Download Creatinine

THE RENAL
SYSTEM AT A
GLANCE
Julie, Ashley, Christen, Candace, Jennifer, Sarah, & Cindy
Objectives
BUN
• When is it used
• Nursing implications
• Normal values
• Abnormal result
Creatinine
• When it is used
• Nursing implications
• Normal values
• Abnormal result
Creatinine Clearance
• When it is used
• Nursing implications normal values
• Abnormal result
Tests for BUN/Creatinine
Renal Diseases/Illnesses
Dialysis Methods
Blood Urea Nitrogen
• Measures the amount of urea nitrogen in the
blood
• Urea is formed in the liver as the end product of
protein metabolism and digestion
• Protein is broken down into amino acids during
ingestion, once in the liver, these amino acids are
catabolized and free ammonia is formed.
• Ammonia molecules are combined to form urea,
which is then transported by the blood to the
kidneys for excretion.
When is BUN Used?
• Used to assess kidney function and liver
function as well as glomerular filtration rate.
• Levels reflect the balance between the
production and excretion of urea.
• It may also be used to determine if body fluids
are urine or not.
Nursing Implications
• Explain procedure to the patient
• Provide teaching regarding what the test will
be measuring.
• Inform the patient that no fasting is required
with this test.
• Monitor puncture site for bleeding
Normal Values
• Normal values for an adult under the age of
90 years old are 2.9-7.5 mmol/L
• For patients over the age of 90, levels are 3.611.1 mmol/L
BUN
• Cardiac Patients
– Reduced Renal Perfusion
– Intravascular Fluid Volume Deficit
• Increase as GFR decreases
– ARF
– CRF
– Dehydration
• Altered Protein intake
• Protein Catabolism
Creatinine
• End product of creatine metabolism.
• Creatine is an energy-requiring metabolite of the
skeletal muscle.
• Creatine is converted to creatinine during
metabolism where it is filtered through the
kidney’s and excreted.
• Only a small amount of creatine is converted to
creatinine, this level remains stable except when
there is damage to skeletal muscle.
• The measuring of creatinine is an indicator of
renal function
Indications
• Before administration of nephrotoxix
medications, to assess renal function
• Check glomerular function
• Monitor effectiveness of renal treatment
• Check accuracy of 24 hour urine collection
• Assess level of nephron damage
Normal Values
Age
SI Units
Adult male
124-230 umol/kg/24hr
Adult female
97-177 umol/kg/24hr
Nursing Implications
• Inform patient the test if used to assess renal
function
• Obtain a detailed history, including
medications
• Discuss procedure with patient
• Instruct patient as to proper procedure for
urine collection.
• Discuss with patient the process of a 24 hour
urine collection.
Factors effecting
levels
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Creatinine
Extremes of age and body size
Severe malnutrition or obesity
Disease of skeletal muscle
Paraplegia or quadriplegia
Vegetarian diet
Rapidly changing kidney function
Pregnancy
Creatinine
• Increased In:
– Nephritis
– Chronic Renal Disease
• Decreased In:
– Muscular Atrophy
– Anemia
– Advanced Degeneration of the Kidneys
Creatinine Clearance
• Diagnostic test of renal function
• Compares the amount of creatinine in a
blood sample and urine sample to
determine rate the kidneys are clearing
creatinine from the blood
• Measure of glomerular filtration rate
Indications
• Determine extent of nephron damage in
known renal disease
• Before administering nephrotoxic drugs
• Accuracy of 24-hr urine collection
• Assess glomerular function
• Effectiveness renal disease treatment
Normal Values
• Adult male 85-125mL/min/1.73 m
• Adult female 75-115mL/min/1.73 m
• Each decade after 40 y decrease of 6-7
mL/min/m
(conventional units x 0.0167)
abnormal result
• Degree of impairment:
– Borderline: 62.5-80 mL/min/m
– Slight: 52-62.5 mL/min/m
– Mild: 42-52 mL/min/m
– Moderate: 28-42 mL/min/m
2
– Marked: Less than 28 mL/min/m
Nursing Implications
• Inform patient of test
• Obtain pt. genitourinary history & results of
related tests/procedures
• Obtain list of medications pt. taking
• Review procedure
• Inform pt. urine timeframe of urine collection & to
void all urine in collection device
• Sensitivity to social & cultural issues
Creatinine Clearance
• Decreased In:
– Kidney Diseases
• Acute Renal Failure
• Chronic Renal Failure
• Increased In:
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Diabetes
Renal Artery Obstruction
Renal Vein Thrombosis
Glomularulonephritis
Nephritis
Tests For...
Creatinine
• Blood/serum:
– Serum (about 1mL) collected
in a red or tiger- top tube. Or
– Plasma collected in greentop (heparin) tube is also
acceptable
• Urine:
– Urine (5mL) collected from an
unpreserved random or
timed specimen – needs to be
collected in a clean plastic
collection container
BUN
• Blood/serum:
– Serum (about 1mL) collected
in a red or tiger- top tube. Or
– Plasma collected in green- top
(heparin) tube is also
acceptable
How to Test...
Blood
Urine
Random Specimen
Clean Catch
• Female client procedure
• Male client procedure
Timed
• Obtain a 3L urine specimen
container, toilet-mounted
collection device and a
plastic bag for transporting
the specimen container
Dialysis
• When your kidney’s cannot adequately
remove waste from your body dialysis may be
implemented
• Pts can survive on dialysis for years
• The only way to stop dialysis (and still survive)
is to have a kidney transplant
Why Have Dialysis?
Because it treats:
• Renal Failure
• Edema
• Hepatic coma
• Hyperkalemia
• Hypercalcemia
• Hypertension
• Uremia
• Fluid overload
• Pulmonary edema
• Acidosis
• Pericarditis
• Severe confusion
There are 2 Types of
Dialysis
Hemodialysis
Periotoneal Dialysis
Hemodialysis
• Hemodialysis works to
– remove toxins (N) & excess water from the blood
stream
– maintain and restore the electrolyte balance &
acid-base buffer system (done in the dialyzer)
– have ‘clean’ or filtered blood re enter the body as
it would when leaving the kidney
Dialyzer
The blood filtering
device
• Filtration through:
• Diffusion – how the
toxins are removed
• Osmosis – takes away
extra water
• Ultrafiltration – takes
away extra water
Complications
• Artheriosclerotic cardiovascular
disease
• Hypertriglyceridema
• Amemia
• Fatigue
• Gastric ulcer
• Fluid overload
• Exsangulation
• Hypotension
• Muscle cramping
• Air emboli
• Dysrythmia
• Chest pain
• Cerebral fluid shifts
Peritoneal Dialysis
• Peritoneal dialysis is implemented to...
– Remove the toxic fluids
– Remove metabolic wastes
– Re-establish normal fluid and electrolyte balance.
Who needs treatment?
Who should not receive this treatment?
How to patients receive this treatment?
How does this effect a patient receiving
this treatment?
Complications
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Peritonitis
Leakage
Bleeding
Hypertriglyceridemia
Abdominal hernias
Clot Formation
Constipation
References
•
Day, R.A., Paul, P., Williams, B., Smeltzer, S.C. & Bare, B. (2006).
Textbook of medical-surgical nursing. Philadelphia, PA: Lippincott
Williams and Wilkins.
•
McCance, K.L. & Huether, S.E (2006). Pathophysiology: The biological
basis for disease in adults and children. St. Louis, MO: Elsevier Mosby.
•
Myers, T. (Ed.). (2006). Mosby’s dictionary of medicine, nursing and
health professions (7th ed.). St. Louis, MO: Mosby Elsevier.
•
Pagana, K.D. & Pagana, T.J. (2010). Mosby’s manual of diagnostic and
laboratory tests (4th ed.) St. Louis, MO: Mosby’s Elsevier Inc.
•
Van Leeuwen, A.M, Kranpitz, T.R and Smith, L. (2006). Davis’s
comprehensive handbook of laboratory and diagnostic tests with
nursing implications (2nd ed.). Philadelphia, PA: F.A Davis Company.