metabolites Diminished osmotic stimulation of thirst Incomplete emptying of bladder Urinary incontinence
Diagnostic Evaluation
Urinalysis and culture
Urine tests
Albuminuria—albumin in urine not measurable by dipstick
Normal values in freshly voided sample should range between 2.0-20 for men and 2.8-28 for women. Higher levels indicate microalbuminuria.
Creatinine clearance—tests clearance of creatinine in one min. Reflects GFR.
Serum creatinine—measures effectiveness of renal function. 0.6 to 1.2 mg/dL
Nur 4206 Management of patients with
renal/urinary disorders
By Linda Self
Functions of the Kidney
Regulation of water excretion Regulation of electrolyte function Regulation of acid-base balance—retain
Can also be determined by 24h specimen
Renal Function tests
Urine osmolality—indication of concentrating ability, changes seen early in disease processes
Excretion of waste products-body’s main excretory organ. Urea, creatinine, phosphates, uric acid and sulfates. Drug metabolites.
Risk factors for renal or urologic disorders
Urea nitrogen—also indicator of renal function. 7-18 mg/dL. Measures renal excretion of urea nitirogen, a byproduct of protein metabolism. Is not always elevated with kidney disease. Not best indicator of renal function.
Gerontologic Considerations
GFR decreases following 40 years with a yearly decline of about 1 mL/min
Renal reserve declines Multiple medications can result in toxic
HCO3- and excrete acid in urine Regulation of blood pressure--RAAS Regulation of RBCs Vitamin D synthesis
Functions of Kidney cont.
Secretion of prostaglandin E and prostacyclin which cause vasodilation, important in maintaining renal blood flow
Renal function tests cont.
Liver must function properly to produce urea nitrogen. BUN levels indicate the extent of renal clearance of this nitrogenous waste product.
Sp. Gravity—1.005-1.020 Microscopic examination for protein, RBCs,
ketones, glycosuria, presence of bacteria, general appearance and odor Leukocyte esterase—enzyme found in WBCs Nitrites –bacteria convert nitrates to nitrites Osmolality—accurate measurement of the kidney’s ability to concentrate urine. Normal rБайду номын сангаасnge is 500-1200 mOsm/kg. Culture important in ‘Id’ing pathogen
1. Hypertension 2. Diabetes mellitus 3. Immobilization 4. Parkinson’s disease 5. SLE 6. Gout 7. Sickle cell anemia, multiple myeloma 8. BPH 9. Pregnancy 10. SCI
May see elevation of BUN with bleeding into tissues or from rapid cell destruction from infection/steroids
Renal Function Tests