Patient Case Study - Acute Kidney Injury (AKI)

Kidney injury caused by decreased blood flow.

Kidney damage within the kidney itself.

Symptoms include weight loss, orthostatic hypotension, tachycardia, and possibly decreased urine output.

Causes include reduced fluid intake, cardiac disease, and liver disease.

Causes include nephrotoxic medications, trauma or muscle disorders, and exposure to contrast agents.

Kidney condition affecting the glomeruli (filtering units).

Assessment of the total amount of fluid in the body.

A type of kidney injury affecting the tubules (tubes in the kidneys).

Low blood volume

Insufficient blood flow to an organ or tissue

Kidney damage from inside the kidney itself.

Kidney damage caused by factors like hypotension and ischemia.

Damage to tissue due to lack of blood flow.

Rate at which blood is filtered in the kidneys

Blockage of a tube or channel

Kidney damage due to harmful chemicals or drugs.

Kidney's attempts to cope with disruptions.

Toxic substances that can damage kidney tubes

Can cause kidney vasoconstriction at high levels and kidney stone formations

Mechanism for regulating blood flow through the kidney

Damage to tissues when blood flow returns after being cut off

A measure of kidney function, reflecting the amount of creatinine in the blood. High levels indicate potential kidney impairment.

For men, a normal creatinine level is between 0.7 and 1.3 mg/dL.

A creatinine level above the normal range, indicating potential kidney impairment. It is important to investigate the cause.

Inflammation of the bladder, often causing symptoms like pain, frequent urination, and blood in urine.

A sign of cystitis, indicating inflammation and potential problems with bladder function.

Critically ill patients with AKI need 25-30 kcal/kg/day. Fat intake should be 30-40% of total energy, and carbohydrates should make up 50-60%. Individualization is crucial, considering factors like comorbidities, metabolic stress, body composition, and RRT.

Protein intake varies based on dialysis status. Non-dialysis AKI patients need 0.8-1 g/kg/day. Intermittent Hemodialysis (IHD) patients need 1.2-1.5 g/kg/day, and Continuous Renal Replacement Therapy (CRRT) patients need 1.5-2.5 g/kg/day.

Potassium and phosphorus levels need close monitoring and adjustment to prevent accumulation, especially in non-dialysis patients. Sodium intake should be limited to prevent fluid overload. Calcium and magnesium levels also need monitoring and potential adjustment during RRT.

Fluid intake should be adjusted based on the patient's volume status, especially in cases of fluid overload or oliguria. Fluid balance needs rigorous monitoring, particularly in patients on parenteral nutrition (PN).

EN is the preferred feeding route if the gastrointestinal tract is functional. It supports gut integrity and immune function, playing an important role in recovery.

PN is used when EN is not feasible or contraindicated. It's crucial to adjust the PN formula to control fluid and electrolyte levels effectively.

AKI can impair the kidneys' ability to eliminate excess fluids effectively. Fluid overload can put extra strain on the heart and circulation, leading to complications.

Electrolyte imbalances can disrupt critical bodily functions like nerve and muscle activity, heart rhythm, and even cause coma. Close monitoring helps prevent dangerous fluctuations.

Nutritional support adjusted for AKI patients to prevent complications. This includes tailoring protein and electrolyte intake, monitoring trace elements, and supplementing vitamins.

AKI patients, especially those on CRRT, may experience significant losses of trace elements like zinc, selenium, and copper. Monitoring and supplementation are crucial.

AKI patients need supplemental water-soluble vitamins, especially vitamin B and vitamin C, due to losses during RRT. Daily requirements vary with metabolic needs and RRT modality.

Regularly assess nutritional, metabolic, and renal parameters to personalize nutrition support and adapt it to the patient's changing needs.

Adjust protein and electrolyte intake based on the type of renal replacement therapy (IHD or CRRT) and its frequency.

Monitor markers of metabolic stress to ensure nutrition support doesn't worsen the patient's condition.

Furosemide is a loop diuretic used to reduce edema in AKI patients by inhibiting salt and water reabsorption in the kidneys.

Losartan is an angiotensin II receptor blocker used to control hypertension in AKI patients by blocking a key hormone involved in blood pressure regulation.

A medical procedure involving inserting a needle into a cyst to puncture and drain the fluid. Sometimes, a solution is injected afterwards to prevent fluid build-up.

Losartan is a medication that can affect kidney function. Close monitoring is needed, and dosage may need to be adjusted based on kidney function and potassium levels.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can worsen kidney function and contribute to progression of kidney disease (AKI). Educate patients to avoid NSAIDs without consulting a doctor.

Sodium bicarbonate is a medication that can correct metabolic acidosis, which is a condition related to kidney problems.

Nitrofurantoin is a safe and effective treatment for bladder infections (cystitis) in men, especially if their kidney function is good.

Kidney problems (AKI) can lead to electrolyte imbalances, like low sodium (hyponatremia) and high potassium (hyperkalemia), which can worsen symptoms.

Estimated glomerular filtration rate (eGFR) is a test that provides a more accurate assessment of kidney function.

Screening for protein in urine helps detect early signs of kidney damage and quantifies the amount of protein being lost.

Maintaining a healthy blood pressure (BP) can slow down the progression of chronic kidney disease (CKD) and reduce the risk of complications.

Monitoring potassium (K) and sodium (Na) levels is crucial for patients with AKI, as imbalances can worsen their symptoms.