Diagnostic Testing for

Urinary System Disorders

Urinalysis
Urinalysis provides important clinical information about kidney function and
Urine Culture and Sensitivity
helps diagnose diseases Urine Culture
Components: Determines whether bacteria are present, as well as their strains and
Urine color concentration
Urine clarity and odor
Urine pH and specific gravity
Sensitivity
includes the identification of the antimicrobial therapy that is best suited
Tests to detect protein, glucose, and ketone bodies in urine for a particular strain
Microscopic examination of urine sediment after centrifugation to Collection: Clean-catch/MSCC
detect RBCs, WBCs. Casts, crystals, and bacteria
Obtain via Mid-stream clean catch (MSCC)
Renal Function Tests
Assess the status of kidney function
Evaluate the severity of kidney disease
•Tests:
•Renal concentration tests (i.e., Sp. Gravity and urine osmolality)
•Creatinine clearance
•Serum creatinine
•Blood urea nitrogen (BUN)
Renal Concentration Tests
Specific Gravity
an expression of the degree of concentration of the urine that measures
the density of a solution compared to the density of water
Normal: 1.010-1.025
Urine osmolality
measures the number of solute particles in a kilogram of water
Normal: 200-800 mOsm/kg
Specimen: urine
Blood tests
Serum creatinine
Creatinine- the end product of muscle energy metabolism
The test measures effectiveness of renal function
Normal: 0.6-1.2mg/dL
Blood Urea Nitrogen (BUN)
Urea- the nitrogenous end product of protein metabolism
Serves as an index of renal function
Normal: 7-18mg/dL
Creatinine Clearance
Detects and evaluates progression of kidney disease
The test measures volume of blood cleared of endogenous creatinine
in 1 minute – approximate GFR
Measured in mL/min/1.73m2
Method of collection: 24- hour urine specimen
 •Nursing Responsibilities (After):
Start Time: Finish Time: Bed rest until VS are stable – to prevent orthostatic hypotension
7:00 AM 7:00 AM Pink- tinged urine is NORMAL 24- 48 hours after procedure
Today Tomorrow Dysuria, frequency, and hematuria are common- due to tissue
irritation
Observe for urinary retention, signs of infection and excessive
First sample Collect all Last sample is the hematuria. Notify physician
Discard this sample subsequent urine urine on or before Monitor VS and I&O
samples finish time Hot sitz bath to relieve pelvic discomfort, as ordered
Store as indicated Collect and send all Force fluids to prevent ascending UTI
(e.g., refrigerate) stored specimens to
laboratory Intravenous Pyelography
Collecting a 24- hour urine sample
(IVP)
Kidney, Ureter, Bladder (KUB) An IVP shows the kidneys, ureter, and bladder via x-ray imaging as
the dye moves through the upper and then the lower urinary system

Studies Uses a radiopaque contrast agent given via IV

X-ray visualization of the KUB

Performed to delineate the size, shape, and position of kidneys and
reveal urinary system abnormalities
•Nursing Responsibilities:
Assure the patient that procedure is painless
Bowel preparation, as ordered- to prevent gas and fecal interference
with visualization:
•Laxative in the evening
•Enema in AM

Kidney, Ureter, Bladder (KUB) Nursing Responsibilities (Before):

Secure written consent
Studies
Direct visualization of the urethra, bladder wall, trigone, urethral opening
NPO 6 to 8 hours
Bowel preparation
•Laxatives, as ordered
through a cystoscope
Assess allergy to seafoods and/or iodine
Epinephrine at bedside- anaphylactic shock is a potential complication
Nursing Responsibilities (After):
Monitor VS
Increase fluid intake – to help excrete dye
Inform patient that a burning sensation on voiding may be
experienced
Monitor for signs of delayed allergic reaction (skin rashes, pruritus,
dyspnea)

Retrograde Pyelography
•Nursing Responsibilities (Before):
Secure written consent
(RGP)
Catheters are advanced through the ureters into the renal pelvis by means
Reinforce teaching that procedure is done under local/general of cystoscopy. A contrast agent is then injected via cystoscope
anesthesia Indication/s:
•Force fluid if local anesthesia – to prevent ascending UTI IVP does not provide adequate visualization of the collecting systems
•NPO if general anesthesia ESWL
Inform that desire to void is felt as cystoscope is inserted Allergy to IV contrast agent
Place patient in lithotomy during procedure
Nursing Responsibilities (Before):
Secure written consent
Assess for allergy to dye
Inform patient that discomfort may be felt during procedure
Prepare epinephrine at bedside
 •Nursing Responsibilities (After): If open biopsy:
Monitor VS Position: prone
Monitor for urinary retention, infection, and prolonged hematuria. Similar preparation with major abdominal surgeries
Notify physician Nursing Responsibilities (After):
Increase fluid intake to prevent UTI and to excrete dye.
Monitor VS and for signs and symptoms of internal bleeding
Renal Angiography IV fluids as prescribed – to help clear the kidneys and prevent clot
formation
Bed rest and pressure dressings should be maintained for the
A.K.A. renal arteriography prescribed period of time
Provides x-ray image of the renal arteries Urine may contain blood for the first 24 to 48 hours
Contrast agent is injected to opacify renal arterial supply Analgesics, as prescribe
Indication/s:
Evaluate renal blood flow in suspected renal trauma
Differentiate renal cysts from tumors
Evaluate hypertension
Nursing Responsibilities (Before):
Bowel preparation (Laxatives, as ordered)
Shave injection site (groin for femoral, axilla for axillary)
Mark peripheral pulse sites – for easy access during postprocedural
assessment
Nursing Responsibilities (After):
Monitor VS until stable
If axillary approach was done, take BP on opposite arm
Assess injection site for swelling and hematoma
Assess neurovascular status of operative extremity and compare with
uninvolved extremity
Cold compress to injection site to decrease edema and pain
Sandbag over catheter insertion site- to further prevent bleeding
Bed rest x 24 hours, no sitting
Monitor urine output – to assess renal function

Kidney Biopsy
A small section of the renal cortex is obtained either percutaneously
(needle biopsy) or by open biopsy through a small flank incision.
Indications:
Unexplained acute kidney injury
Persistent proteinuria or hematuria
Transplant rejection
Glomerulopathies
Contraindications:
Bleeding tendencies
Uncontrolled HTN
Sepsis
Solitary kidney
Large polycystic kidney
Kidney neoplasm
UTI
Morbid obesity
Nursing Responsibilities (Before):
Check coagulation studies – to identify any risk of posy biopsy
bleeding
Secure written consent
NPO for 6 to 8 hours
Obtain urine specimen for baseline
Establish an IV line
If needle biopsy:
Position: prone with sandbag under the abdomen
Instruct patient to breathe in and hold that breath while needle is
being inserted – to prevent kidney from moving
Sedation will be given and skin at biopsy site will be infiltrated with
local anesthetic