Urinalysis provides important clinical

information about kidney function and helps

diagnose other diseases, such as diabetes.

Urine culture determines whether bacteria

are present in the urine, as well as their
strains and concentrarion.

Urine culture and sensitivity also identify the

antimicrobial therapy best suited for the
particular strains identified, taking into
consideration the antibiotics that have the
best rate of resolution in that particular
geographic region.

COMPONENTS

NORMAL VALUES

Color

Pale to deep amber

Turbidity

Clear

Specific Gravity

1.002-1.035

pH

4.5 8.0

Glucose

Negative

Ketones

Negative

Protein

Negative

Bilirubin

Negative

RBC

0 -3

WBC

0-4

Bacteria

None

Casts

None

Crystals

None

Several abnormalities such as hematuria

and proteinuria, produce no symptoms but
may be detected during a routine urinalysis
using a dipstick.

Normally, about 1 million RBCs pass into the

urine daily (equivalent to 1-3 RBCs per highpower field).

Hematuria (more than 3 RBCs per highpower field) can develop from an
abnormality anywhere along the
genitourinary tract (more common in
women than in men).

Common causes of hematuria include:

- acute infection (cystitis, urethritis, or

prostatitis)
- renal caculi
- neoplasm
- systemic disorders (bleeding disorders
and malignant lesions)
- medications warfarin (Coumadin) and
heparin (Heparin Sodium)

Hematuria may be initially detected using a

dipstick test, further microscopic evaluation
is necessary.

Proteinuria may be a benign finding, or it

may signify serious disease.

Occasional loss of up to 150 mg/day of

protein in the urine, primarily albumin, is
considered normal and usually does not
require further evaluation.

A dipstick examination (can detect 30 t0

1000 mg/dL of protein) should be used as
a screening test only, because urine
concentration, pH, hematuria, and
radiocontrast materials all affect the
results.

Dipstick analysis does not detect protein

concentrations of less than 30 mg/dL, test
cannot be used for early detection of
diabetic nephropathy.

Microalbuminuria (excretion of 20 to 200

mg/dL of protein in the urine) is an early
sign of diabetic nehropathy.

Common benign causes of transient

proteinuria are: fever, strenuous exercise,
and prolonged standing.

Causes of persistent proteinuria include:

- glomerular diseases
- collagen diseases
- diabetes mellitus
- preeclampsia
- hypothyroidism
- heart failure
- exposure to heavy metals
- use of medications (NSAIDs and ACE
inhibitors)

Measures the density of a solution

compared to the density of water
which is 1.000.

Specific gravity is altered by the

presence of blood, protein, and casts
in the urine.

The normal range of urine specific

gravity is 1.010 to 1.025.

Methods of determining specific

gravity :
- Multiple-test dipstick (most
common
method)
- Urinometer (least accurate
method)
- Refractometer (an instrument
which
measures differences in
the speed of light
passing
through air and the urine sample)

Urine specific gravity depends largely

on hydration status.
- fluid intake (specific gravity )
- fluid intake (specific gravity )

In patients with kidney disease, urine specific

gravity does not vary with fluid intake, and
the patients urine is said to have a fixed
specific gravity.

Disorders or conditions that cause

decreased urine specific gravity:
- diabetes insipidus
- glomerulonephritis
- severe renal damage

Conditions that can cause increased

specific gravity include:
- diabetes mellitus
- nephritis
- fluid deficit

Is the most accurate measurement of the kidneys

ability to dilute and concentrate urine.

It measures the number of solute particles in a

kilogram of water.

Serum and urine osmolality are measured

simultaneously to assess the bodys fluid status.

In healthy adults serum osmolality is 280 to 300

mOsm/kg, and normal urine osmolality is 200 to
800 mOsm/kg.

For a 24-hour urine sample, the normal value is 300

to 900 mOsm/kg.

Are used to evaluate the severity of the

kidney disease and to assess the status of
the patients kidney function.

It also provides information about the

effectiveness of the kidney in carrying out its
excretory function.

Renal function test results may be within

normal limits until the GFR is reduced to less
than 50% of normal.

Common tests include: renal concentration

tests, creatinine clearance, and serum
creatinine and blood urea nitrogen levels.

Patient knowledge
Psychosocial and emotional factors; fear,
anxiety
Urologic function; include voiding
habits/pattern
Fluid intake
Hygiene
Presence of pain or discomfort
Allergies

Knowledge deficiency
Pain
Fear

Patient goals may include

understanding of procedures, tests,
and expected behaviors; decreased
pain or absence of discomfort; and
decreased apprehension and fear.

Patient teaching: provide a description of the tests

and procedures in language the patient can
understand.

Use appropriate, correct terminology.

Encourage fluid intake unless contraindicated.

Instruct patient in methods to reduce discomfort:

sitz baths, relaxation techniques.

Administer analgesics and antispasmodics as

prescribed.

Assess voiding and provide instruction related to

voiding practices and hygiene.

Provide privacy and respect.

Kidney, Ureter, and Bladder

Studies
May be performed to
delineate the size, shape,
and position of the kidneys
and reveal any
abnormalities, such as
calculi (stones) in the kidneys
or urinary tract,
hydronephrosis (distention of
the pelvis of the kidneys),
cysts, tumors, or kidney
displacement by
abnormalities in surrounding
tissues.

A noninvasive procedure
that uses sound waves
passed into the body
through a transducer to
detect abnormalities of
internal tissues and organs.
Structure
Abnormalities such as fluid
accumulation , masses,
congenital malformations,
changes in organ size, or
obstruction, can be
identified.
Ultrasonography requires
a full bladder, therefore, fluid
intake should be encourage
before the procedure.

Is a noninvasive method of measuring the

volume of urine in the bladder.

It may be indicated for the following

situations:
- urinary frequency
- inability to void after the removal of an
indwelling catheter
- measurement of postvoiding residual
urine
volume
- inability to void postoperatively
- assessment of the need for
catheterization
during the initial stages
of an intermittent catheterization program

Are noninvasive
techniques that provide
excellent crosssectional views of the
kidney and urinary tract.
They are used in
evaluating genitourinary
masses, nephrolithiasis,
chronic renal infections,
renal or urinary tract
trauma, metastatic
disease, and soft tissue
abnormalities.

Nuclear scans require injection

of a radioisotope into the
circulatory system, which is then
monitored as it moves throughout
the blood vessels of the kidneys.
A scintillation camera is placed
posterior to the kidney with the
patient in a supine, prone, or
seated position.
Indicated to evaluate acute
and chronic renal failure, renal
masses, and blood flow before
and after kidney transplantation.

Intravenous urography includes various

specific test:
- excretory urography
- intravenous pyelogram or intravenous
urogram (shows kidneys, ureter, and
bladder) radiopaque contrast is
administered intravenously
- infusion drip pyelography requires an
intravenous infusion of a large volume of a
dilute contrast agent to opacify the renal
parenchyma and completely fill the
urinary
tract.

Intravenous urography is conducted as

part of the initial assessment of any
suspected urologic problem (lesions in
the kidneys and ureters).

It provides a rough estimate of renal

function.

In retrograde pyelography, ureteral

catheters are advanced through the
ureters into the renal pelvis by means of
cystoscopy.
Contrast agent is then injected.
Usually performed if intavenous
urography provides inadequate
visualization of the collecting systems.
May also be used before ESWL or in
patients with urologic cancer who need
follow-up and are allergic to intravenous
contrast agents.
Complications: infection, hematuria,
and perforation of the ureter.
Used less frequently because of
improved techniques in excretory
urography.

Aids in evaluating
vesicouretral reflux
(backflow of urine from
the bladder into one or
both ureters) and assess
for bladder injury.
Catheter is inserted into
the bladder, and contrast
agent is instilled to outline
the bladder wall.
Performed in conjunction
with simultaneous pressure
recordings inside the
bladder.

Uses a fluoroscopy
machine to visualize
the lower urinary
tract and examine
urine storage in the
bladder.
Used as a
diagnostic tool to
identify
vesicoureteral reflux.
Urethral catheter is
inserted, and a
contrast agent is
instilled into the
bladder.

A renal angiogram, or renal arteriogram,

provides an image of the renal arteries.
The femoral (or axillary) artery is pierced
with a needle , and a catheter is
threaded up through the femoral and
iliac arteries into the aorta or renal artery.
A contrast agent is injected to opacify
the renal artery supply.

Renal Angiography is used to:

- evaluate renal blood flow in
suspected
renal trauma
- to differentiate renal cysts from
tumors
- to evaluate hypertension
- it is also used preoperatively for
renal
transplantation

It can be performed in one of two ways: (1) by a

cystoscope inserted into the urethra, or (2)
percutaneously through a small incision.

Cystoscopic examination is used to visualize the urethra

and bladder directly.

Small ureteral catheters can be passed through the

cystoscope, allowing assessment of the ureters and the
pelvis of each kidneys.

It permits the urologist to obtain urine specimen from

each kidney to evaluate kidney function.

Cup forceps can be inserted into the cystoscope for

biopsy.

Calculi may be removed from the urethra, bladder,

and ureter using cystoscopy.

Renal and Ureteral Brush Biopsy

- Brush biopsy techniques provide
specific information when abnormal xray findings of the ureter or renal pelvis
raise questions about whether the
defect is a tumor, a stone, a blood
clot, or an artifact.
- First, a cystoscopic examination is
conducted. Then the suspected lesion
is brushed back and forth to obtain
cells and surface tissue fragments for
histologic analysis.

Kidney Biopsy
- Used in diagnosing and evaluating the
extent of kidney disease.
- Indications for biopsy include: unexplained
acute renal failure, persistent proteinuria or
hematuria, transplant rejection, and
glomerulonephritis.
- A small section of renal cortex is obtained
either percutaneously through the skin and
into the renal tissue or by open biopsy
through a small flank incision.

Provides an accurate evaluation of

voiding problems.
Useful in evaluating urinary retention
of unknown cause.
Effects of medication on bladder
function
Neuropathic bladder dysfunction.
Incontinence
Bladder outlet obstruction
Recurrent UTIs

Uroflowmetry (flow rate) is the record of the

volume of urine passing through the urethra
per time unit (milliliters per second).

Cystometrogram (CMG) is a graphic

recording of the pressures in the bladder.
The major diagnostic portion of urodynamic
testing and is divided into 2 portions: filling
and emptying of the urinary bladder.

Urine pressure-flow study presently

considered
the standard urodynamic test. Bladder
pressure, urine flow, and sphincter
electromyography are measured
simultaneously. This allows for a detailed
picture of the voiding dysfunction.

Electromyography is used to evaluate

neuromuscular function of the lower tract. It is
usually performed at the same time as the CMG.

Video fluorourodynamic study is the simultaneous

visualization of the lower urinary tract, allowing for
a complete and detailed assessment of the
voiding dysfunction.

Urethral pressure profile measures the amount of

urethral pressure along the length of the urethra
needed to maintain continence.

Valsalvas leak-point pressure test assesses internal

sphincter function. While in a sitting or standing
position, the patient is asked to cough or perform
Valsalvas maneuver until urine leakage occurs.