Functions of the kidneys:
- removing waste (urea, uric acid)
- regulating electrolyte & water balance
- maintaining acid-base balance
- controlling blood volume & maintaining BP
Define:
- micturition:
- diuresis:
- dysuria:
- oliguria:
- polyuria:
- anuria:
- enuresis
- Micturition: act of passing urine
- Diuresis: increased excretion of urine
- dysuria: pain or burning sensation when voiding
- oliguria: urine production<30ml/hr, <400ml/24hr
- polyuria: excessive volume of urine >2.5L/24hr
- anuria: passing <100ml/24hr
- enuresis: inability to control passing urine
Symptoms associated with renal problems:
- haematuria
- urgency to void
- confusion/delirium
- dysuria
- abdominal (especially flank) pain
- incontinence
- change in appearance/smell of urine
- hesitancy of urine flow/change in stream volume
Renal assessment: Inspect
- skin, hair, nails: Mees’ line on nails = chronic renal failure
- oedema around eyes
- urine on breath (urea breakdown in saliva)
- extremities: fistula in forearm, oedema in legs from renal failure
- abdomen: enlarged abdomen from ascites or polycystic kidney disease
Renal assessment: Palpate
- kidneys are not usually palpable unless enlarged (right lower than left)
- bladder not palpable
- thrill: vibration produced by turbulent blood flow (normal in fistula)
- oedema (pitting oedema occurs when excess fluid accumulates in the interstitial space
Renal assessment: Auscultate
- bruit: normal in fistula
- renal arteries: heard above umbilicus, bruit abnormal & commonly caused by atherosclerosis
- BP: most patients with renal disease will have hypertension, which exacerbates renal disease
Renal assessment: Percussion
- bladder: full = dull sound
- murphy’s kidney punch = sharp rapid strike of renal angle, if pain consider infection
- shifting dullness test: shifting dullness in abdomen indicates free fluid in abdomen
Urinalysis
Full Ward Test (FWT) - non sterile specimen (clean catch)
Midstream collection (MSU) - sterile specimen container, clean perineal area, discard first part of void, used for culture of microbes and sensitivity to antibiotics
Catheter collection (CSU) - sterile specimen container, catheter clamped, swab access port on drainage tube, withdraw urine with sterile syringe, used for culture and sensitivity, ALWAYS indicate if from catheter.
24 hr urine collection - measures levels of hormones, steroids, creatinine, protein
Bladder scan
- measures volume of urine in bladder
- should be used before catheterisation
- determines if bladder if emptying correctly
PVR volumes:
- Post Void Residual Volumes
- measures how completely the bladder empties with voiding
- less than 50ml considered normal
- high PVR increases risk of UTI
- measured with bladder scan
Stress incontinence:
- bladder neck sphincter is unable to prevent urine flow when pressure is placed on abdomen (sneeze, cough)
- more common in women
- most common cause = weakness in pelvic floor (pregnancy, childbirth, menopause, surgery, obesity)
Urge/overactive incontinence:
- inability to delay voiding after sensation of bladder fullness
- caused by detrusor muscle instability and overactivity
- symptoms: frequency, urgency, nocturia, small voiding
- treatments aimed at reducing detrusor muscle tone (Oxybutynin)
Overflow incontinence:
- inability to empty the bladder, over-distension, frequent loss of small amount of urine
- symptoms: straining, dribbling, poor stream, supra pubic ache, frequency
- treatment aims to reduce obstruction or urine volume (surgery, catheter, TURP (trans-urethral resection of prostate)
Functional incontinence:
- resulting from physical, environmental, or psycho-social causes which decrease ability to respond to the need to void
- cognitive impairment (dementia, Parkinson’s)
- physical disability or impaired mobility (osteoarthritis)
- sedation (postoperative, sleeping tablets)
- environmental barriers (eg. heavy bathroom door)
UTI symptoms:
- pain
- burning
- stinging
- pain during sex
- cloudy urine
- smelly urine
Most common cause of UTI
Escherichia coli
Urinary risk factors:
- female
- obstruction
- menopause
- obesity
- elderly
- incontinence
- diabetes
- pregnancy
- poor personal hygiene
- constipation
- renal impairment
- urinary retention
- sexually active
- indwelling catheterisation
Treatment for UTI
- showers rather than bath
- cotton underwear/non-restrictive underwear
- dry from urethra to anus
- antibiotics
