AKI & CKD Overview - Nursing Collage - PDF

AKI & CKD Overview Nursing Collage Mohammed M.Keshawy (MD) Assistant prof. of Internal Medicine Nephrology Section Faculty of Medicine , SCU ESNT  Definition: AKI ◼...

AKI & CKD Overview Nursing Collage Mohammed M.Keshawy (MD) Assistant prof. of Internal Medicine Nephrology Section Faculty of Medicine , SCU ESNT  Definition: AKI ◼ AKI: Sudden deterioration in the ability of the kidneys to maintain fluid, solute or electrolyte homeostasis R I F L E Bellomo R critical care 2004 (AKIN) (Mehta RL Critical Care 2007) Treatment of AKI In prerenal failure : restoration of blood vloume is mandatroy using blood products or IV fluids In intrinsic renal faliure ◼ Maintain Electrolyte balance ◼ Discontinue any nephrotoxic drug ◼ May need to stimulate production of urine with IV fluids and diuretics. In postrenal failure : relieve the cause of obstruction surgically or endoscopically Standard care for AKI patient  Indication of RRT Indications Characteristics Relative/Absolute Metabolic BUN > 76 mg/dl (27 mmol/L) Relative abnormalities BUN > 100 mg/dl (35.7 mmol/L) Absolute Hyperkalemia > 6 mEq/L Relative Hyperkalemia > 6 mEq/L with ECG abnormalities Absolute Dysnatremia Hypermagnesemia > 8 mEq/L (4 mmol/L) Relative Hypermagnesemia > 8 mEq/L (4 mmol/L) with anuria and absent Relative deep tendon reflexes Absolute pH > 7.15 Acidosis pH < 7.15 Relative Lactic acidosis related to metformin use Absolute Absolute RIFLE class R (AKI stage I) Anuria/oliguria RIFLE class I (AKI stage II) Relative RIFLE class F (AKI stage III) Relative Fluid overload Diuretic sensitive Relative Diuretic resistant Relative Absolute Gibney N. Clin J Am Soc Nephrol (2008) Definition of CKD ◼ CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health irrespective of the cause. Identification of Risk ◼ Hypertension, ◼ Diabetes mellitus, ◼ Autoimmune disease, ◼ Older age, ◼ African ancestry, ◼ a family history of renal disease, ◼ a previous episode of acute kidney injury, ◼ the presence of A. proteinuria, b. abnormal urinary sediment, or c. structural abnormalities of the urinary tract Decreased GFR ◼ GFR is the overall index of kidney function. ◼ The normal GFR in young adults is approximately 125 mL/min/1.73 m2; GFR