Laboratory and Laboratory and Diagnostic TestsDiagnostic Tests

PN 134PN 134

UrinalysisUrinalysis: : most common study of urinemost common study of urine Performed on either a clean-catch Performed on either a clean-catch

specimen or catheterized specimenspecimen or catheterized specimen Use of Reagent Strips (e.g.. MultiStix 10)Use of Reagent Strips (e.g.. MultiStix 10) Culture & Sensitivity prn evidence of Culture & Sensitivity prn evidence of

infection – i.e. Blood, leucocytes, etc.infection – i.e. Blood, leucocytes, etc.

24 hr. Urine –24 hr. Urine – The kidneys excrete The kidneys excrete substances at various rates and amounts substances at various rates and amounts during a 24 hr. period. during a 24 hr. period. • Some substances that are measured Some substances that are measured

are: urine protein, urine creatinine, uric are: urine protein, urine creatinine, uric acid levelsacid levels, , and catecholamines + 66 and catecholamines + 66 other itemsother items

• Procedure: Procedure: • Discard the first voiding of the day.Discard the first voiding of the day.• Start the “time” for the 24 hr. Start the “time” for the 24 hr.

collectioncollection• Collect urine x 24 hrs.Collect urine x 24 hrs.

Collection- remind patient not to place Collection- remind patient not to place toilet paper in collection container. Have toilet paper in collection container. Have patient void before BM to avoid patient void before BM to avoid contamination.contamination.

-if there is a preservative in the -if there is a preservative in the collection container, may need tocollection container, may need to refrigerate or put on ice. If norefrigerate or put on ice. If no preservative, may need topreservative, may need to refrigerate or put on ice. Checkrefrigerate or put on ice. Check with the lab and for any with the lab and for any institutional procedures. institutional procedures.

Specific GravitySpecific Gravity – measures the patients – measures the patients hydration status. Also gives information hydration status. Also gives information about the kidneys ability to concentrate about the kidneys ability to concentrate urineurine– High Specific Gravity High Specific Gravity indicates indicates

dehydrationdehydration– Low Specific Gravity Low Specific Gravity indicates high indicates high

fluid intakefluid intake

BUN vs creatineBUN vs creatine

http://www.youtube.com/watch?v=iYy7heyog0Q

Serum (blood) Tests -Blood Urea Nitrogen (BUN) Used to determine the kidney’s ability to rid the blood of non-protein nitrogen waste and urea which results from protein breakdown -Normal range- 10-20 mg/dL -If it becomes too high, may result in disorientation and seizures

Blood CreatinineBlood Creatinine measures the amount of measures the amount of creatinine in the blood. Used to diagnosis creatinine in the blood. Used to diagnosis impaired kidney function.impaired kidney function.– Creatinine Creatinine is the catabolic product of is the catabolic product of

creatine. Creatine is used in skeletal muscle creatine. Creatine is used in skeletal muscle contraction. The daily production of creatinine contraction. The daily production of creatinine [and therefore, creatinine] depends on muscle [and therefore, creatinine] depends on muscle mass. mass.

– Creatinine is present in both blood and urine.Creatinine is present in both blood and urine.– Creatinine is excreted by the kidneys. Only Creatinine is excreted by the kidneys. Only

renal disorders will cause an elevation in renal disorders will cause an elevation in creatinine. creatinine.

Creatinine ClearanceCreatinine Clearance – Creatinine is generated during muscle Creatinine is generated during muscle

contraction and excreted by glomerular contraction and excreted by glomerular filtration.filtration.

– The levels are directly related to muscle mass The levels are directly related to muscle mass and measured over a 24 hr periodand measured over a 24 hr period

– Fasting blood sample is drawn at the start and Fasting blood sample is drawn at the start and conclusion of a 24 hr urine collection.conclusion of a 24 hr urine collection.

– Normal range for serum (female)= 0.5 – 1.1 Normal range for serum (female)= 0.5 – 1.1 mg./dL; (male) = 0.6 – 1.2mg/dLmg./dL; (male) = 0.6 – 1.2mg/dL

– Normal range for urine = (female) 87-107 Normal range for urine = (female) 87-107 ml/min; (male) = 107-139ml/minml/min; (male) = 107-139ml/min

Prostate-Specific Antigen (PSA)Prostate-Specific Antigen (PSA)– An organ-specific glycoprotein produced by An organ-specific glycoprotein produced by

normal prostatic tissuenormal prostatic tissue– Elevated levels result from prostate cancer, Elevated levels result from prostate cancer,

BPH, and prostatitisBPH, and prostatitis Urine Osmolality Urine Osmolality

– This measures the weight of the solute This measures the weight of the solute compared with its own weight. May be compared with its own weight. May be preferred over specific gravitypreferred over specific gravity

– Plasma osmolality may be done at the same Plasma osmolality may be done at the same time when pituitary disorders are suspectedtime when pituitary disorders are suspected

– Results provide information of the Results provide information of the concentration ability of the kidneyconcentration ability of the kidney

Radiograph StudiesRadiograph Studies Kidney-Ureter-Bladder (KUB)Kidney-Ureter-Bladder (KUB) – evaluates the – evaluates the

status of the abdomen and urinary tract status of the abdomen and urinary tract structures.structures.– No special prep. Explanation to patient of the No special prep. Explanation to patient of the

test and reason for it.test and reason for it.– Abnormal findings may indicate: tumors, Abnormal findings may indicate: tumors,

calculi, cysts, glomerulonephritis, etc.calculi, cysts, glomerulonephritis, etc.

Intravenous Pyelogram (IVP)Intravenous Pyelogram (IVP)– Evaluates the structures of the urinary tract, Evaluates the structures of the urinary tract,

filling of the renal pelvis with urine, and the filling of the renal pelvis with urine, and the transport of urine via the ureters to the bladdertransport of urine via the ureters to the bladder

– A radiopaque dye is injected into a vein.A radiopaque dye is injected into a vein.– *Most important that the nurse ask the *Most important that the nurse ask the

patient if he/she is allergic to iodine or patient if he/she is allergic to iodine or iodine-containing foods.iodine-containing foods. If the answer is If the answer is “yes”, then an alternative method must be “yes”, then an alternative method must be orderedordered

– Preparation: NPO x 8 hrs. before the test; light Preparation: NPO x 8 hrs. before the test; light meal the night before; non-gas forming meal the night before; non-gas forming laxativelaxative

– During the Procedure: VS checkDuring the Procedure: VS check

-Radiographs will be taken at various intervals -Radiographs will be taken at various intervals to monitor the movement of the dyeto monitor the movement of the dye

– Abnormal finding: structural deviations, calculi Abnormal finding: structural deviations, calculi within the urinary tract, tumors, within the urinary tract, tumors, hydronephrosis, etc.hydronephrosis, etc.

Retrograde PyelographyRetrograde Pyelography – involves an exam of – involves an exam of the lower urinary tract with a cystoscope under the lower urinary tract with a cystoscope under aseptic conditionsaseptic conditions– Urologist injects radiopaque dye directly into Urologist injects radiopaque dye directly into

the ureters to visualize the upper urinary tract. the ureters to visualize the upper urinary tract. Urine samples can be obtained directly from Urine samples can be obtained directly from renal pelvisrenal pelvis

Retrograde Cystography -Radiopaque dye is injected via a catheter to -Radiopaque dye is injected via a catheter to

visualize the bladder to asses its structure or to visualize the bladder to asses its structure or to determine the reason for recurrent infections.determine the reason for recurrent infections.

– RETROGRADE URETHROGRAPHY: A catheter is RETROGRADE URETHROGRAPHY: A catheter is inserted and dye is injected to asses the state inserted and dye is injected to asses the state of the urethral structureof the urethral structure

RetrogradeRetrograde PyelographyPyelography

RetrogradeRetrograde CystographyCystography

Voiding Cystourethrography:Voiding Cystourethrography: used with used with other tests to detect abnormalities of the other tests to detect abnormalities of the bladder and urethra.bladder and urethra.– Preparation: Enema before test; insertion Preparation: Enema before test; insertion

of catheterof catheter– The pt. will be asked to void while The pt. will be asked to void while

radiographsradiographs

are being taken.are being taken.– Defects that can be noted are: structural Defects that can be noted are: structural

abnormalities, diverticulitis, reflux back up abnormalities, diverticulitis, reflux back up into the ureter, etc.into the ureter, etc.

Endoscopic Procedures Endoscopic Procedures are visual are visual exams of hollow organs using an exams of hollow organs using an instrument with a scope and a light instrument with a scope and a light source.source.– Performed by a urologist. Consent form Performed by a urologist. Consent form

needs to be signedneeds to be signed– CystoscopyCystoscopy – a visual exam to inspect, – a visual exam to inspect,

treat, or diagnose disorders of the treat, or diagnose disorders of the bladder and proximal structuresbladder and proximal structures

– Preparation: Explanation to pt. Patient is Preparation: Explanation to pt. Patient is sedated, then a local anesthesia is sedated, then a local anesthesia is given. given.

ALWAYS KEEP THE PT. SAFE.ALWAYS KEEP THE PT. SAFE.- Pt. placed in lithotomy positionPt. placed in lithotomy position- Scope is passed. Continuous fluid Scope is passed. Continuous fluid

irrigation is needed to facilitate irrigation is needed to facilitate visualizationvisualization

- Post Procedure: Hydration to dilute the Post Procedure: Hydration to dilute the urine and monitor the first post-urine and monitor the first post-procedure voiprocedure voidd

– – Urologist can obtain a brush biopsy [from the Urologist can obtain a brush biopsy [from the renal pelvis or calyces] with a ureteral catheter renal pelvis or calyces] with a ureteral catheter during this procedure.during this procedure.

NephroscopyNephroscopy

--A renal endoscopy is done using the A renal endoscopy is done using the percutaneous (skin puncture) route. This percutaneous (skin puncture) route. This method provides direct visualization of the method provides direct visualization of the upper urinary structures. A biopsy, urine upper urinary structures. A biopsy, urine specimen, or calculi can be obtainedspecimen, or calculi can be obtained

Renal Angiography Renal Angiography shows the blood supply to shows the blood supply to the kidneys, masses, and detects complications the kidneys, masses, and detects complications after a kidney transplantation.after a kidney transplantation.– Preparation: NPO the night before; explanation Preparation: NPO the night before; explanation

to pt.to pt.– A small catheter is inserted into an artery A small catheter is inserted into an artery

(usually the femoral artery). Radiopaque dye is (usually the femoral artery). Radiopaque dye is inserted and x-rays taken.inserted and x-rays taken.

– Post Care: Pt. must lie flat in bed x 6hrs with the Post Care: Pt. must lie flat in bed x 6hrs with the involved leg straightinvolved leg straight

Puncture site assessed by nurse q 15 min. x 1 Puncture site assessed by nurse q 15 min. x 1 hr.; then q 2 hrs. x 24 hrs.hr.; then q 2 hrs. x 24 hrs.

Pressure dressing must remain on x 6 hrs. or Pressure dressing must remain on x 6 hrs. or as ordered.as ordered.

Pedal pulses included with VSPedal pulses included with VS

Renal Venogram Renal Venogram gives information about gives information about the kidney’s venous drainagethe kidney’s venous drainage– Femoral vein is common access site for Femoral vein is common access site for

dye injectiondye injection– Post Care: similar to arterial angiogram Post Care: similar to arterial angiogram

but not for as long.but not for as long.

Renal AngiographyRenal Angiography

Renal VenogramRenal Venogram

Computerized Tomography (CT)Computerized Tomography (CT)– a computer-controlled scanner is used a computer-controlled scanner is used

to obtain the imagesto obtain the images– Can differentiate massesCan differentiate masses– A radiopaque dye may be used. A radiopaque dye may be used. NOTE: NOTE:

Before the dye is used, serum creatinine Before the dye is used, serum creatinine and urea levels are drawn. If these are and urea levels are drawn. If these are abnormal, the dye is not used.abnormal, the dye is not used.

– The pt. must lie very, very still. This is The pt. must lie very, very still. This is extremely IMPORTANT!extremely IMPORTANT!

Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)– Uses nuclear magnetic resonance as its Uses nuclear magnetic resonance as its

source of energy.source of energy.– No special prep. but the pt. No special prep. but the pt. cannot cannot

have any metal on his/her person or have any metal on his/her person or body.body.

Renal ScanRenal Scan – A radionuclide tracer (IV – A radionuclide tracer (IV injection) will be taken up by the renal injection) will be taken up by the renal tubular cells or excreted by the glomerular tubular cells or excreted by the glomerular filtrate. filtrate. – Provides data re: function of kidney cellsProvides data re: function of kidney cells– Check the facility’s policy concerning Check the facility’s policy concerning

the disposal of the pt.’s urine for the the disposal of the pt.’s urine for the first 24 hrs.first 24 hrs.

– No pregnant nurse should work No pregnant nurse should work with this pt.with this pt.

Ultrasonography Ultrasonography uses the reflection of uses the reflection of sound waves to produce images of deep sound waves to produce images of deep body structures.body structures.– a conducting jelly is placed on the skin a conducting jelly is placed on the skin

over the area to be studied.over the area to be studied.– Size, shape, position, and any Size, shape, position, and any

delineations of the kidney can be delineations of the kidney can be provided by this wayprovided by this way

– No special prep. except pt. explanation.No special prep. except pt. explanation.

Transrectal UltrasoundTransrectal Ultrasound– This is instrumentation of the prostate glandThis is instrumentation of the prostate gland– Provides clear prostatic tumor imagesProvides clear prostatic tumor images– A biopsy can also be done to provide tissue A biopsy can also be done to provide tissue

samples.samples. Renal BiopsyRenal Biopsy

– 2 ways to perform this2 ways to perform this: : 1. 1. Open procedureOpen procedure2. Percutaneous needle insertion2. Percutaneous needle insertion

TransurethralTransurethral UltrasoundUltrasound

Renal BiopsyRenal Biopsy

Urodynamic Studies Urodynamic Studies are indicated when a neurological are indicated when a neurological disease is suspected of being a reason for incontinencedisease is suspected of being a reason for incontinence– Also known as a cystometrogramAlso known as a cystometrogram

Catheter is inserted then connected to a cystometer Catheter is inserted then connected to a cystometer which measures bladder capacity and pressurewhich measures bladder capacity and pressure

Cholinergic and Anticholinergic medication may be Cholinergic and Anticholinergic medication may be administered to determine their effects on bladder administered to determine their effects on bladder function: a cholinergic drug stimulates an atonic function: a cholinergic drug stimulates an atonic bladder, an anticholinergic drug brings and bladder, an anticholinergic drug brings and overactive bladder to a more normal level or functionoveractive bladder to a more normal level or function

– Evaluated the detrusor reflexEvaluated the detrusor reflex

– Urethral pressures can Urethral pressures can also be measured.also be measured.