Download Urine Specimens

The main methods of functional
diagnostics of kidney system
Anatomy
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Hilum (hilus)
Renal artery and vein
Cortex
Medulla
Renal pyramids and renal papillae
Major and minor calyces
Renal Pelvis
Ureters
Urine Specimens
The nurse is responsible for collecting urine specimens
for a number of tests: Clean voided specimens for
routine urinalysis, clean – catch or midstream urine
specimens for urine culture, timed urine specimen,
indwelling catheter specimen.
Clean voided Urine Specimen
• Usually done on the first voided specimen in the
morning
• At least 10 ml of urine sufficient for routine analysis
• Client who is disabled, seriously ill or disoriented may
need to use a bedpan or urinal in bed, these need
special instructions:
• The specimen must be free of fecal
contamination
• Don’t discard the toilet tissue in bedpan
• Put the lid tightly on the container to prevent
spillage of the urine.
• If the outside of container is contaminated, clean
it with a disinfectant.
The nurse must:– Make sure that the specimen label with laboratory
requisition carry the correct information and
attach them securely to the specimen.
Clean-Catch or Midstream Urine Specimen
It is collected when a urine culture is ordered to
identify microorganisms causing urinary tract
infection. Care is taken to ensure that the specimen is
as free as possible from contamination around the
urinary meatus.
• Clean – catch specimens are collected into a sterile
specimen container with a lid.
• Clean the urinary meatus with antiseptic solution
• Instruct the client to start voiding
• Collect 30-60 ml of urine in the container.
• Label the specimen and transport it to the laboratory.
Timed Urine Specimen
It requires collection of all urine produced and
voided over a specific period of time, ranging
from 1-2 hours to -24 hours. Each voiding of
urine is collected in a small, clean container
and then emptied immediately into the large
refrigerated bottle or carton.
It is done for the following purposes:
• To assess the ability of the kidney to concentrate and
dilute urine.
• To determine disorders of glucose metabolism such as
DM.
• To determine levels of specific constitutes such as
albumin, creatinine.
To collect the time urine specimen:
– Obtain the specimen with preservative from the
laboratory. Label the container with
identifying
information for the client, the test
to be performed, time started, and time of
completion.
– Provide a clean receptacle to collect urine
(bedpan).
– Post signs in the client’s chart, room, alerting the
person to save all urine during the specified time.
– At the start of the collection period, discard the
first voiding
– Save all urine produced during the time collection
period in the container.
– At the end of collection, ask the pt to void the last
time and add them in the container.
– Record collection of the specimen, timed started
Urine Testing
Several simple urine tests are often done by nurses on
the nursing units. These include tests for specific
gravity, PH, and the presence of abnormal constituent
such as glucose, ketones, protein.
• Specific gravity – is indicator of urine concentration,
or the amount of solutes present in the urine
• Normally ranges from 1.010 to 1.025
• PH is measured to determine the relative acidity or
alkalinity of urine (7 is neutral, less than 7 is acidic,
greater than 7 is alkaline).
• Glucose – urine is tested for glucose to screen
clients for diabetes mellitus and to assess
clients for abnormal glucose to tolerance
during pregnancy.
• Ketones – ketones bodies a product of the
breakdown of fatty acids normally are not
present in the urine.
• Protein
• Occult blood
• Osmolality – is measure of the solute
concentration of urine. Normal values are 500
to 800 mOsm/kg.
Clients with Urinary Alterations
Visualization procedures also may be used to evaluate
urinary function.
• An X – ray of the KUB: Kidneys, Ureters, Bladder
• IVP (Intravenous pyelography) – contrast medium
is injected intravenously.
• Retrograde pyelography – contrast medium is
instilled directly into the kidney pelvis via the urethra,
bladder, and ureters following injection or instillation
of the contrast medium, x- ray are taken to evaluate
urinary tract structures.
• Ultrasonography: noninvasive test that uses
reflected sound waves to visualize the kidney.
• Cystoscopy: a lighted instrument inserted through the
urethra to visualize the bladder, urethral orifices
and urethra.
Magnetic Resonance Imaging (MRI)
Is a noninvasive diagnostic scanning technique in
which the client is placed in a magnatic field. MRI
provides a better contrast between normal and
abnormal tissue than the CT scan. For visualization of
the brain, spine, limbs, and joints, heart, blood
vessels, abdomen and pelvis. The procedure lasts
between 60 and 90 minutes.
Radiological examination :
1.ultrasonography:
<>it is cheap, easy , non invasive and non hazardous. It can demonstrate clearly the
renal size ,contour, echotextures ,stone , back pressure, renal mass or cyst, and
perirenal collection, also show the upper and lower parts of the ureter.
<>pelvic ultrasonogrophy may show mass and calculate the residual urine
<>it is useful for guiding needle for renal biopsy or aspiration of perirenal
collection.
Doppler flow imaging of the renal vessels will assess both anatomy (structure) and
physiology (flow) of the blood supply of the kidney. So it may help in diagnosis of
renal artery occlusion or stenosis , renal vein thrombosis and kidney transplant
rejection.
2.plain abdominal x-ray (KUB):(kidney ,ureter, bladder)may show
a.stones
b.calcification of the kidney ,urinary bladder, seminal vesicles.
c.renal contour and soft tissue shadow
3.Intravenous urography (IVU):
shows the anatimy of the kidney and urinary system ,any mass ,stones
,back pressure changes and also demonstrates kidney function and
obstruction. It should be done in the light of renal function .
4.Cystography and voiding cystourethrography to show vesicoureteric reflux
(VUR) and residual urine.
5.Urodynamic studies:
these will give anatomic and physiologic assessment of the lower
urinary tract.
6.angiography: this includes
a.renal arteriography (either conventional or digital subtraction). It is
mainly indicated for diagnosis of renovascular hypertension or persistent
haematuria following trauma.
b. renal venography. This is indicated for diagnosis of renal vein
thrombosis.
7. Computerized tomography (CT):it is strongly indicated in
patients with obstructive uropathy with non-evident cause.
8.Radionuclides imaging (renogram):
a.static renal imaging to diagnose renal scaring ,renal
tumours anatomic abnormalities.
b.dynamic renal imaging which is helpful in examining renal
perfusion and dynamic parenchymal images and excretion
into bladder (vascular phase)and so diagnosing renal vascular
occulsion ,narrowing as well as ureteric obstruction and
measurement of the total or individual kidney GFR.
9.Magnetic resonance imaging (MRI)
MRI provides excellent anatomical information which are
helpful in studying malignancies of the urinary tract and
assessment of renal vessels by MRI angiography.
Kidney biopsy
• It shows the pathology of the underlying renal
disease.
• The biopsy should be examined by light microscope
(LM) ,electronic microscope (EM) and
immunofluorescent microscope (IF)
• Very helpful in diagnosing, prognosis and therapeutic
guidance.
cystoscopy, ureteroscopy.
• Diagnosis :
of bladder disease , (tumour)by direct vision or
biopsy.
• Therapeutic:
ureteric catheter: also , ascending pyelography
, differential renal function.