Urinalysis and
Fluid Balance
Charting
Module 6 –
NURS1002
Suzanne Bishaw – Unit Coordinator
Overview
Examine the kidneys and their function
Explore causes of renal failure
Describe briefly other renal diseases
Discuss primary care and kidney health
Outline treatment options and simple tests
Know your kidneys
• Kidneys play a vital role in the body. Without them,
the body would struggle to process toxins, and this
would have a devastating impact on a persons
health.
• Kidneys work hard to clean the blood and create
urine 24 hours a day. Without kidney function, the
body would struggle to process toxins and eliminate
waste.
• Therefore keeping kidneys healthy so they can
perform these important tasks throughout a persons
lifespan is integral to maintaining the health of other
organs, preventing further health complications.
Where are the kidneys?
• The kidneys are located near the middle of the back, on either side
of the spine. They are protected from physical injury by a large
layer of fat, along with the lower ribs and back muscles.
• Kidneys are bean-shaped and each one is the size of an adult fist
(about 150 grams). Most people are born with two kidneys, but
around one in every 750 people are born with just one. The good
news is that people can still lead a healthy life with just one. One
kidney alone can provide up to 75 per cent of normal kidney
function.
The Kidney
• The entire organ is not one
big filter.
• Each kidney is made up of
about one million tiny filters
called nephrons. Blood enters
the kidneys through the renal
artery and goes back into the
body by the renal vein.
• Kidneys remove wastes,
control the body's fluid
balance, and keep the right
levels of electrolytes. All of the
blood in the body passes
through them about 40 times
a day.
Waste Removal
• Blood comes into the kidney, waste gets removed, and salt, water,
and minerals are adjusted, if needed. The filtered blood goes back
into the body. Waste gets turned into urine, which collects in the
kidney's pelvis -- a funnel-shaped structure that drains down a
tube called the ureter to the bladder.
• Each kidney has around a million tiny filters called nephrons. You
could have only 10% of your kidneys working, and you may not
notice any symptoms or problems.
Renal Failure
• If blood stops flowing into a kidney, part or all of it could die. That can
lead to kidney failure.
• Acute renal failure (kidney failure): A sudden worsening in how well your
kidneys work. Dehydration, a blockage in the urinary tract, or kidney
damage can cause acute renal failure, which may be reversible.
• Chronic renal failure: A permanent partial loss of how well your kidneys
work. Diabetes and high blood pressure are the most common causes.
• End-stage renal disease (ESRD): Complete loss of kidney strength, usually
due to progressive chronic kidney disease. People with ESRD require
regular dialysis for survival.
Other diseases
• Pyelonephritis (infection of kidney pelvis): Bacteria may infect the kidney,
usually causing back pain and fever. A spread of bacteria from an
untreated bladder infection is the most common cause of pyelonephritis.
• Glomerulonephritis: An overactive immune system may attack the
kidney, causing inflammation and some damage. Blood and protein in
the urine are common problems that occur with glomerulonephritis. It
can also result in kidney failure.
• Kidney stones (nephrolithiasis): Minerals in urine form crystals (stones),
which may grow large enough to block urine flow. It's considered one of
the most painful conditions. Most kidney stones pass on their own, but
some are too large and need to be treated.
Other diseases
• Nephrotic syndrome: Damage to the kidneys causes them to spill
large amounts of protein into the urine. Leg swelling (oedema) may
be a symptom.
• Polycystic kidney disease: A genetic condition resulting in large
cysts in both kidneys that hinder their work.
• Diabetic nephropathy: High blood sugar from diabetes
progressively damages the kidneys, eventually causing chronic
kidney disease. Protein in the urine (nephrotic syndrome) may also
result.
• Hypertensive nephropathy: Kidney damage caused by high blood
pressure. Chronic renal failure may eventually result.
Severe kidney disease
• Papillary necrosis: Severe damage to the kidneys can cause chunks
of kidney tissue to break off internally and clog the kidneys. If
untreated, the resulting damage can lead to total kidney failure.
• Kidney cancer: Renal cell carcinoma is the most common cancer
affecting the kidney. Smoking is the most common cause of kidney
cancer.
• Interstitial nephritis: Inflammation of the connective tissue inside
the kidney, often causing acute renal failure. Allergic reactions and
drug side effects are the usual causes.
Lastly
• Minimal change disease: A form of nephrotic syndrome in which
kidney cells look almost normal under the microscope. The disease
can cause significant leg swelling (oedema). Steroids are used to
treat minimal change disease.
• Nephrogenic diabetes insipidus: The kidneys lose the ability to
concentrate the urine, usually due to a drug reaction. Although it's
rarely dangerous, diabetes insipidus causes constant thirst
and frequent urination.
• Renal cyst: A hollowed-out space in the kidney. Isolated kidney
cysts often happen as people age, and they almost never cause a
problem. Complex cysts and masses can be cancerous.
Simple tests – monitoring kidney health
• Urinalysis: A routine test of the urine by a machine and often by a person
looking through a microscope. Urinalysis can help detect infections,
inflammation, microscopic bleeding, and kidney damage.
• Kidney ultrasound: A probe placed on the skin reflects sound waves off the
kidneys, creating images on a screen. Ultrasound can reveal blockages in urine
flow, stones, cysts, or suspicious masses in the kidneys.
• Urine and blood cultures: If an infection is suspected, cultures of the blood and
urine may identify the bacteria responsible. This can help target antibiotic
therapy.
• Ureteroscopy: An endoscope (flexible tube with a camera on its end) is passed
through the urethra into the bladder and ureters. Ureteroscopy generally
cannot reach the kidneys themselves, but can help treat conditions that also
affect the ureters.
Detailed kidney examination
• Computed tomography (CT) scan: A CT scanner takes a series of X-
rays, and a computer creates detailed images of the kidneys.
• Magnetic resonance imaging (MRI) scan: A scanner uses radio waves
in a magnetic field to make high-resolution images of the kidneys.
• Kidney biopsy: Using a needle inserted into the back, a small piece
of kidney tissue is removed. Examining the kidney tissue under a
microscope may help diagnose a kidney problem.
Kidney Treatments
• Antibiotics: Kidney infections caused by bacteria are treated with
antibiotics. Often, cultures of the blood or urine can help guide the
choice of antibiotic therapy.
• Nephrostomy: A tube (catheter) is placed through the skin into the
kidney. Urine then drains directly from the kidney, bypassing any
blockages in urine flow.
• Lithotripsy: Some kidney stones may be shattered into small pieces
that can pass in the urine. Most often, lithotripsy is done by a
machine that projects ultrasound shock waves through the body.
• Nephrectomy: Surgery to remove a kidney. Nephrectomy is
performed for kidney cancer or severe kidney damage.
Dialysis & Transplant
• Dialysis: Artificial filtering of the blood to replace the work that damaged
kidneys can't do. Haemodialysis is the most common method of dialysis
in the U.S.
• Haemodialysis: A person with complete kidney failure is connected to a
dialysis machine, which filters the blood and returns it to the body.
Haemodialysis is typically done 3 days per week in people with ESRD.
• Peritoneal dialysis: Placing large amounts of a special fluid in
the abdomen through a catheter allows the body to filter the blood using
the natural membrane lining the abdomen. After a while, the fluid with
the waste is drained and discarded.
• Kidney transplant: Transplanting a kidney into a person with ESRD can
restore kidney function. A kidney may be transplanted from a living
donor, or from a recently deceased organ donor.
Promoting Kidney
Health - weblinks
• Kidney Australia
• Big Red Bus
• Primary Care Kidney Education
• Online FREE webinars
• Health Professional Resources
• Aboriginal and Torres Strait
Islander Peoples Resources
Testing for kidney health
• Examining the health of a persons kidney function can be done with
two very simple tests.
• Blood Test
• Urinalysis
• In addition monitoring and recording urine output can also determine
kidney function
• Fluid Balance Chart
• 24 hour urine collection
Urinalysis
Simple examination of the urine
using a reagent strip
Random urine; should be tested
within 4hrs of collection.
Dipstick tests are available for pH,
protein, glucose, ketones, bilirubin,
blood, urobilinogen, nitrite,
leucocyte esterase.
Access the Royal College of
Pathologists Australasia for further
information
Simple Urinalysis
• pH: check for successful therapeutic acidification or alkalinisation.
• Specific Gravity: commonly measures hydration status by measuring the concentration of
particles in urine. Normal urine specific gravity levels are between 1.010 and 1.020. A
urine specific gravity above 1.020 indicates concentrated urine and can indicate a fluid
volume deficit, similarly to an elevated urine osmolarity. A urine specific gravity below
1.010 indicates dilute urine, which can occur with excessive fluid intake.
• Albumin: suspected nephrotic syndrome, glomerulonephritis, urinary tract inflammation.
Urinalysis will not detect 'microalbuminuria'.
• Glucose: diabetes mellitus and other causes of hyperglycaemia. The test should not be
used to diagnose hyper- or hypo- glycaemia.
• Ketones: diabetic ketoacidosis, starvation ketosis.
• Bilirubin: differential diagnosis of jaundice.
• Blood: inflammation, trauma, or tumour of renal tract, haemoglobinuria, myoglobinuria,
coloured urine.
• Urobilinogen: the test is not reliable in the assessment of patients with liver disease.
• Nitrite: urinary tract infection.
• Leucocyte esterase: urinary tract inflammation.
eGFR
eGFR stands for estimated Glomerular Filtration Rate.
• eGFR is calculated from blood test results using a formula
that looks at the level of creatinine (a waste product) in the
blood.
• Results consistently below 60mL/min/1.73m2 indicate
chronic kidney disease.
• eGFR can also be calculated by using the eGFR calculator link
below.
• https://kidney.org.au/health-professionals/egfr-calculator
• Download the eGFR Fact Sheet and review the stages of chronic kidney
disease and the risk factors
In conclusion
• Kidney health is integral to overall health and life
• The kidney is a filter of all waste product and is an essential organ in
maintaining homeostasis
• Kidney damage can occur at any age and by a variety of causes
• Chronic kidney disease (CKD) is an epidemic in some Australia
subgroups
• Obesity is a driver of kidney disease
• Dialysis and transplant are required in the event of kidney failure
Prepared by Suzanne Bishaw
UC NURS1002 March 2022
References
Berman, A., Snyder, S.J., Levert-Jones, T., Dwyer, T., Hales, M., Harvey, N., Stanley, D. (2021). Kozier
& Erb’s Fundamentals of Nursing (5th Australian ed., Vol. 1-3). Pearson. (ISBN/ISSN:
9781488626623) (ISBN/ISSN: Vol 1: 9781488626609, Vol 2: 9781488626616 Vol 3:
9781488626623)
Berman, A., Snyder, S.J., Levert-Jones, T., Dwyer, T., Hales, M., Harvey, N., Stanley, D. (2021). Skills
in Clinical Nursing (2nd Australian ed.) Pearson (ISBN/ISSN: 9781488620690).
Kidney Health Australia https://kidney.org.au/
Images sourced from
Kidney Health Australia https://kidney.org.au/
Berman et al. (2021) Kozier & Erb’s Fundamentals of Nursing (5th Australian ed., Vol. 1-3).
https://www.emedicinehealth.com/image-gallery/kidneys_picture/images.htm
