Kidney, Ureter, and Bladder Study

Kidney, Ureter, and Bladder Study

Synonym/acronym: Flat plate of the abdomen, KUB, plain film of the abdomen.

Common use

To visualize and assess the abdominal organs for obstruction or abnormality related to mass, trauma, bleeding, stones, or congenital anomaly.

Area of application

Kidneys, ureters, bladder, and abdomen.

Contrast

None.

Description

A kidney, ureter, and bladder (KUB) x-ray examination provides information regarding the structure, size, and position of the abdominal organs; it also indicates whether there is any obstruction or abnormality of the abdomen caused by disease or congenital malformation. Calcifications of the renal calyces, renal pelvis, and any radiopaque calculi present in the urinary tract or surrounding organs may be visualized in addition to normal air and gas patterns within the intestinal tract. Perforation of the intestinal tract or an intestinal obstruction can be visualized on erect KUB images. KUB x-rays are among the first examinations done to diagnose intra-abdominal diseases such as intestinal obstruction, masses, tumors, ruptured organs, abnormal gas accumulation, and ascites.

This procedure is contraindicated for

  • high alert Patients who are pregnant or suspected of being pregnant, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother.

Indications

  • Determine the cause of acute abdominal pain or palpable mass
  • Evaluate the effects of lower abdominal trauma, such as internal hemorrhage
  • Evaluate known or suspected intestinal obstructions
  • Evaluate the presence of renal, ureter, or other organ calculi
  • Evaluate the size, shape, and position of the liver, kidneys, and spleen
  • Evaluate suspected abnormal fluid, air, or metallic objects in the abdomen

Potential diagnosis

Normal findings

  • Normal size and shape of kidneys
  • Normal bladder, absence of masses and renal calculi, and no abnormal accumulation of air or fluid

Abnormal findings related to

  • Abnormal accumulation of bowel gas
  • Ascites
  • Bladder distention
  • Congenital renal anomaly
  • Hydronephrosis
  • Intestinal obstruction
  • Organomegaly
  • Renal calculi
  • Renal hematomas
  • Ruptured viscus
  • Soft tissue masses
  • Trauma to liver, spleen, kidneys, and bladder
  • Vascular calcification

Critical findings

  • Bowel obstruction
  • Ischemic bowel
  • Visceral injury

  • It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

  • Factors that may impair clear imaging

    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
    • Improper adjustment of the radiographic equipment to accommodate obese or thin patients, which can cause overexposure or underexposure and a poor-quality study.
    • Incorrect positioning of the patient, which may produce poor visualization of the area to be examined, for images done by portable equipment.
    • Retained barium from a previous radiological procedure.

  • Other considerations

    • Consultation with a health-care provider (HCP) should occur before the procedure for radiation safety concerns regarding patients younger than 17. Pediatric & Geriatric Imaging Children and geriatric patients are at risk for receiving a higher radiation dose than necessary if settings are not adjusted for their small size. Pediatric Imaging Information on the Image Gently Campaign can be found at the Alliance for Radiation Safety in Pediatric Imaging (www.pedrad.org/associations/5364/ig/).
    • Risks associated with radiation overexposure can result from frequent x-ray procedures. Personnel in the room with the patient should wear a protective lead apron, stand behind a shield, or leave the area while the examination is being done. Personnel working in the examination area should wear badges to record their level of radiation exposure.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the status of the abdomen.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s gastrointestinal and genitourinary systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain and explain that little to no pain is expected during the test, but there may be moments of discomfort. Inform the patient that the procedure is performed in the radiology department or at the bedside by a registered radiologic technologist and takes approximately 5 to 15 min to complete.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to remove all metallic objects from the area to be examined.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure the patient has removed all metallic objects from the area to be examined prior to the procedure.
  • Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
  • Instruct the patient to cooperate fully and follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Place the patient on the table in a supine position with hands relaxed at the side.
  • Instruct the patient to inhale deeply and hold his or her breath while the x-ray images are taken, and then to exhale after the images are taken.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include angiography renal, calculus kidney stone panel, CT abdomen, CT pelvis, CT renal, IVP, and MRI abdomen, retrograde ureteropyelography, US abdomen, US kidney, US pelvis, and UA.
  • Refer to the Gastrointestinal and Genitourinary systems tables at the end of the book for related tests by body system.