renal assessment&diagnosis

1. assessment


2. diagnosis

1) Cr (serum creatinine level) : 0.6 to 1.3 mg/dl

2) BUN (Blood Urea Nitrogen) : 8 to 25 mg/dl

3) serum uric acid level: 2.5 to 8 mg/dl

4-1) ★ UA (Urinalysis)

  • Wash the perineal area and use a clean container for collection. Obtain 10 to 15mL of the first-morning voiding if possible. Refrigerating samples may alter the specific gravity. If the client is menstruating, note this on the laboratory requisition form.
  • USG (Urine Specific Gravity): 1.015 to 1.025 (An increase in USG occurs with insufficient fluid intake, decreased renal perfusion, or increased ADH. A decreased in USG occurs with increased fluid intake or diabetes insipidus; it may also indicate renal disease or the kidney’s inability to concentrate urine.

4-2) [Pediatric] infant urine test

  • 안아서
  • 컵보다는 bowel
  • wet diaper를 aspiration
  • ① collection bag 을 붙임 (뒤에서 앞으로) ② diaper를 loosely하게 채움 ③ collection bag을 떼내 urine을 specimen bottle 로

5) ★ urine C&S (Culture and sensitivity)

  • A urine test that identifies the presence of microorganisms (culture) and determines the specific antibiotics to treat the existing microorganism (sensitivity) appropriately.
  • Clean the perineal area and urinary meatus with a bacteriostatic solution. (소독 솜으로 앞에서 뒤로 3번 닦음) Collect the midstream sample in a sterile container. (voiding 시작 → 중간에 컵 대줌 → voiding 끝나기 전에 컵 치우기) Send the collected specimen to the laboratory immediately. Identify any sources of potential contaminants during the collection of the specimen, such as the hands, skin, clothing, hair, or vaginal or rectal secretions. Urine from the client who drank a very large amount of fluids may be too dilute to provide a positive culture.
  • Cath UA: ① Clamp 15 to 30 minutes. ② Clean the port with alcohol. ③ Sample with the syringe. ④ Unclamp. ⑤ Labeling.

6) 24hr urine collection

  • Check with the laboratory about specific instructions for the client to follow, such as dietary or medication restrictions.
  • Instruct the client about the urine collection. At the start time, instruct the client to void (or empty the tubing and drainage bag if the client has a Foley catheter) and discard that sample. Collect all urine for the prescribed time. Keep the urine specimen on ice or refrigerated and check with the laboratory regarding adding a preservative to the specimen during collection. At the end of the prescribed time, instruct the client to empty the bladder and add that urine to the collection container.

7) Creatinine clearance test

  • The creatinine clearance test evaluates how well the kidneys remove creatinine from the blood.
  • The test includes obtaining a blood sample and timed urine specimens. Blood is drawn when the urine specimen collection is complete.

8) uric acid test

  • A 24hr urine collection sample is tested to diagnose gout and kidney disease.

9) VMA test (Vanillylmandelic acid)

  • The test is a 24hr urine collection to diagnose pheochromocytoma, a tumor of the adrenal gland.
  • Instruct the client to avoid foods such as caffeine, cocoa, vanilla, cheese, gelatin, licorice, and fruits for at least 2 days before and during urine collection and to check with the HCP regarding the administration of any prescribed medications before or during testing. Instruct the client to avoid stress.

10) KUB (Kidneys, Ureters, and Bladder) radiography

11) ultrasonography

12) CT

13) MRI

14) IVP (IntraVenous Pyelography)

  • An x-ray procedure in which an intravenous injection of a radiopaque dye is used to visualize and identify abnormalities in the renal system.
  • Obtain informed consent. Maintain NPO status after midnight on the night before the procedures. Assess the client for allergies to dye, iodine, or seafood. instruct the client that he or she may feel an urge to throat irritation, flushing, nausea, or a salty taste following injection of the dye. Establish intravenous access. Administer laxatives if prescribed.
  • Monitor vital signs. Monitor the client for a delayed reaction to the dye. Instruct the client to drink at least 1L of fluid unless contraindicated.

15) renography (kidney scan)

  • an IV injection of a radioisotope
  • Obtain informed consent. Maintain NPO status for 8 hours before the procedure. Assess the client for allergies to dye, iodine, or seafood. Establish intravenous access.
  • Monitor the client for reaction to the radionuclide. Instruct the client that the radionuclide clears from the body in about 8 hours. The radioisotope is eliminated in 24 hours; wear gloves for excretion precautions. Follow standard precautions when caring for incontinent clients and double-bag client linens per agency policy. Encourage fluid intake unless contraindicated.

16) renal biopsy

  • Obtain informed consent. Maintain NPO status 4 to 6 hours before the procedures. Assess vital signs. Assess baseline coagulation studies; notify the HCP if abnormal results are noted.
  • During the procedure, position the client prone with a pillow under the abdomen and shoulders. Hold the breath when needle insertion.
  • Monitor vital signs. Monitor for bleeding. Provide pressure to the biopsy site for 30 minutes. Place the client on strict bed rest in the supine position with a back roll for additional support for 2 to 6 hours after the biopsy. Instruct the client to avoid heavy lifting and strenuous activity for 1 to 2 weeks. Encourage fluid intake of 1500 to 2000 mL as prescribed. Instruct the client to notify HCP if either a temperature greater than 100℉ or hematuria occurs after the first 24 hours post-procedure.