Acute Kidney Injury
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Acute Kidney Injury
• Is a rapid loss of renal function due to damage to the kidney.
• A wide range of potentially life-threatening metabolic complication
can occur including metabolic acidosis as well as fluid and
electrolyte imbalances.
• Treatment is aimed at replacing renal function temporarily to:
1. Minimize potentially lethal complications
2. Reduce potential causes of increased kidney injury
Goal: with the goal of minimizing long-term loss of renal function
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Acute Kidney Injury
• A problem seen in an outpatient settings.
• A widely criterion for AKI is above 50% or greater increase in
serum creatinine above baseline, urine volume may be normal
(changes may occur).
Other changes include:
• Nonoliguria
• Oliguria
• Anuria
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Acute Kidney Injury
• Hypovolemia
• Hypotension
• Reduced cardiac output and heart failure
• Obstruction of the kidney or lower urinary tract
• Bilateral obstruction or renal arteries or veins.
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Acute Kidney Injury
Classification:
• Risk
• Injury
• Failure
• Loss
• ESKD
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Acute Kidney Injury
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Acute Kidney Injury
Categories/Cause:
Prerenal Failure
• Occurs 60% to 70% of cases, is the result of impaired blood
flow that leads to hypoperfusion of the kidney commonly
caused by volume depletion (burns, hemorrhage, GI losses),
hypotension (sepsis, shock) and renal artery stenosis.
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Acute Kidney Injury
Categories/Cause:
Intrarenal Failure:
• The result of actual parenchymal damage to the glomeruli or
kidney tubules.
• Acute tubular Necrosis (ATN) or AKI damages the kidney
tubules. Characteristic of ATN are intratubular obstruction,
tubular back leak, vasoconstriction, and changes in glomerular
permeability.
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Acute Kidney Injury
Categories/Cause:
Postrenal Failure:
• Result from obstruction distal to the kidney by conditions such
as renal calculi, strictures, blood clots, benign prostatic
hypertrophy, malignancies, and pregnancy.
• Pressure rises in the kidney tubules, and eventually the GFR
decrease.
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Acute Kidney Injury
Phases of Acute Kidney Injury
Four phases of AKI:
• Initiation
• Oliguria
• Diuresis
• Recovery
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Acute Kidney Injury
Phases of Acute Kidney Injury
Initiation
• Period begins with the initial insult and ends when oliguria
develops.
Oliguria
• Uremic symptoms first appear and life-threatening conditions
such as hyperkalemia develop.
• Accompanied by increase in the serum concentration of
substances usually excreted by the kidneys.
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Acute Kidney Injury
Phases of Acute Kidney Injury
Diuresis
• It is marked by a gradual increase in urine output, which
signals that glomerular filtration has started to recover.
• Laboratory values stabilizes and eventually decreases.
Recovery
• It signals the improvement of renal function and may take 3 to
12 months. Laboratory values return to the patient’s normal
level.
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Acute Kidney Injury
Diagnostic test
• Urine output measurements
• Urine test
• Blood tests
• Ultrasound
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Acute Kidney Injury
Assessment
• Health history
• Physical Assessment
• Laboratory evaluation
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Acute Kidney Injury
Diagnoses
• Imbalanced nutrition: Less than body requirements
• Risk for infection
• Risk for Fluid Volume Deficit
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Acute Kidney Injury
Prevention
• Continually assess renal function (urine output, laboratory values)
when appropriate.
• Pay special attention to wounds, burns, and other precursors of
sepsis.
• Prevent and treat infections promptly. Infections can produce
progressive kidney damage.
• Provide adequate hydration.
• Treat hypotension promptly.
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Acute Kidney Injury
Medical Management
• There is no specific pharmacologic therapy proven to treat AKI
secondary to hypoperfusion and/or sepsis. The only therapeutic or
preventive intervention that has an established beneficial effect in
the management of AKI is the intravenous (IV) administration of
isotonic sodium chloride solution. It should be given in quantities
sufficient to keep the patient euvolemic or even hypervolemic.
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Acute Kidney Injury
Nursing Management
• Monitoring Fluid and Electrolyte Balance
• Reducing metabolic Rate
• Promoting pulmonary function
• Preventing infection
• Providing skin care
• Providing psychosocial support
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End
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