Acute Kidney Injury (AKI) Definition
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What is AKI?

  • A temporary loss of renal function due to kidney injury
  • A chronic loss of renal function due to kidney disease
  • A gradual loss of renal function due to kidney damage
  • A rapid loss of renal function due to damage to the kidneys (correct)

    • What is the AKI accepted criterion?

  • A 100% or greater increase in serum creatinine above baseline
  • A 25% or greater increase in serum creatinine above baseline
  • A 75% or greater increase in serum creatinine above baseline
  • A 50% or greater increase in serum creatinine above baseline (correct)

    • What is oliguria?

  • Less than 3 mL/kg/h of urine output
  • Less than 1 mL/kg/h of urine output
  • Less than 0.5 mL/kg/h of urine output (correct)
  • Less than 2 mL/kg/h of urine output

    • What is an example of a condition that reduces blood flow to the kidney?

    <p>Hypovolemia</p> Signup and view all the answers

    What is the RIFLE classification system?

    <p>Risk, Injury, Failure, Loss &amp; End-stage Kidney Disease</p> Signup and view all the answers

    What is a prerenal cause of AKI?

    <p>Impaired blood flow to the kidney</p> Signup and view all the answers

    What can happen if the underlying conditions that cause AKI are corrected before permanent damage occurs?

    <p>The signs may be reversed</p> Signup and view all the answers

    What can cause hypoperfusion of the kidney?

    <p>Hypovolemia</p> Signup and view all the answers

    What is an example of a condition that can cause damage to the glomeruli or kidney tubules?

    <p>Kidney stone</p> Signup and view all the answers

    What is a potential complication of AKI?

    <p>Metabolic acidosis</p> Signup and view all the answers

    What is a possible complication of Acute Kidney Injury (AKI)?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the main objective of treatment in AKI?

    <p>All of the above</p> Signup and view all the answers

    What is used to treat hyperkalemia?

    <p>Cation-exchange resins</p> Signup and view all the answers

    What is the timeframe of rhabdomyolysis/myoglobinuria?

    <p>Last 10 to 14 days</p> Signup and view all the answers

    What is a goal of nutritional therapy in AKI?

    <p>Providing a high-carbohydrate diet</p> Signup and view all the answers

    What is a nursing intervention to prevent respiratory tract infection?

    <p>Turning, coughing, and deep breathing</p> Signup and view all the answers

    What is a common laboratory finding in Prerenal Azotemia?

    <p>Urinary sodium levels less than 20 mEq/L</p> Signup and view all the answers

    What is a common cause of Postrenal Failure?

    <p>Benign prostatic hyperplasia</p> Signup and view all the answers

    What is a possible cause of metabolic acidosis in AKI?

    <p>Increase in blood phosphate concentrations</p> Signup and view all the answers

    What is a possible complication of AKI?

    <p>Anemia</p> Signup and view all the answers

    What is a symptom of Acute Kidney Injury (AKI)?

    <p>Oliguria</p> Signup and view all the answers

    What is used to treat metabolic acidosis?

    <p>All of the above</p> Signup and view all the answers

    What is a nephrotoxic agent?

    <p>All of the above</p> Signup and view all the answers

    What is the typical duration of the Recovery phase in AKI?

    <p>3 to 12 months</p> Signup and view all the answers

    What is a priority nursing intervention in AKI?

    <p>Monitoring fluid and electrolyte balance</p> Signup and view all the answers

    What is a complication of hyperkalemia?

    <p>Dysrhythmias</p> Signup and view all the answers

    What is a common finding in Intrarenal Azotemia?

    <p>Urinary sodium levels greater than 40 mEq/L</p> Signup and view all the answers

    What is a common cause of AKI?

    <p>All of the above</p> Signup and view all the answers

    What is a common laboratory finding in AKI?

    <p>Increased BUN and creatinine</p> Signup and view all the answers

    What is a common diagnostic test used in AKI?

    <p>All of the above</p> Signup and view all the answers

    Why is careful skin care important in AKI patients?

    <p>Due to the skin's susceptibility to breakdown as a result of edema</p> Signup and view all the answers

    What is a important aspect of skin care in AKI patients?

    <p>Bathing with cool water</p> Signup and view all the answers

    Why is frequent turning important in AKI patients?

    <p>To prevent skin breakdown</p> Signup and view all the answers

    What is an important aspect of providing psychosocial support to AKI patients?

    <p>Explain the purpose of treatment by the physician and nurse</p> Signup and view all the answers

    What is an important aspect of continuing patient assessment in AKI?

    <p>Continued assessment of the patient for complications of AKI &amp; precipitating causes</p> Signup and view all the answers

    Why is keeping the skin clean and moisturized important in AKI patients?

    <p>To reduce the risk of skin breakdown</p> Signup and view all the answers

    What is the primary cause of Acute tubular necrosis (ATN)?

    <p>Actual damage to kidney tissue</p> Signup and view all the answers

    What is the effect of Intratubular obstruction on GFR?

    <p>Decrease of GFR</p> Signup and view all the answers

    What is the primary cause of Postrenal failure?

    <p>Obstruction to urine flow</p> Signup and view all the answers

    What is the effect of pressure rise in kidney tubules on GFR?

    <p>Decrease of GFR</p> Signup and view all the answers

    What is the effect of Prerenal failure on cardiac efficiency?

    <p>Impairment in cardiac efficiency</p> Signup and view all the answers

    What is the cause of Hemoglobinuria?

    <p>Both A and B</p> Signup and view all the answers

    What is the stage of Prerenal failure that begins with the initial insult and ends when oliguria develops?

    <p>Initiation</p> Signup and view all the answers

    What is the result of prolonged renal ischemia?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    What is the effect of vasodilation on blood pressure?

    <p>Decrease in blood pressure</p> Signup and view all the answers

    What is the cause of pigment nephropathy?

    <p>Breakdown of blood cells containing pigments</p> Signup and view all the answers

    Study Notes

    Definition of AKI

    • Acute Kidney Injury (AKI) is a rapid loss of renal function due to damage to the kidneys, causing a wide range of life-threatening metabolic and fluid & electrolyte imbalances.
    • Accepted criterion for AKI: 50% or greater increase in serum creatinine above baseline (normal= less than 1 mg/dL) or oliguria (less than 0.5 mL/kg/h).

    Pathophysiology of AKI

    • Impaired blood flow → hypoperfusion to kidney, resulting in decreased GFR.
    • Actual damage to kidney tissue, including acute tubular necrosis (ATN) and intratubular obstruction.
    • Obstruction distal to the kidney by renal calculi, strictures, blood clots, etc.

    Categories of AKI

    • Prerenal (hypoperfusion of kidney): results from hypovolemia, hypotension, and reduced cardiac output.
    • Intrarenal (actual damage to kidney tissue): results from acute tubular necrosis, intratubular obstruction, and changes in glomerular permeability.
    • Postrenal (obstruction to urine flow): results from obstruction distal to the kidney.

    Causes of AKI

    • Prerenal Failure: hemorrhage, gastrointestinal losses, renal losses, cardiogenic shock, myocardial infarction, anaphylaxis, and vasodilation.
    • Intrarenal Failure: aminoglycoside antibiotics, angiotensin-converting enzyme inhibitors, heavy metals, nonsteroidal anti-inflammatory drugs, radiopaque contrast agents, solvents and chemicals, acute glomerulonephritis, and infectious processes.
    • Postrenal Failure: urinary tract obstruction, including benign prostatic hyperplasia, blood clots, calculi, and tumors.

    Phases of AKI

    • Initiation: begins with the initial insult and ends when oliguria develops, lasting around 10-14 days.
    • Oliguria: characterized by a decrease in urine output, increased serum urea, creatinine, uric acid, organic acids, potassium, and magnesium.
    • Diuresis: a gradual increase in urine output, signaling the start of glomerular filtration recovery.
    • Recovery: laboratory values stabilize and eventually decrease, indicating improved renal function, which may take 3-12 months.

    Laboratory Values

    • Prerenal azotemia: decreased amount of sodium in the urine (less than 20 mEq/L).
    • Intrarenal azotemia: urinary sodium levels greater than 40 mEq/L with urinary casts.

    Evaluation and Diagnosis

    • Evaluation for changes in urine output, including hematuria and low specific gravity.
    • Ultrasonography, CT or MRI scan, and serum KFT to diagnose AKI.### Assessment and Diagnosis
    • Decreased GFR, oliguria, and anuria can lead to hyperkalemia, which can cause dysrhythmias
    • Metabolic acidosis and increased blood phosphate concentrations can occur
    • Low calcium levels can result from decreased absorption from the intestine and as a compensatory mechanism for elevated blood phosphate levels

    Treatment Objectives

    • Prevent complications
    • Restore normal chemical balance
    • Eliminate the underlying cause
    • Maintain fluid balance
    • Provide renal replacement therapy

    Medical Management

    • Monitor CVP and hourly urine output in ICU patients
    • Treat hypotension promptly
    • Continually assess renal function
    • Prevent and treat infections
    • Treat wounds, burns, and sepsis
    • Prevent infections from ascending in the urinary tract
    • Relieve obstruction in postrenal AKI
    • Provide supportive therapy in intrarenal AKI

    Pharmacologic Therapy

    • Diuretics such as Mannitol and Furosemide (Lasix) may be used
    • Dialysis may be initiated to prevent complications
    • Administer cation-exchange resins (Sodium Polystyrene Sulfonate, Kayexalate) orally or by retention enema for hyperkalemia
    • IV dextrose 50%, insulin, and calcium may be used for hemodynamically unstable patients
    • Sodium bicarbonate therapy or dialysis may be used for metabolic acidosis

    Monitoring Fluid and Electrolyte Balance

    • Monitor serum electrolyte levels and physical indicators of complications
    • Monitor cardiac function and musculoskeletal status closely for signs of hyperkalemia
    • IV solutions must be carefully selected based on the patient's fluid and electrolyte status
    • Monitor cardiac function and musculoskeletal status closely for signs of hyperkalemia

    Nutritional Therapy

    • Weigh daily
    • Provide a high-carbohydrate diet to spare protein for tissue healing
    • Restrict foods and fluids containing potassium or phosphorus
    • Provide a high-protein, high-calorie diet in the diuretic phase
    • Resume activities gradually following the diuretic phase

    Nursing Management

    • Assess for urine output, edema, distention of the jugular veins, alterations in heart sounds and breath sounds, and difficulty in breathing
    • Report immediately to the physician and prepare for emergency treatment if severe fluid and electrolyte disturbances occur
    • Provide physical and emotional support to the patient and family
    • Monitor pulmonary function and promote it through deep breathing and coughing exercises
    • Prevent infection through asepsis and careful skin care
    • Provide skin care through frequent turning, bathing with cool water, and keeping the skin clean and moisturized

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    Learn about Acute Kidney Injury, a rapid loss of renal function due to kidney damage. Understand the causes and effects of AKI.

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