Acute Kidney Injury Flashcards
Explain the anatomy of the kidney
renal capsule
cortex
medulla
renal pelvis
Nephron - ascending loop of henle - descending loop of henle pertitubular cappilaries proximal tubule glomerulus distal tubule
What are the by products of the kidneys filtration?
H+
- waste product
- by product of H2O
- needs to get it out, if it is not excreted metabolic acidosis
Urea
- waste product
- By product of protein
- made in the liver filtered through kidneys
- high levels of urea means the kidneys are not functioning well
- Heart failure and dehydration can also cause this
creatinine
- waste product
- by product of muscle contraction
- decrease in kidney function when there is high levels
What is the function of the kidney?
- Keeping the concentrations of various ions and other important substances constant
- Keeping the volume of water in your body constant
- Removing wastes from your body
- Keeping the acid/base concentration of your blood constant
Explain reabsorption?
Once inside the lumen of the nephron, small molecules, such as ions, glucose and amino acids, get reabsorbed from the filtrate
Finish this sentence
If it doesn’t go into the potty __________
It stays in the body
What are some common kidney disorder?
- Acute Kidney Injury (AKI)
- Chronic Kidney Disease
- End-stage Kidney Disease
What is renal insufficiency?
Kidneys are unable to remove accumulated metabolites from the blood, leading to altered fluid, electrolyte and acid–base balance
What are the 3 categories of Acute Kidney Injury (AKI)
Prerenal
Intrinsic
Postrenal
Explain Pre renal and give an example of something that can affect the body prerenally
any condition decreasing renal blood flow, causing subsequent hypo perfusion
Ø Causes are factors external to the kidneys that reduce
renal blood flow: Severe dehydration, heart failure, ↓ CO
Ø Decreases glomerular filtration rate, causes oliguria
Explain Intrinsic (intra renal) and give an example of something that can affect the body intrarenally
acute damage to the Kidneys themselves
Ø Conditions causing direct damage to kidney tissue
Ø Results from prolonged ischaemia, nephrotoxins
Ø Acute tubular necrosis (ATN)
• Results from ischaemia, nephrotoxins, or sepsis
• Severe ischaemia causes disruption in basement
membrane
• Nephrotoxic agents cause necrosis of tubular
epithelial cells (CT contrast)
• Potentially reversible
What needs to be done after having CT contrast?
Flush it out with lots of fluids
Explain Postrenal and give an example of something that can affect the body post renally
Any condition that obstructs the outflow of urine
Ø Causes include: • Benign prostatic hyperplasia • Prostate cancer • Calculi • Trauma • Extrarenal tumors
What are the manifestations of AKI?
3 phases, explain each
• Oliguric phase
– Waste product accumulation: Elevated BUN and serum creatinine levels
– Neurologic disorders: Fatigue and difficulty concentrating, Seizures, stupor, coma
• Diuretic phase
– Daily urine output is 1 to 3L, may reach 5L or more
– Monitor for hyponatraemia, hypokalaemia, and dehydration
• Recovery phase
– Up to 12 months for kidney function to stabilise
How is AKI classified
(5 classifications)
RIFLE
Risk injury failure loss end-stage
For the Risk classification what is the serum creatinine/ GFR level and Urine output?
Increased creatinine × 1.5 or decrease in GFR > 25%
For the Injury of kidneys what is the serum creatinine/ GFR level and Urine output?
Increased creatinine × 2 or decrease GFR > 50%
for the Failure of kidneys what is the serum creatinine/ GFR level and Urine output?
increased creatinine × 3 or decrease in GFR > 75%
Loss of functioning happens at how many weeks?
Complete loss of kidney function > 4 weeks
End - stage kidney disease happens at how many months?
End-stage kidney disease > 3 months
What diagnostic studies can be done for AKI?
– Thorough history – Serum creatinine – Urinalysis – Kidney ultrasonography – Renal scan – Computed tomography (CT) scan
What multidisciplinary care needs to be done for the patient?
– Ensure adequate intravascular volume and cardiac output
– Closely monitor fluid intake during oliguric phase
– Hyperkalaemia
– Nutritional therapy
What is the treatment for Prerenal, intra renal, postrenal?
Pre-renal – restoring blood flow to kidneys Intra-renal – treating intrinsic disease e.g. glomerulonephritis Post-renal – removing an obstruction
What are the 3 ways for renal replacement therapy?
- Haemodialysis
- Peritoneal dialysis
- Renal transplantation
What is dialysis and why is it used?
• Movement of fluid/molecules across a semipermeable membrane from one compartment to another
• Used to correct fluid/electrolyte imbalances and to remove waste products in renal failure
• Treat drug overdoses
• Two methods of dialysis available – Peritoneal dialysis (PD)
– Haemodialysis (HD)
When is dialysis done?
• Begun when patient’s uraemia can no longer be adequately managed conservatively
• Initiated when GFR (or creatinine clearance) is less than 15 mL/min
• Ultrafiltration
– Water and fluid removal
– Results when there is an osmotic gradient across the membrane
Explain Chronic Kidney Disease including early symptoms and late symptoms and GFR
- Slowly and insidiously there is irreversible damage to the kidneys
- CKD is diagnosed when Glomerular Filtration Rate (GFR) is 90)
- Early symptoms: NONE, except proteinuria
- Late symptoms: nocturia, nausea, itch, vomiting, headaches, breathlessness and weight loss
what are the 6 stages of CKD
1,2,3a,3b,4,5
What happens in Stage 1 of CKD?
normal or increased GFR >90
Diagnosis and treatment
CVD risk reduction
Slow progression
What happens in Stage 2 of CKD?
Kidney damage with mild decreased GFR (60-89)
Elimination of progression
What happens in Stage 3a of CKD?
Moderate decreased GFR (45-59)
Evaluation and treatment of complications
What happens in Stage 3b of CKD?
Moderate to severe decreased GFR (30-45)
More frequent evaluation
treatment of complications
What happens in Stage 4 of CKD?
Severe decrease in GFR (15-29)
Preparation for kidney replacement therapy
(dialysis, kidney transplant)
What happens in Stage 5 of CKD?
Kidney failure
<15 or dialysis
Renal replacement therapy
(if uraemia is present and pt desires treatment)
What electrolyte imbalances can occur?
• Potassium - Hyperkalaemia (Fatal dysrhythmias)
• Sodium – Elevated
– Because of impaired excretion, sodium is retained
(Water is retained: Oedema, hypertension, CHF)
• Metabolic acidosis
– Inability of kidneys to excrete acid load. Defective reabsorption/regeneration of bicarbonate
Give 2 signs and symptoms from the Haemotologic system
– Anaemia
– Bleeding tendencies
– Infection
Give 2 signs and symptoms from the Cardiovascular system
– Hypertension
– Heart failure
– Peripheral oedema
– Dysrhythmias
Give 2 signs and symptoms from the Respiratory system
– Dyspnea may occur with fluid overload
- pulmonary oedema
- respiratory infections
Give 2 signs and symptoms from the Gastrointestinal system
– Every part of GI system is affected • Cause: excessive urea – Mucosal ulcerations – GI bleeding – Anorexia, nausea, vomiting, constipation
Give 2 signs and symptoms from the Neurologic system
– Altered mental ability
– Seizures
– Coma
Give 2 signs and symptoms from the Reproductive system
– Infertility
– Decreased libido
– Low sperm counts
Give 2 signs and symptoms of Psychologic changes
– Personality and behavioural changes
– Withdrawal
– Depression
What treatments can be used?
Antihypertensive therapy
Dyslipidaemia
Nutritional therapy
What nursing managements can be done?
• Health promotion
• Acute intervention
– Daily weight and daily BPs
– Identify signs and symptoms of fluid overload and hyperkalaemia
– Strict dietary adherence
– Medication teaching
– Motivate patients in management of their disease
• Ambulatory and home care
– When conservative therapy is no longer effective, HD, PD, and transplantation are treatment options
