-straw colored

-mild odor

-specific gravity = 1.010-1.050

-usually clear (may be slightly cloudy)

(turbidity)

-may indicated prescence of large amounts of protein, blood, bacteria, and pus

-may indicate hematuria, excessive bilirubin

-highly concentrated urine

-infection

-certain dietary components or medication

-blood in urine

small amounts = infection, inflammation or tumors

gross amounts = increased glomerular permeability or hemorrhage

(proteinuria, albuminuria)

-leakage of albumin or mixed plasma proteins into filtrate

indicate inflammation of kidney tubules

(WBC casts, bacterial casts or RBC casts)

indicates ability of tubules to concentrate urine

-low = dilute urine (with normal hydration)

-high = concentrated urine (with normal hydration)

(ketonuria)

found when DM is not well controlled

BUN

indicate failure to excrete nitrogen wastes due to decreased GFR

metabolic changes assoicated with renal failure

-water retention, electrolyte abnormalities, elevated BUN, Cr, ammonia

indicates decreased GFR

failure of tubules to control acid-base balance

identify causative organism of infection

select appropriate drug treatment for infection

e.g., creatinine or inulin clearnance in 24 hour urine

used to assess GFR

cystoscopy

visualizes lower urinary tract

may be used in performing biopsy or to remove kidney stones

diuretic drugs

cause incresed excretion of water through the kidneys

reduces fluid volume in tissues and blood

prescribed for renal disease, HTN, edema, CHF, liver disease, pulmonary edema

many cause removal of excess Na+ ions and water from the body

some are K+ wasting and some are K+ sparing

artificial filtration of blood and reabsorption of substances

sustains life during kidney failure

principles of dialysis

removal of wastes from blood to fluid known as the dialysate

Hemodialysis uses: ultrafiltration -hydrostatic pressure pushing fluid with dissolved substances across a semipermeable membrane, diffusion and osmosis

periotneal dialysis uses: diffusion and osmosis

done in medical facility or home

arteriovenous fistual created to allow access (usually in the arm)

patients arterial blood flows into machine 

exchange of wastes, fluid and electrolytes between blood and dialysate (blood and protein stay in the blood)

after exchange is completed, blood is returned to patient's vein 

AV shunt infection

Thrombus formation

Air embolus --> PE

blood vessels involved in shunt become sclerosed or damaged

pt. has an increased risk of infections with Hep B, C or HIV

Dialysis disequilibrium syndrome

nausea, vomiting, headache, altered mental status, may suffer seizures or coma

due to rapid water shifts between neurons and blood

wastes removed too quickly and develop a hypotonic plasma 

periotoneal dialysis

usually done on outpatient basis

dialyzing fluid is instilled into the cavity

dwell time = exchange between blood and dialysate

dialysate is drained via gravity into container

takes more time

more continuous process

more common in women

increased pressure forces urine through sphincter

coughing, laughing, lifting, multiple pregnancies

common in older adults due to:

incompetent bladder sphincter (dribbling of urine after voiding)

weakened detrusor muscle may prevent complete emptying of bladder (frequency and incontinence)

"spastic" or "overactive" bladder

due to inappropriate contraction of detrusor muscle

caused by: irritation of bladder lining (caffiene, infection), abnormal nervous system control

loss of the contreol of micturition

may be spastic or flaccid

spinal cord injuries or brain damage

interference with CNS and ANS voluntary controls of the bladder

involuntary urination by a child age 4+

often related to developmental delay, sleep pattern, psychosocial aspect

most commonly nocturnal enuresis

urinary retention 

inability to empty bladder

may be accompanied by overflow incontinence

spinal cord injury at sacral level blocks micturition reflex (unable to empty bladder, urinary catheterization)

may follow anesthesia (general or spinal)

very common

bacterial ascend into tract (Escherichia coli is common causative organism)

with pyelonephritis it may be a blood borne pathogen

classified by location:

lower = cystitis and urethritis

upper = pyelonephritis

-women

-older men (prostatic hypertrophy and urine retention)

-congenital abnormalities in children (reflux of urine from lower tract into kidney)

-incontinence

-retention

-direct contamination with fecal material

-renal calculi

bladder wall and urethra are inflammed

-hyperactive bladder due to irritation

-reduced bladder capacity due to swelling

ascending bacteria from genital area

E.coli most common

-pain is common in pelvic area

-dysuria, urgency, frequency, and nocturia

-systemic signs may be present (fever, malaise, nausea, leukocytosis)

-urine often cloudy with unusual odor

-urinalysis indicates bacteriuria, pyuria, microscopic hematuria

-urine culture

one or both kidneys may be involved

usually ascending infection from ureter into kidney

may be due to bactermia

may be acute or chronic

purulent exudate fills pelvis and calyces

abcess formation

pt. may become bacteremic with pyelonephritis

may compress renal artery and vein leading to acute renal failure

recurrent or chronic infection can lead to scar tissue formation leading to loss of tubule function

obstruction and collection of filtrate --> hydronephrosis

may progress to chronic renal failure if untreated

-polyuria, oliguria, dysuria, hematuria, cloudy urine

-signs of cystitis plus pain associated with renal disease (dull, aching pain in lower back or flank area)

-systemic signs more severe (chills, nausea, vomiting, sepsis (if bacteria enter blood))

urinalysis - 

bacteria, WBC, RBC, urinary casts usually present and reflects renal tubule involvement

follows upper respiratory tract or skin infection with certain strains of group A beta-hemolytic strep

onset of s/s is usually 10-14 days after strep infection

usually affects children ages 3-7 and boys more than girls

disease is due to a type III hypersensitivity reaction "Immune complex hypersensitivity"

pathopysiology of type III reaction

antibody binds to antigen that was released into blood or body fluid (not attached to cell) and forms complex in blood

antibody-antigen complex is then deposited in tissue and complement is activated

damage is due to complement activation/inflammatory response 

anti-streptococcal (ASO) antibodies are produced against strep antigens

antigen-antibody complexes form in blood and are deposited in glomeruli

activates complement system

inflammatory response in glomeruli

increased capillary permeability - leakage of some protein and large numbers of erythrocytes into urine

congestion and cell proliferation in glomeruli

decreased GFR

oliguria, activation of renin-angiotensin system, retention of fluid and wastes, hyptertension