplantation surgery for
fluid and electrolyte imbalance, infection, graft rejection and other
complications.
• Evaluation
o The client is expected to improve physically and mentally when dialysis
begins.
o The clients weight and blood pressure should begin to stabilize if dietary
and fluid restrictions are followed and as fluid balance stabilizes
o The client should report regular, normal bowel movements.
o The client should report less fatigue and increased energy and activity as
hematocrit values approach normal levels
o Skin should remain contact
o The client should understand and adapt to the treatment regimen and be
successfully maintained with peritoneal dialysis or hemodialysis.
o Clients having peritoneal dialysis should be able to demonstrate
successful performance of the dialysis procedure and care of the vascular
access site or peritoneal catheter. The should remain free from
complications of dialysis
D. DIALYSIS
It is the diffusion of solutes and osmosis of water through a passive, porous
membrane from the plasma to the dialysis solution and vice-versa in response to a
concentration or pressure gradient.
• Types of Dialysis
• Hemodialysis
• Peritoneal Dialysis
 HEMODIALYSIS
• Involves shunting the patient’s blood from the body through a machine in
which diffusion, osmosis and ultrafiltration occur and back into the patient’s
circulation.
• Used for clients with acute or irreversible renal failure and fluid and electrolyte
imbalances.
• It is usually the treatment of choice when toxic agents, such as barbiturates
after an overdose, need to be removed from the body quickly.
ACCESS TO THE BLOODSTREAM
A. External Arterio-venous Cannula or Shunt

-Teflon cannula tips are placed in an artery and nearby vein. These cannula
tips are connected by silicone rubber tubing and a Teflon bridge to complete
the shunt
-It ahs a short life-span (9 months) due to clotting and infection
B. External Arterio-venous Fistula
-anastomosing an artery directly to a vein (usually radial artery and cephalic

vein at the wrist)
-blood is shunted from the artery to the vein causing the vein to enlarge
(ripening) after a few weeks
-average life is 4 years; circumvented problems of infection, clotting and

possible hemorhhage
-disadvantages are painful venipuncture, formation of aneurysms; achieving

hemostatis post dialysis and ischemia of the hand.
NURSING RESPONSIBILITIES FOR HEMODIALYSIS
Before:
1. Measure and record baseline vital signs as weight, temperature, pulse rate,
respiration, blood pressure.
2. Measure pre treatment result of BUN, creatinine, Na, K levels and Hematocrit.
During:
1. Sterile techniques for needle and shunt connections.

2. Anchor connections securely.
3. Check equipments for readiness, safety and gauge settings.
4. Monitor vital signs every 15 minutes for 1 hour then every 30 minutes thereafter.
5. Watch out for rapid shifts in volume or electrolytes that may result in
hypovolemia, angina, dysrhythmias, nausea and muscle cramps due to dialysis
disequilibrium syndrome wherein the osmotic gradient produced across the
blood-brain barrier by the efficient removal of urea from the blood but not from
the brain tissues. Urea draws in water from the ECF and can cause cerebral
edema.
After:
1. Measure and record vital signs and weight.

2. Precautions against infection.
3. Routine care to shunt or fistula.
4. Avoid trauma to sites.
5. Do not use arm with shunt or fistula for blood pressure taking and needlesticks.
6. Record BUN, creatinine Na, K levels to note of treatment.
Between Treatments
1. Follow diet (Low Na, K, low protein) and fluid restrictions.

2. Take medications as ordered
3. Limit weight gain to 0.5 kg/ day between treatment
4. Care of access site:
a. No BP or IV punctures on arm with shunt / fistula.
b. Cleanse site aseptically with Peroxide.
c. Clean shunt with alcohol sponges from exist site.
d. Cover with dry sterile dressing
e. Avoid trauma to site, wear loose sleeves, avoid temperature extremes,
avoid lifting heavy objects, and avoid prolonged immersion of arm in
water.
POSSIBLE COMPLICATIONS OF HEMODIALYSIS
1. Blood clots
-due to decreased blood flow which results from:
a. systemic hypotension
b. infection of shunt/fistula
c. compression of shunt/fistula
d. tight bandages/restrictive clothing
e. phlebitis from puncture of involved veins
f. prolonged inflation of BP cuff
-how do you detect clots:
a. absence of dark/separated blood in the tubing
2. Infection on site of cannula insertion
- signs of infection
a. redness
b. tenderness
c. swelling
d. excessive warmth of skin
Complication of Dialyzer Reuse
1. pyrogenic reactions 3. Membrane repture

2. bacteremia 4. occlusion of hollow fibers
EVALUATION:
Successful achievement of patient outcomes for the patient receiving hemodialysis is

indicated by the following:
 lack of excessive fluid weight gain between dialysis treatment

 states that no pain is present and that discomfort experienced during dialysis is
decreased
 participates in a program to maintain prescribed activity level
 eats according to preference during therapy
 correctly explains dialysis, care of venous access, common side effects and
recommended work or activity schedule.
 PERITONEAL DIALYSIS
A catheter is placed in the peritoneum cavity by paracentesis. Two liters of sterile
dialysis solution are allowed to run into the peritoneal cavity through the catheter for 10-
20 minutes. Equilibrium between the dialysis fluid and the highly vascular semi-
permeable peritoneal membrane takes place. The peritoneum acts as the semi-
permeable membrane. This is called the “dwell time” which is generally 30-45 minutes.
The fluid is then allowed to drain by gravity into a closed, sterile connecting system.
Cycle is repeated successfully over a period of 1-2 days.
Types of Peritoneal Dialysis:
1. Continuous Cycling Peritoneal Dialysis

-connecting the peritoneal catheter to an automated peritoneal dialysis machine that
perform 3-5 cycles during the night while patient sleeps; last bag of solution remains
in abdomen during daytime.
2. Continuous Ambulatory Peritoneal Dialysis
- a permanent dialysis catheter is inserted into the abdomen; a connector joins the
transfer set to the bag of the fluid. Plastic bags are used; performs 3 -5 exchanges
daily; last bag of solution remains in the abdomen overnight.
3. Intermittent Peritoneal Dialysis
- connected for about 10 hour, with cycle changing every 30 -60 minutes; abdomen
is left “dry” between sessions.
NURSING RESPONSIBILITIES IN PERITONEAL DIALYSIS
Before:
1. have patient empty the bladder to avoid puncturing it during catheter insertions
2. measure and record weight, abdominal girth, temperature, pulse, respiration,
blood pressure
3. measure and record blood chemistry values like BUN, creatinine, Na, K,
Hematocrit
4. sterile technique during insertion of catheter
5. after insertion of catheter, observe for perforation of bowel (dialysate outflow
stained with feces or blood) or bladder (pink or blood tinged)
6. warm dialysate up to 37°C before infusion
7. flush tubing to remove air, connect to catheter, anchor connections and tubings
securely and be sure there are no kinks on the tubings
During:
1. measure and record output, weight regularly and TPR, BP every 10 min. till
stable then every 2-4 hours as ordered
2. keep accurate record of dialysis cycles (inflow, dwell, outflow times). Record
strength of solutions used, additions made, and fluid balance (amount retained or
lost)
3. observe for peritonitis (collect samples of dialysate for culture and sensitivity
tests whenever solution is turbid, bloody, or has an odor or when routinely
ordered).
4. observe for respiratory embarrassment (dyspnea and rales) which results from
abdomen being too full of fluid or leakage of dialysate into the thoracic cavity
through defect in the diaphragm.
5. Have client change position frequently, do ROM exercises, and do deep
breathing.
After:
1. determine fluid balance (measure weight, TPR, BP, abdominal girth)

2. check blood chemistry (BUN, creatinine, Na, K)
3. maintain adequate nutrition, adhering to high protein diet which is needed to
replace those lost during the procedure
4. facilitate learning
-the teaching plan should include:
a. the process of dialysis and how the dialysis relates to the patient’s own
body needs
b. signs and symptoms of infection of eth peritoneal cavity or catheter site

and when to obtain care if these occur
c. appropriate care of the permanent peritoneal catheter
d. common side effects of treatment, means of controlling mild symptoms

and means of obtaining medical attention for severe or persistent
complications
e. changes in medication schedule required before and after dialysis
f. a work and activity schedule as physical capabilities permit with minimal

interference from scheduled dialysis time.
Cycle-related problems:
1. inflow problems- obstructed catheter (clots, fibrin, omentum, catheter

malposition), leakage of fluid around catheter insertion site.
2. Dwell time problems- prolonged time may cause water depletion or
hyperglycemia
3. Outflow problems- kinks in tubing or catheter, catheter occluded by loops of
bowel, constipation
PROCEDURE
PROCEDURE RATIONALE
1. warm dialysate solution to body Avoid hypothermia and shock during

temperature procedure
2. apply mask, then prepare dialysis Avoid introducing pathogens into

administration set. Have client wear peritoneal cavity
mask during connection and
disconnection of administration set.
3. place drainage bag below client Facilitates drainage by gravity
4. connect outflow tubing to drainage Provides route for removal of

bag dialysate solution.
5. connect dialysis infusion lines to

the bag
6. place client in supine position when Promote comfort and relaxation.

equipment and solutions are ready When tube is new, supine position
helps prevents hernia.
7. prime infusion tubing by allowing Maintains integrity of system and

solution to fill tube. prevents air from entering the line
8. check patency of catheter: Ensure that catheter is ready for use

and that client will tolerate initiation of
a. rapidly instill 500 ml of dialysate treatment
into client’s peritoneal cavity
b. immediately unclamp the outflow

line, and let fluid drain into the
collection bag
9. open the clamps on the infusion Fluid dwell time varies, dependent on
lines, and infuse the prescribed concentration off electrolytes to be
amount of dialysate over 5 to 10 min.; removed
allow solution to dwell for prescribed
interval (10 min. to 4 hours). Remove
and discard gloves, and perform hand
hygiene.
10. when dwell time is completed, Position helps to eliminate all of

open the outflow clamps and allow dialysate
the solution to drain into the collection
bag. Client may need to change
position, roll from side to side.
11. repeat the cycles of infusion-dwell Prescribed cycling is necessary to

–drainage (using new batches of achieved desired fluid and electrolyte
solution each cycle) until the balance
prescribed amount of dialysate and
the prescribed number of cycle have
been achieved.
12. when dialysis treatment is Avoid introducing pathogens into the

completed, disconnect the inflow line peritoneal cavity.
from the catheter, place a sterile cap
over the catheter end, then discard
gloves.
COMPLICATIONS OF PERITONEAL DIALYSIS
COMPLICATIONS SIGNS AND INTERVENTIONS

SYMPTOMS
1. peritonitis Abdominal pain Aseptic technique
Elevated temperature Culture and sensitivity

of dialysate
Antibiotic treatment
Possible removal of
catheter
2. Exit site infection Redness Assess response to
cleansing agents
Swelling
Continue thorough
Heat daily site care
Pain Antibiotics as ordered
3.Abdominal Pain If related to rapid

inflow, decrease rate of
infusion during initial
exchanges
4.Air in the peritoneal Shoulder pain Prime new tubing

cavity carefully
Distended abdomen
Do not use vented
system
5.Overheated dialysate Increased temperature Drain solution
Abdominal pain Treat for hypothermia
Cardiac disrythmias Evaluate warming

procedure
6.Inadequately warm Hypothermia Drain solution

dialysate
Treat for hypothermia
Evaluate warming
procedure
7. Fluid Overload Dyspnea Calculate fluid balance

accurately
Altered mental status
Use a more hypertonic
Alteration in breath dialysate
sounds
Limit fluid intake
Shorten dwell time
Correct catheter
malfunction
Monitor weight, V.S and

cardiorespiratory status
frequently
8. Fluid Deficit Alteration in fluid and Calculate fluid balance

electrolyte balance accurately
Discontinue use of
hypertonic solution
Replace fluid and

sodium losses
Monitor V.S and weight

closely
Lengthen dwell time
9. Hypokalemia Decreased level of Monitor serum

potassium potassium
Add potassium to
dialysate for clients
with normal levels
Increase dietary intake

of Potassium if with
chronic problem
10. Drainage of Fluid Inadequate outflow Small amount of

Heparin is added to the
dialysate
Turn patient from side

to side to reposition the
catheter in the
peritoneal cavity
Raise head of bed
Apply firm pressure to

the abdomen using
both hands

Genitourinary System

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I.

Anatomy and Physiology of the Genitourinary System

Components of the renal system

 Kidneys and ureters

The kidneys also produce renin (a hormone important in regulating blood

II.Diagnostic Tests and Table of Laboratory Values

Measures effectiveness of renal function. Creatinine is end product of muscle

Normal Value: 0.6 – 1.2 mg/dl (50 – 110 µmol/dL

How the test is performed

How to prepare for the test

• Aminoglycosides (for example, gentamicin)

Serves as index of renal function. Urea is nitrogenous end product of protein

Normal Value: 7-18 mg/dl, patients over 60 years: 8-20 mg/dL

How the test is performed

How to prepare for the test

Drugs that can increase BUN measurements include:

Drugs that can decrease BUN measurements include:

The urinalysis provides important clinical information on kidney function and

Evaluates ability of kidneys to concentrate solutes in urine.

Normal value: 1.010 – 1.025

How the test is performed

o The test requires a clean-catch urine sample.

How to prepare for the test

Urine culture and Sensitivity

Urine examination includes:

• Urine clarity and odor

• Urine pH and specific gravity

• Microscopic examination of urine sediment after centrifuging to detect RBCs

• The creatinine clearance test may be ordered whenever a doctor wants to

o A 24-hour urine sample generally required. Occasionally, 6- or 12-hour urine

For an adult or child:

For an infant or young child:

• The nurse should collect the urine specimen 12 or 24 hours as ordered.

• Vanillylmandelic acid test:

• A test for catecholamine-secreting tumors (pheochromocytoma and

• Performed on a 24-hour urine specimen; it is based on the finding that

• KUB (kidney, ureter, bladder)

A KUB is a plain frontal supine radiograph of the abdomen. It is often

KUB is typically used to investigate gastrointestinal conditions such as a bowel

• X-Ray the kidney, ureter and bladder

 Establish/maintain fluid and electrolyte balance

What does the test result mean?

Urine is taken from the patient.

• The patient is scanned with the ultrasonography machine

A computerized axial tomography scan is an x-ray procedure that combines many x-

 Promote / maintain the client’s dignity

• Magnetic Resonance Imaging

• Intravenous Pyelogram (IVP)

An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and

o This examination is usually done on an outpatient basis.

Angiography is the use of an x-ray to look at arteries in order to detect blockage or

After the test

3.CTA/MRA protocol first thing after conference when assigned to imaging.

4.Residents should arrive by 7:30 AM if not at conference or case review. Be

5.Scheduling of cases, or add-on cases, should be referred to Fellows.

7.Perform procedures with supervision by Fellow/Attending.

9.Fill post note at completion of procedure and call admitting resident.

12.Attend all AM conferences.

A renal scan is a nuclear medicine exam in which a small amount of radioactive

o A kidney biopsy is done by a urologist, nephrologist, or a radiologist in a clinic or

Your health professional drawing blood will:

White blood cell (WBC, leukocyte) count

Men and nonpregnant women 4,500–11,000/mcL3 or 4.5–11.0 x 109/liter (SI units)