Capriotti 3e Preview

G OALS This activity will help students correctly interpret urinalysis results.

O NLINE A PPLICATION • Ask students to find an example of a urinalysis result online (making certain personal information is removed). Students should post their assessment of the results. • Students may complete the student handout as an individual assignment. Drawing Conclusions: Prerenal, Intrarenal, and Postrenal Dysfunction D IRECTIONS • Assign students to work in pairs. • Ask them to draw a kidney, blood vessels serving the kidney, and the lower urinary tract, including the ureter and bladder. • On the diagram, students should include factors and conditions, in the proper location, that may cause prerenal, intrarenal, and postrenal dysfunction. o For example, near the blood vessels, students may list heart failure and sympathetic nervous system activation. Near the kidney, for intrarenal failure, students may list nephrotoxic medications. • A student handout is provided and answers are shown below. Type of Renal Failure Causes Laboratory Values/ Patient Presentation Prerenal Heart failure

Significant increase in BUN BUN:Cr > 20 FENa < 1 Hypotension, increased HR, dehydration Increased BUN Increased Cr BUN:Cr < 20 FENa- > 2 Decreased urine output, fluid retention, edema Urine output may be decreased Increased residual volume in bladder postvoid Imaging studies (renal ultrasound, etc.) Pain, nausea, vomiting, CVA pain

Hypovolemic shock Renal artery stenosis

Intrarenal

Nephrotoxic drugs Toxins (septic shock) Kidney trauma (infections)

Postrenal

Urethral obstruction Ureteral obstruction Prostate enlargement Kidney stones Anatomic abnormality

T IPS As a review activity, bring the entire class together to discuss the types of renal failure, causes, how patients may present, and expected laboratory values. If students do not want to draw, a fillable table is provided on the student handout.