CHAPTER 15 Urinary System Copyright 2011 Delmar Cengage

Urinary System Overview • Functions of urinary system – Removes waste products from blood

Structures of the Urinary System • Kidneys – Reddish-brown, bean-shaped organs located on either

Structures of the Urinary System • Kidneys: Components of nephron – Glomerulus • Ball-shaped

Structures of the Urinary System • Kidneys: Components of nephron – Renal tubule •

Structures of the Urinary System • Kidneys – Medulla • Inner layer of kidney

Structures of the Urinary System • Kidneys – Medulla • Minor calyces merge to

Structures of the Urinary System • Ureters – Muscular tubes lined with mucous membrane

Structures of the Urinary System • Bladder – Hollow, muscular sac in pelvic cavity

Structures of the Urinary System • Urethra – Mucous membrane-lined tube that leads from

Structures of the Urinary System Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Question True or False: The core unit of the kidney’s filtration system is the

Answer True. Our kidneys contain millions of these microscopic filtration units. Copyright © 2011

Question The layer in the kidney that collects the urine and ultimately forms the

Answer c. The nephron empties into the minor calyces, which merge into the major

Formation of Urine • Formation of urine consists of three distinct processes: glomerular filtration,

Formation of Urine • Glomerular filtration – As blood passes through the glomeruli, blood

Formation of Urine • Tubular reabsorption – As glomerular filtrate passes through renal tubules,

Formation of Urine • Urine – Urine consists of water and other materials that

Animation Click Here to Play Urine Formation Animation Copyright © 2011 Delmar, Cengage Learning.

Question True or False: Basically, the formation of urine begins in the glomerulus. Copyright

Answer True. Only 1 percent of what started as glomerular filtrate is excreted as

Characteristics of Normal Urine • Color – From pale yellow to a deep golden

Characteristics of Normal Urine • Clarity – Normal urine is clear – Cloudy, turbid

Characteristics of Normal Urine • Odor – Normal urine is aromatic – Has a

Characteristics of Normal Urine • p. H – Normal urine is slightly acidic, p.

Characteristics of Normal Urine • Protein – Normal urine may have small amounts of

Characteristics of Normal Urine • Ketones – Normal urine does not contain ketone bodies

Question Which substance can be found in normal urine, but only in insignificant amounts?

Answer b. Although normal conditions can show ketones and glucose in the urine, there

Common Signs and Symptoms • Albuminuria – Presence in urine of abnormally large quantities

Common Signs and Symptoms • Bacteriuria – Presence of bacteria in urine • Dysuria

Common Signs and Symptoms • Fatigue – State of exhaustion or loss of strength

Common Signs and Symptoms • Glycosuria – Abnormal presence of sugar, especially glucose, in

Common Signs and Symptoms • Ketonuria – Presence of excessive amounts of ketone bodies

Common Signs and Symptoms • Malaise – Vague feeling of bodily weakness or discomfort,

Common Signs and Symptoms • Oliguria – Secretion of a diminished amount of urine

Common Signs and Symptoms • Polyuria – Excretion of abnormally large amounts of urine

Question True or False: Frequency, urgency, and bacteriuria are common symptoms of a kidney

Answer False. At this stage it is still a bladder infection. However, it will

PATHOLOGICAL CONDITIONS Urinary System Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cystitis • Pronounced – (siss-TYE-tis) • Defined – Inflammation of urinary bladder • Characterized

Glomerulonephritis (Acute) • Pronounced – (gloh-mair-yoo-loh-neh-FRYE-tis) • Defined – Inflammation of glomerulus of kidneys

Hydronephrosis • Pronounced – (high-droh-neh-FROH-sis) • Defined – Distension of pelvis and calyces of

Hydronephrosis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Nephrotic Syndrome • Pronounced – (neh-FROT-ik SIN-drohm) • Defined – Clinical symptoms occurring when

Polycystic Kidney Disease • Pronounced – (pol-ee-SISS-tik kidney dih-ZEEZ) • Defined – Hereditary disorder

Question Distention of the kidney and ureter due to an obstruction is called _______.

Answer b. A renal calculus is the primary cause of this condition. Copyright ©

Pyelonephritis (Acute) • Pronounced – (pye-eh-loh-neh-FRY-tis) • Defined – Bacterial infection of the renal

Renal Calculi • Pronounced – (REE-nal KAL-kew-lye) • Defined – Stone formations in kidney

Renal Cell Carcinoma • Pronounced – (REE-nal SELL kar-sin-OH-mah) • Defined – Malignant tumor

Renal Failure, Chronic • Pronounced – (REE-nal FAIL-yoor, KRON-ik) • Defined – Progressively slow

Vesicoureteral Reflux • Pronounced – (vess-ih-koh-yoo-REE-ter-al REE-fluks) • Defined – Abnormal backflow (reflux) of

Wilm’s Tumor • Pronounced – (VILMZ TOO-mor) • Defined – Malignant tumor of the

Question True or False: Unfortunately, in renal cell carcinoma a person is asymptomatic until

Answer True. Finding this in the early stages is usually an incidental finding while

Treatment of Renal Failure • Peritoneal dialysis – Mechanical filtering process – Used to

Treatment of Renal Failure • Continuous ambulatory peritoneal dialysis (CAPD) – Requires transfer set,

Treatment of Renal Failure Continuous Ambulatory Peritoneal Dialysis Copyright © 2011 Delmar, Cengage Learning.

Treatment of Renal Failure • Continuous cycling peritoneal dialysis (CCPD) – Uses a machine

Treatment of Renal Failure Continuous Cycling Peritoneal Dialysis Copyright © 2011 Delmar, Cengage Learning.

Treatment of Renal Failure • Hemodialysis – Process of removing excess fluids and toxins

Treatment of Renal Failure Hemodialysis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Arteriovenous fistula – Access vessel created for use with

Treatment of Renal Failure Arteriovenous fistula for hemodialysis Copyright © 2011 Delmar, Cengage Learning.

Treatment of Renal Failure • Kidney transplantation – Surgical implantation of a healthy, human

Treatment of Renal Failure • Kidney transplantation – – Donor kidney surgically placed in

Question With some good training, this method can be done by the patient and

Answer d. This must be done 3 to 5 times daily, but the patient

Question True or False: When a healthy kidney is implanted, the natural kidney must

Answer False. In fact, even the blood supply to the recipient’s kidney is left

DIAGNOSTIC TECHNIQUES, TREATMENTS, AND PROCEDURES Urinary System Copyright © 2011 Delmar, Cengage Learning. ALL

Diagnostic Techniques, Treatments, and Procedures • Blood urea nitrogen (BUN) – Blood test performed

Diagnostic Techniques, Treatments, and Procedures • Creatinine clearance test – Diagnostic test for kidney

Diagnostic Techniques, Treatments, and Procedures • Cystoscopy – Process of viewing interior of bladder

Diagnostic Techniques, Treatments, and Procedures • Intravenous pyelogram (IVP) – Radiographic procedure that provides

Diagnostic Techniques, Treatments, and Procedures • KUB (kidneys, ureters, bladder) – X-ray of lower

Question True or False: An intravenous pyelogram (IVP) is useful in identifying an obstruction

Answer True. The absence of white dye will pinpoint the location of the blockage

Diagnostic Techniques, Treatments, and Procedures • Renal scan – Radioactive isotope (tracer) is injected

Diagnostic Techniques, Treatments, and Procedures • Retrograde Pyelogram (RP) – Radiographic procedure in which

Diagnostic Techniques, Treatments, and Procedures • Ultrasonography – Procedure in which sound waves are

Diagnostic Techniques, Treatments, and Procedures • Urine culture – Procedure used to cultivate the

Diagnostic Techniques, Treatments, and Procedures • 24 -Hour urine specimen – Collection of urine

Diagnostic Techniques, Treatments, and Procedures • Voiding cystourethrography – X-ray visualization of bladder and

Question Which of the following would be done if a bladder infection was suspected?

Answer d. A urinalysis is done first. If bacteriuria is found, a urine culture

Urine Specimen Collections • Catheterized specimen – Also known as a sterile specimen –

Urine Specimen Collections • Clean-catch specimen – Also known as midstream specimen – Collection

Urine Specimen Collections • First-voided specimen – Also known as an early-morning specimen –

Urine Specimen Collections • Random specimen – Urine specimen that is collected at any

Question The term used for urine left over after voiding is called _____. a.

Answer a. High residuals could indicate a physical problem in the bladder, urethra, or

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Urinary System Overview • Functions of urinary system – Removes waste products from blood – Produces and eliminates urine – Kidneys produce hormone erythropoietin (EPO) • Stimulates production of red blood cells within bone marrow – Kidneys produce enzyme renin • Aids in raising blood pressure Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Kidneys – Reddish-brown, bean-shaped organs located on either side of the vertebral column at back of upper abdominal cavity – Cortex • Outer layer of kidney • Contains millions of microscopic units called nephrons – Functional units of kidneys Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Kidneys: Components of nephron – Glomerulus • Ball-shaped collection of very tiny, coiled, and intertwined capillaries – Bowman’s capsule (renal capsule) • Double-walled cup surrounding the glomerulus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Kidneys: Components of nephron – Renal tubule • Proximal convoluted tubule • Loop of Henle • Distal convoluted tubule – Peritubular capillaries Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Kidneys – Medulla • Inner layer of kidney • Consist of triangular tissues called renal pyramids—loops and collecting tubules of nephron • Pyramids extend into a cuplike urine collection cavity called minor calyx Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Kidneys – Medulla • Minor calyces merge to form major calyx • Major calyces merge to form renal pelvis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Ureters – Muscular tubes lined with mucous membrane – One leads from each kidney down to urinary bladder – Urine is propelled from renal pelvis through ureters by wavelike contractions known as peristalsis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Bladder – Hollow, muscular sac in pelvic cavity • • • Between pubic symphysis and rectum in men Between pubic symphysis and uterus and vagina in women Serves as a temporary reservoir for urine Spherical shaped when full Resembles inverted pyramid when empty Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Structures of the Urinary System • Urethra – Mucous membrane-lined tube that leads from bladder to exterior of body • Urine exits bladder through urethra • External opening of urethra is the urinary meatus – Female urethra carries only urine – Male urethra carries both urine and semen during ejaculation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Question The layer in the kidney that collects the urine and ultimately forms the renal pelvis is called the ______. a. b. c. d. glomerulus renal capsule medulla calyx Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Formation of Urine • Formation of urine consists of three distinct processes: glomerular filtration, tubular reabsorption, and tubular secretion – Process begins as blood enters kidneys via left and right renal arteries • Renal arteries branch out into smaller vessels throughout kidney tissue, until these arterioles reach cortex of kidney • Each arteriole leads to a glomerulus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Formation of Urine • Glomerular filtration – As blood passes through the glomeruli, blood pressure forces materials through glomerular walls into Bowman’s capsule • Glomerular filtrate = water, sugar, salts, and nitrogenous waste products such as urea, creatinine, and uric acid that filter out of blood through thin walls of glomeruli Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Formation of Urine • Tubular reabsorption – As glomerular filtrate passes through renal tubules, water, sugar, and salts are returned to bloodstream through network of capillaries that surround them • Tubular secretion – Materials are selectively transferred from blood into the filtrate to be excreted in the urine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Formation of Urine • Urine – Urine consists of water and other materials that were filtered or secreted into the tubules but not reabsorbed • Normally one percent of glomerular filtrate is excreted as urine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Characteristics of Normal Urine • Clarity – Normal urine is clear – Cloudy, turbid appearance to the urine may be due to presence of pus, bacteria, presence of bladder or kidney infection, or a specimen that has been standing for more than an hour Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Characteristics of Normal Urine • Odor – Normal urine is aromatic – Has a strong but agreeable odor • Specific gravity – Normal urine has specific gravity of 1. 003 to 1. 030 – Specific gravity = measurement of the amount of solids in the urine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Characteristics of Normal Urine • p. H – Normal urine is slightly acidic, p. H of 6. 0 • p. H range is 4. 5 to 8. 0 – p. H represents relative acidity or alkalinity of a solution • p. H of 7. 0 is neutral • p. H below 7. 0 is acid • p. H above 7. 0 is alkaline (base) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Characteristics of Normal Urine • Protein – Normal urine may have small amounts of protein present – Only in insignificant amounts, too small to be detected by reagent strip • Glucose – Normal urine does not contain glucose Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Question Which substance can be found in normal urine, but only in insignificant amounts? a. b. c. d. ketones protein glucose none of the above Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Albuminuria – Presence in urine of abnormally large quantities of protein, usually albumin – Also known as proteinuria • Anuria – Cessation (stopping) of urine production, or a urinary output of less than 100 m. L per day Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Bacteriuria – Presence of bacteria in urine • Dysuria – Painful urination • Enuresis – Condition of urinary incontinence, especially at night in bed – Bedwetting Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Fatigue – State of exhaustion or loss of strength or endurance – May follow strenuous physical activity • Frequency – In case of urinary frequency = urination at short intervals (frequently) without increase in the daily volume of urinary output due to reduced bladder capacity Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Glycosuria – Abnormal presence of sugar, especially glucose, in urine • Hematuria – Abnormal presence of blood in urine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Ketonuria – Presence of excessive amounts of ketone bodies in urine • Lethargy – State or quality of being indifferent, apathetic (without emotion), or sluggish Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Malaise – Vague feeling of bodily weakness or discomfort, often marking the onset of disease or infection • Nocturia – Urination, especially excessive, at night – Also called nycturia Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Oliguria – Secretion of a diminished amount of urine in relation to fluid intake – Scanty urine output • Polydipsia – Excessive thirst Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Common Signs and Symptoms • Polyuria – Excretion of abnormally large amounts of urine • Pyuria – Pus in urine, usually a sign of an infection of urinary tract • Urgency – Feeling to void urine immediately Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cystitis • Pronounced – (siss-TYE-tis) • Defined – Inflammation of urinary bladder • Characterized by urgency and frequency of urination, and by hematuria Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Glomerulonephritis (Acute) • Pronounced – (gloh-mair-yoo-loh-neh-FRYE-tis) • Defined – Inflammation of glomerulus of kidneys • Condition characterized by proteinuria, hematuria, and decreased urine production Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hydronephrosis • Pronounced – (high-droh-neh-FROH-sis) • Defined – Distension of pelvis and calyces of the kidney caused by urine that cannot flow past an obstruction in a ureter Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Nephrotic Syndrome • Pronounced – (neh-FROT-ik SIN-drohm) • Defined – Clinical symptoms occurring when damage to glomerulus of the kidney is present and large quantities of protein are lost through the glomerular membrane into urine – Results in severe proteinuria – Also called nephrosis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Polycystic Kidney Disease • Pronounced – (pol-ee-SISS-tik kidney dih-ZEEZ) • Defined – Hereditary disorder of kidneys in which grape-like, fluidfilled sacs or cysts replace normal kidney tissue Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Question Distention of the kidney and ureter due to an obstruction is called _______. a. b. c. d. cystitis hydronephrosis renal calculi polycystic kidney disease Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Pyelonephritis (Acute) • Pronounced – (pye-eh-loh-neh-FRY-tis) • Defined – Bacterial infection of the renal pelvis of the kidney • Infection begins in the bladder and travels up the ureters to the renal pelvis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Renal Cell Carcinoma • Pronounced – (REE-nal SELL kar-sin-OH-mah) • Defined – Malignant tumor of kidney occurring in adulthood • Patient is asymptomatic (symptom free) until latter stages of disease Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Renal Failure, Chronic • Pronounced – (REE-nal FAIL-yoor, KRON-ik) • Defined – Progressively slow development of kidney failure occurring over a period of years • Late stages of chronic renal failure known as end-stage renal disease (ESRD) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Vesicoureteral Reflux • Pronounced – (vess-ih-koh-yoo-REE-ter-al REE-fluks) • Defined – Abnormal backflow (reflux) of urine from the bladder to the ureter Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Wilm’s Tumor • Pronounced – (VILMZ TOO-mor) • Defined – Malignant tumor of the kidney occurring predominately in childhood – Most frequent finding is palpable mass in the abdomen Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Peritoneal dialysis – Mechanical filtering process – Used to cleanse blood of waste products, draw off excess fluids, and regulate body chemistry when kidneys fail to function properly – Peritoneal membrane is used as filter Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Continuous ambulatory peritoneal dialysis (CAPD) – Requires transfer set, connected to bag of dialysate solution – Dialysate solution remains in abdomen for approximately four hours after exchange • Process is repeated 3 to 5 times daily – Advantage: no machine, convenient for travel Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Continuous cycling peritoneal dialysis (CCPD) – Uses a machine that warms the solution and cycles it in and out of the peritoneal cavity at evenly spaced intervals at night while the patient sleeps – Process takes 8 to 10 hours – Last exchange remains in abdomen during the day for approximately 12 to 15 hours Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Hemodialysis – Process of removing excess fluids and toxins from blood by continually shunting patient’s blood from body into a dialysis machine for filtering, and returning clean blood to patient’s bloodstream – Usually three treatments a week, 3 to 4 hours at a time – May be performed at dialysis center or at home Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Arteriovenous fistula – Access vessel created for use with hemodialysis – Opening or fistula is created between an artery and a vein in the forearm – Flow of arterial blood into venous system at point of fistula causes vein to become distended – Provides a large enough vessel with a strong blood flow for the hemodialysis connection Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Kidney transplantation – Surgical implantation of a healthy, human donor kidney into the body of a patient with irreversible renal failure – Kidney function is restored with a successful transplant and the patient is no longer dependent on dialysis – Donor kidney may come from living donor (usually blood relatives) or cadaver donors (nonliving matches) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment of Renal Failure • Kidney transplantation – – Donor kidney surgically placed in iliac fossa Donor renal artery connected to recipient’s iliac artery Donor renal vein connected to recipient’s iliac vein Donor ureter connected to recipient’s bladder • Donor kidney usually functions once it is in place Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Question With some good training, this method can be done by the patient and is convenient for traveling. a. b. c. d. continuous cycling peritoneal dialysis (CCPD) hemodialysis AV fistula continuous ambulatory peritoneal dialysis (CAPD) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Blood urea nitrogen (BUN) – Blood test performed to determine amount of urea and nitrogen (waste products normally excreted by the kidney) present in blood • Catheterization – Introduction of a catheter into a body cavity or organ to instill a substance or remove a fluid Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Creatinine clearance test – Diagnostic test for kidney function that measures filtration rate of creatinine, a waste product (of muscle metabolism), which is normally removed by kidney • Cystometrography – Examination performed to evaluate bladder tone; measuring bladder pressure during filling and voiding Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Cystoscopy – Process of viewing interior of bladder using a cystoscope • Extracorporeal lithotripsy – Non-invasive mechanical procedure for breaking up renal calculi so they can pass through ureters – Also known as extracorporeal shock-wave lithotripsy Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Intravenous pyelogram (IVP) – Radiographic procedure that provides visualization of the entire urinary tract: Kidneys, ureters, bladder, and urethra • Contrast dye is injected intravenously • Multiple X-ray films are taken as medium is cleared from blood Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • KUB (kidneys, ureters, bladder) – X-ray of lower abdomen that defines size, shape, and location of the kidneys, ureters, and bladder • Contrast medium is not used with this x-ray • Renal angiography – X-ray visualization of internal anatomy of renal blood vessels after injection of a contrast medium Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Renal scan – Radioactive isotope (tracer) is injected intravenously – Radioactivity over each kidney is measured as tracer passes through kidney Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Retrograde Pyelogram (RP) – Radiographic procedure in which small-caliber catheters are passed through a cystoscope into ureters to visualize ureters and renal pelvis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Ultrasonography – Procedure in which sound waves are transmitted into body structures as a small transducer is passed over patient’s skin – Also called ultrasound • Urinalysis – Physical, chemical, or microscopic examination of urine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Urine culture – Procedure used to cultivate the growth of bacteria present in a urine specimen, for proper microscopic identification of the specific pathogen • Sample of urine specimen swabbed onto a culture medium plate and placed into an incubator for 24 to 72 hours • Plate is then examined for growth on culture medium Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • 24 -Hour urine specimen – Collection of urine excreted by the individual over a 24 hour period – Urine collected in one large container – Also called a composite urine specimen Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnostic Techniques, Treatments, and Procedures • Voiding cystourethrography – X-ray visualization of bladder and urethra during voiding process after bladder has been filled with a contrast material Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Question Which of the following would be done if a bladder infection was suspected? a. b. c. d. urinalysis urine culture ultrasound a and b Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Answer d. A urinalysis is done first. If bacteriuria is found, a urine culture can be done to identify the organism and ensure proper antibiotic coverage. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Urine Specimen Collections • Catheterized specimen – Also known as a sterile specimen – Using aseptic techniques, a very small, straight catheter is inserted into the bladder via the urethra to withdraw a urine specimen • Urine flows through catheter into a sterile specimen container Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Urine Specimen Collections • Clean-catch specimen – Also known as midstream specimen – Collection method used to avoid contamination of the urine specimen from the microorganisms normally present on the external genitalia – Patient cleanses external genitalia with antiseptic wipe – Expels small amount of urine into toilet, then collects specimen in sterile container Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Urine Specimen Collections • First-voided specimen – Also known as an early-morning specimen – Patient instructed to collect first voided specimen of the morning • Specimen should be refrigerated until it can be taken to the medical office or laboratory Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Urine Specimen Collections • Random specimen – Urine specimen that is collected at any time • Residual urine specimen – Specimen obtained by catheterization after the patient empties the bladder by voiding • Amount of urine remaining in the bladder after voiding is noted as the residual amount Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.