renal diagnostic tests or investigations

RENAL DIAGNOSTIC

TESTS

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RENAL DIAGNOSTIC TESTS

1. Laboratory studies.

2. Radiology & Imagine.

3. Other tests.

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1. LABORATARY STUDIES

a) Tests of Renal Function.b) Prostate-specific antigen

(PSA)c) Urinalysis.

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a) TESTS OF RENAL FUNCTION

Renal function tests are used to determine effectiveness of the kidneys' excretory functioning, to evaluate the severity of kidney disease, and to follow the patient's progress.

There is no single test of renal function; best results are obtained by combining a number of clinical tests.

Renal function is variable from time to time.4

WHAT ARE THE TESTS OF RENAL FUNCTION ? ? ?

1.Renal concentration test. Specific gravity Osmolality of urine

2. Creatinine clearance.

3. Serum creatinine.

4. Serum urea nitrogen (Blood urea nitrogen [BUN]).

5. Protein.

6. Microalbumin/Creatinine ratio.

7. Urine casts. 5



(PSA)c) Urinalysis.

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b) PROSTATE-SPECIFIC ANTIGEN (PSA)

An amino acid glycoprotein that is measured in the serum by a simple blood test.

An elevated PSA indicates the presence of prostate disease, but is not exclusive to prostate cancer.

Level rises continuously with the growth of prostate cancer.

Normal serum PSA level is less than 4 ng/mL. Levels less than 10 ng/mL may be indicative of benign prostatic hyperplasia (BPH) and not necessarily prostate cancer.

Patients who have undergone treatment for prostate cancer are monitored periodically with PSA levels for recurrence

No patient preparation is necessary.

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(PSA)c) Urinalysis.

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c) URINALYSIS Involves examination of the urine for overall

characteristics, including appearance, pH, specific gravity, and osmolality as well as microscopic evaluation for the presence of normal and abnormal cells.

Appearance - normal urine is clear Odour - normal urine has a faint aromatic odor Colour - Normal urine is clear yellow or amber pH of urine - Normal pH is around 6 (acid); may

normally vary from 4.6 to 7.5. Specific gravity - Normal specific gravity ranges

from 1.005 to 1.025 Osmolality - Average value is 300 to 1,090

mOsm/ kg for females; 390 to 1,090 mOsm/kg for males.

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URINALYSIS : NURSING AND PATIENT CARE CONSIDERATIONS

Freshly voided urine provides the best results for routine urinalysis; some tests may require first morning specimen.

Obtain sample of about 30 mL. Urine culture and sensitivity tests are

typically performed using the same specimen obtained for urinalysis; therefore, use clean-catch or catheterization techniques.

Patients with urinary diversions, especially ileal conduit diversions, require special techniques to obtain urine that is not contaminated with bacteria from the intestinal diversion.

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TECHNIQUE FOR OBTAINING CLEAN-CATCH MIDSTREAM

VOIDED SPECIMEN EQUIPMENT FROM MALE PATIENT

Instruct the patient to expose glans and cleanse area around meatus. Wash area with mild antiseptic solution or liquid soap. Rinse thoroughly.

Allow the initial urinary flow to escape. Collect the midstream urine specimen in a

sterile container. Avoid collecting the last few drops of urine.

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TECHNIQUE FOR OBTAINING CLEAN-CATCH MIDSTREAM VOIDED SPECIMEN EQUIPMENT FROM FEMALE PATIENT

Ask the patient to separate her labia to expose the urethral orifice. If no one is available to assist the patient, she may sit backward on the toilet seat facing the water tank or sit on (straddle) the wide part of the bedpan.

Clean the area around the urinary meatus with pads soaked with antiseptic/soap solution. Rinse thoroughly.

While the patient keeps the labia separated (see accompanying figure), instruct her to void forcibly.

Allow initial urinary flow to drain into bedpan (toilet) and then catch the midstream specimen in a sterile container, making sure that the container does not come in contact with the genitalia.

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3. Other tests.

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2. RADIOLOGY & IMAGINE.

a) X-ray of Kidneys, Ureters, and Bladderb) Intravenous Pyelogram (Intravenous

Urogram)c) Retrograde Pyelographyd) Renal Angiographye) Renal Scansf) Ultrasoundg) Computed Tomography Scanning (CTS) and

Magnetic Resonance Imaging (MRI)

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a) X-RAY OF KIDNEYS, URETERS, AND BLADDERo Bowel preparation is

recommended.Clear liquids only the day before the examination.

Cathartics/laxatives are given the evening before the examination.

Nothing by mouth (NPO) after midnight the day of the examination (if scheduled for afternoon, clear liquids only in the morning).

Usually done before other testing. Patient will be asked to wear a gown

and remove all metal from the X-ray field

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b) INTRAVENOUS PYELOGRAM (INTRAVENOUS UROGRAM)

I.V. introduction of a radiopaque contrast medium that concentrates in the urine and thus facilitates visualization of the kidneys, ureter, and bladder.

The contrast medium is cleared from the bloodstream by renal excretion.

Contraindicated in patients with renal failure, uncontrolled diabetes, or multiple myeloma.

Contraindicated in patients receiving drug therapy for chronic bronchitis, emphysema, or asthma and in patients taking metformin (Glucophage).

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Patients with known iodine/contrast material allergy must have steroid/antihistamine preparation; in some cases, an anesthesiologist must be available.

Bowel preparation is necessary: Clear liquids only the day before the examination. Cathartics/laxatives are given the evening before

the examination. Nothing by mouth (NPO) after midnight the day of

the examination (if scheduled for afternoon, clear liquids only in the morning).

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d) RENAL ANGIOGRAPHY I.V. catheter is threaded through the

femoral and iliac arteries into the aorta or renal artery.Contrast material is injected to visualize the renal arterial supply.

Evaluates blood flow dynamics, demonstrates abnormal vasculature, and differentiates renal cysts from renal tumors.

May be done to embolize a kidney before nephrectomy for renal tumor.

Clear liquids only after midnight before the examination; adequate hydration is essential.

Continue oral medications (special orders needed for diabetic patients).

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I.V. required. May not be done on the same day as other

studies requiring barium or contrast material. Maintain bed rest for 8 hours after the

examination, with the leg kept straight on the side used for groin access.

Observe frequently for hematoma or bleeding at access site. Keep sandbag at bedside for use if bleeding occurs.

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f) ULTRASOUND

Uses high-frequency sound waves passed into the body and reflected back in varying frequencies based on the composition of soft tissues. Organs in the urinary system create characteristic ultrasonic images that are electronically processed and displayed as an image.

Abnormalities, such as masses, malformations, or obstructions, can be identified; useful in differentiating between solid and fluid-filled masses.

A noninvasive technique. 20

Ultrasound examination of the prostate is performed using a rectal probe. A Fleet enema may be ordered just within hours of the examination.

Ultrasound examination of the bladder requires that the bladder be full.

Patient should not have had any studies using barium for 2 days before ultrasound of the kidney or bladder.

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3. Other tests.

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CYSTOSCOPY Cystoscopy is a method of direct visualization of the

urethra and bladder by means of a cystoscope that is inserted through the urethra into the bladder. It has a self-contained optical lens system that provides a magnified, illuminated view of the bladder.

Nursing interventions after cystoscopic examination: Monitor for complications: urinary retention, urinary

tract hemorrhage, infection within prostate or bladder.

Expect the patient to have some burning on voiding, blood-tinged urine, and urinary frequency from trauma to mucous membrane of the urethra.

Administer or teach self-administration of antibiotics prophylactically as ordered to prevent UTI.

Advise warm sitz baths or analgesics, such as ibuprofen or acetaminophen, to relieve discomfort after cystoscopy. Increase hydration.

Provide routine catheter care if urine retention persists and an indwelling catheter is ordered.

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CYSTOSCOPY

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NEEDLE BIOPSY OF KIDNEY

Performed by percutaneous needle biopsy through renal tissue with ultrasound guidance or by open biopsy through a small flank incision; useful in securing specimens for electron and immunofluorescent microscopy to determine diagnosis, treatment, and prognosis of renal disease.

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NURSING AND PATIENT CARE CONSIDERATIONS Prebiopsy nursing management

Ensure that coagulation studies are carried out to identify the patient at risk for postbiopsy bleeding and that serum creatinine, urinalysis, and urine culture are done.

Ensure that patient fasts for several hours before the procedure, as ordered.

Establish an I.V. line, as ordered. Describe the procedure to the patient, including holding

breath (to prevent movement of the thorax) during during insertion of the biopsy needle.

o Postbiopsy nursing management.• Place the patient in a prone position immediately after

biopsy and on bed rest for 8 to 24 hours to minimize bleeding.

Take vital signs every 5 to 15 minutes for the first hour and then with decreasing frequency if stable to assess for hemorrhage, which is a major complication.

Watch for rise or fall in blood pressure, anorexia, vomiting, or development of a dull, aching discomfort in abdomen.

Assess for flank pain.

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3. Other tests.

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By : Ch@ndim@ - URAHSDP

renal diagnostic tests or investigations

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