Renal Failure AKI & CKD Acute Kidney Injury (AKI) Pathophysiology Sudden loss of kidney function Caused by: ● ● ● Decreased blood flow to kidneys (prerenal) Damage to the kidneys (intrarenal) Mechanical obstruction of urine outflow (postrenal) (“A Cute Kidney Injury Indeed. This One Still Unfinished, but ‘Normal Stanley’ and His Unfor… | Medical School Studying, Nursing School Survival, Nursing School Notes,” n.d.) Phases/Clinical Manifestation of AKI Oliguric Phase Reduced urine output and GFR Fluid overload, edema, hypertension Metabolic acidosis Elevated BUN and Creatinine Neurologic changes Phases/Clinical Manifestation of AKI Diuretic Phase Osmosis diuresis–increase in urine output of 1-5 Liters/day Lasts 1-3 weeks Recovery Phase BUN, Creatinine levels stabilize and return to normal levels May take up to a year Diagnostic Studies and Tests Labwork: ● ● ● ● ● ● Glomerular Filtration Rate (GFR): >90mL/min Blood Nitrogen Urea (BUN): 10-20mg/dL Serum Creatinine: 0.7-1.4 mg/dL Urine Specific Gravity: 1.010-1.025 Urine Output: >30mL/hr Urinalysis Classifications for AKI (https://cjasn.asnjournals.org/content/17/5/717) Chronic Kidney Disease (CKD) Pathophysiology ● Progressive and irreversible destruction of nephrons ● Urine output gradually decreases as a result of the damage ● Considered chronic if GFR remains <60mL/min for more than 3 months ● If GFR drops below 15 mL/min, it is determined as End-Stage Kidney Disease and dialysis or transplant are required (“290 H Kidney Ideas | Kidney, Kidney Health, Chronic Kidney Disease,” n.d.) Clinical Manifestations of CKD ● ● Varying levels of urine output depending on progression of disease Increase waste buildup–BUN and Creatinine levels increase ○ ● ● ● ● ● Can cause nausea, vomiting, lethargy, neurological changes Electrolyte and acid-base imbalances Anemia, tendencies to bleed, and increased risk of infection Hypertension, heart failure, pulmonary edema CNS depression, muscle twitching, neuropathy Decreased Vitamin D activation by kidneys–decreased calcium absorption Hinkle and cheever 1581-1583 Potential Complications and risk factors - Hypertension Diabetes Family history of renal failure Old age Fluid retention Hyperkalemia Anemia Decreased sex drive Irreversible kidney damage Nursing Diagnoses Excess fluid volume Electrolyte imbalance Risk for imbalanced nutrition, less than body requirements Risk for infection Risk for decreased cardiac output Deficient knowledge Nursing/Multidisciplinary Interventions Acute renal failure nursing/interdisciplinary intervention - Monitor intake and output Observe for oliguria followed by polyuria Daily weight Monitor for signs and symptoms of electrolyte imbalance Encourage patient to restrict potassium Dialysis Chronic renal failure interventions - Provide Renal Diet Restrict fluid as prescribed Provide electrolyte replacement or restriction Monitor and plan nursing care for hypertension and heart failure Prepare client for dialysis or kidney transplant Monitor I&O and vital signs Administer medication with caution (“39 Chronic Kidney Disease Diet Info Ideas | Kidney Disease Diet, Chronic Kidney Disease Diet, Chronic Kidney Disease,” n.d.) Dialysis Used to filter the blood to remove wastes and excess fluid Hemodialysis (“Hemodialysis - MedBroadcast.com,” n.d.) Peritoneal Dialysis (NIDDK, 2019) Patient teaching - Teach client to monitor weight and VS daily Report signs and symptoms of complications such as fluid volume overload, Hyperkalemia Instruct client that recovery of renal function could take up to one year Instruct client to avoid nephrotoxic drugs: NSAID, some antibiotics, contrast media Instruct client that they will need dialysis for life or transplant if they have end stage kidney disease Instruct client to stop smoking Instruct client to take medications as prescribed Medications Related to Renal Failure Drug classes commonly associated with renal failure: ACE-Inhibitors: Decreases blood pressure, leading to increased systemic vasodilation Diuretics: Increases urine output Phosphate-Binders: Prevents hyperphosphatemia by limiting extra phosphate from being absorbed (Unbound Medicine, 2019) ACE Inhibitor: Captopril Brand name: Capoten Generic name: Captopril Classification: ACE Inhibitor Purpose: Lowers blood pressure causing systemic vasodilation Side effects: Dry cough, dizziness (orthostatic hypotension), hypotension & tachycardia may affect taste (returns w/in 8-12 weeks) Patient education: - Take medication 1 hour before a meal -Medication must be taken the same time daily, despite feeling ill -If miss a dose, take it immediately, do not double dose (Unbound Medicine, 2019) -Move slowly as it may cause dizziness (orthostatic hypotension) Diuretic: Furosemide Brand name: Lasix Generic name: Furosemide Classification: Loop diuretic Purpose: -Stops sodium & chloride from being reabsorbed -H2O, Na+, Cl, Mg & K+ excretion are increased -Enhances kidney effectiveness -Excess fluid diuresed & BP decreased Side effects: Hypotension, dehydration, hyponatremia, headache, - hypochloremia, hypomagnesemia, dizziness, tinnitus, - hypokalemia, metabolic acidosis & hypovolemia Patient education: Move slowly (orthostatic hypotension) -Contact pcp: if gain 3 lbs w/in 1 day, develop rash, muscleweakness, extremities feel numb/tingling, develop (Unbound Medicine, 2019) nausea, cramping or dizziness. (“Diuretics | Educação,” n.d.) Phosphate-Binders: Lanthanum Carbonate Brand name: Fosrenol Generic name: Lanthanum Carbonate Classification: Phosphate-Binder Purpose: Lowers serum phosphate connected to renal failure Side effects: N/v, diarrhea & hypocalcemia Patient education: -Take medication 2 hours before or after an antacid or thyroid medication. -Antibiotics must be taken at least 1 hour prior or 4 hours following the administration of lanthanum carbonate. -May be take with meals or promptly after. Unbound Medicine, 2019) References References 39 Chronic Kidney Disease Diet Info ideas | kidney disease diet, chronic kidney disease diet, chronic kidney disease. (n.d.). Retrieved July 6, 2022, from Pinterest website: https://www.pinterest.com/patham19/chronic-kidney-disease-diet-info/ 290 H Kidney ideas | kidney, kidney health, chronic kidney disease. (n.d.). Retrieved July 6, 2022, from Pinterest website: https://www.pinterest.com/clroberts44/h-kidney/ A cute kidney injury indeed. This one still unfinished, but “Normal Stanley” and his unfor… | Medical school studying, Nursing school survival, Nursing school notes. (n.d.). Retrieved July 6, 2022, from Pinterest website: https://www.pinterest.com/pin/421016265167060029/ Acute Kidney Injury (AKI) | FKP Kidney Doctors. (2018, April 8). Retrieved July 6, 2022, from https://flkidney.com/acute-kidney-injury-aki/ Beta blockers … | Nursing school, Nursing mnemonics, Pharmacology nursing. (n.d.). Retrieved July 6, 2022, from Pinterest website: https://www.pinterest.ca/pin/450289662729115346/ Birkelo, B. C., Pannu, N., & Siew, E. D. (2022). Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient. Clinical Journal of the American Society of Nephrology. https://doi.org/10.2215/CJN.14181021 Diuretics | Educação. (n.d.). Retrieved July 6, 2022, from Pinterest website: https://www.pinterest.com/pin/81135230765850620/ Furosemide Tablets – Solco Healthcare. (n.d.). Retrieved July 6, 2022, from https://www.solcohealthcare.com/product/furosemide-tablets/ Hemodialysis - MedBroadcast.com. (n.d.). Retrieved July 6, 2022, from www.medbroadcast.com website: https://www.medbroadcast.com/procedure/getprocedure/hemodialysis Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed., Vol. 2). Philadelphia: Wolters Kluwer. NIDDK. (2019, June 5). Peritoneal Dialysis | NIDDK. Retrieved July 6, 2022, from National Institute of Diabetes and Digestive and Kidney Diseases website: https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis NKF Launches Educational Animated Video Series on Kidney Cancer. (2021, July 7). Retrieved July 6, 2022, from National Kidney Foundation website: https://www.kidney.org/news/nkf-launches-educational-animated-video-series-kidney-cancer Tests for kidney disease. (2021, November 22). Retrieved July 6, 2022, from www.kidneyfund.org website: https://www.kidneyfund.org/all-about-kidneys/tests-kidney-disease themelisting. (2022, March 7). THEME LISTING – Listing for your best theme choice. Retrieved July 6, 2022, from THEME LISTING website: http://themelisting.com/ Unbound Medicine. (2019). Nursing CentralTM from Unbound Medicine. Retrieved July 6, 2022, from Unboundmedicine.com website: https://nursing.unboundmedicine.com/nursingcentral Urine Testing: The Simple Way to Keep You and Your Kidneys Healthy. (2015, February 24). Retrieved July 6, 2022, from National Kidney Foundation website: https://www.kidney.org/content/urine-testing-simple-way-keep-you-and-your-kidneys-healthy Vera, M. (2019, May 31). Nursing Diagnosis: The Complete Guide and List for 2019. Retrieved July 6, 2022, from Nurseslabs website: https://nurseslabs.com/nursing-diagnosis/ Weinstock, C. P. (n.d.). Know the Signs and Stages of Kidney Disease. Retrieved July 6, 2022, from AARP website: https://www.aarp.org/health/conditions-treatments/info-2021/signs-stages-of-kidney-disease.html
