Podcast
Questions and Answers
What is indicated by a moderate rise in serum potassium levels in patients with acute kidney injury (AKI)?
What is indicated by a moderate rise in serum potassium levels in patients with acute kidney injury (AKI)?
Which of the following imaging studies are preferred in assessing kidney structure and function due to their reduced nephrotoxic effects?
Which of the following imaging studies are preferred in assessing kidney structure and function due to their reduced nephrotoxic effects?
What commonly occurs in AKI due to water excess?
What commonly occurs in AKI due to water excess?
Which laboratory finding is often associated with acute kidney injury (AKI)?
Which laboratory finding is often associated with acute kidney injury (AKI)?
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What is a characteristic difference observed between acute kidney injury (AKI) and chronic kidney disease (CKD) in imaging assessments?
What is a characteristic difference observed between acute kidney injury (AKI) and chronic kidney disease (CKD) in imaging assessments?
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What is a key strategy for reducing the risk of acute kidney injury (AKI) when nephrotoxic drugs must be used?
What is a key strategy for reducing the risk of acute kidney injury (AKI) when nephrotoxic drugs must be used?
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Which of the following is NOT one of the goals in managing a patient with acute kidney injury (AKI)?
Which of the following is NOT one of the goals in managing a patient with acute kidney injury (AKI)?
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What abnormal finding is typically seen in urinalysis when a patient has acute kidney injury (AKI) due to glomerular damage?
What abnormal finding is typically seen in urinalysis when a patient has acute kidney injury (AKI) due to glomerular damage?
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Which diagnostic tests are commonly used to evaluate renal function in acute kidney injury (AKI)?
Which diagnostic tests are commonly used to evaluate renal function in acute kidney injury (AKI)?
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What effect does acute kidney injury (AKI) have on serum creatinine levels?
What effect does acute kidney injury (AKI) have on serum creatinine levels?
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Which of the following actions should a nurse take when discharging a patient with instructions to avoid nephrotoxic drugs?
Which of the following actions should a nurse take when discharging a patient with instructions to avoid nephrotoxic drugs?
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Which abnormal finding in urinalysis is indicative of acute tubular necrosis (ATN) during acute kidney injury (AKI)?
Which abnormal finding in urinalysis is indicative of acute tubular necrosis (ATN) during acute kidney injury (AKI)?
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Which condition is suggested by the presence of cell casts in the urinalysis of a patient with acute kidney injury (AKI)?
Which condition is suggested by the presence of cell casts in the urinalysis of a patient with acute kidney injury (AKI)?
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Study Notes
Preventing AKI
- Maintaining adequate vascular volume, cardiac output, and blood pressure is vital to preserving kidney perfusion.
- Avoiding nephrotoxic drugs whenever possible is essential.
- When nephrotoxic drugs or substances must be used, the risk of AKI can be reduced by using the minimum effective dose, maintaining hydration, and eliminating other known nephrotoxins from the medication regimen.
- Encourage patients to contact their pharmacist about nephrotoxic drugs.
Managing AKI
- Maintaining the fluid and electrolyte balance is a key goal in managing AKI.
- Other goals include identifying and correcting the underlying cause, preventing additional kidney damage, restoring urine output and kidney function, and compensating for renal impairment until kidney function is restored.
Diagnostic Tests
- Urinalysis often shows abnormal findings in AKI:
- Fixed specific gravity of 1.010
- Proteinuria if glomerular damage is the cause of AKI
- Presence of RBCs, WBCs, and renal tubular epithelial cells
- Cell casts
- Serum creatinine and BUN are used to evaluate renal function.
- Serum creatinine levels increase rapidly within 24 to 48 hours of onset and generally peak within 5 to 10 days.
- Creatinine and BUN levels tend to increase more slowly when urine output is maintained.
- The onset of recovery is marked by a halt in the rise of the serum creatinine and BUN.
- Serum electrolytes are monitored to evaluate the fluid and electrolyte status.
- Serum potassium rises at a moderate rate and is often used to indicate the need for dialysis.
- Hyponatremia is common because of the water excess associated with AKI.
- ABG studies often show a metabolic acidosis caused by the kidneys' inability to adequately eliminate metabolic wastes and hydrogen ions.
- CBC shows reduced RBCs, moderate anemia, and a low hematocrit.
- AKI affects erythropoietin secretion and RBC production.
- Iron and folate absorption may also be impaired, further contributing to anemia.
- Renal ultrasonography is used to identify obstructive causes of renal failure and to differentiate AKI from end-stage renal disease (ESRD).
- In AKI, the kidneys may be enlarged, whereas in CKD, they typically appear small and shrunken.
- CT scan may be done to evaluate kidney size and identify possible obstructions.
- IV pyelography, retrograde pyelography, or antegrade pyelography may be used to evaluate kidney structure and function.
- Radiologic contrast media are used with extreme caution because of their potential nephrotoxicity.
- Retrograde pyelography and antegrade pyelography are preferred for their fewer nephrotoxic effects.
- Renal biopsy may be necessary to differentiate between acute and chronic kidney disease.
Imaging Studies
- Imaging studies may be performed to determine whether a child has AKI or CKD.
- Imaging studies may assist with the assessment of kidney structures, renal blood flow, and renal perfusion and function.
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Description
Test your knowledge on the prevention and management of Acute Kidney Injury (AKI). This quiz covers essential aspects such as maintaining kidney perfusion, fluid balance, and interpreting diagnostic tests relevant to AKI. Discover key strategies for avoiding nephrotoxins and managing kidney function efficiently.
