ACUTE KIDNEY INJURY (AKI) Flashcards
❖ FUNCTIONS OF KIDNEYS
→ Responsible for urine formation.
→ Maintains acid-base balance.
→ Activates the Vitamin D so that calcium can be absorbed in the small intestine and will go now to the blood.
→ Hormones
▪ Renin – released if there is a decrease in blood volume.
▪ Erythropoietin – it stimulates stem cells of the bone marrow to increase the production of red blood cells
Is a layer of connective tissue that surrounds and supports the kidneys.
▪ helps maintain kidneys’ proper position and separate from other abdominal structures
Renal Fascia (Gerota’s fascia)
is a thin membranous sheath that
covers the outer surface of each kidney
Renal Capsule
is divided into two parts:
▪ Cortex (outer). It is 1cm wide and contains the ___ which is responsible for ____ formation.
▪ Medulla (inner) It is 5 cm wide.
➢ It contains the _____, ____, and _____ of the juxtamedullary nephrons
Renal Parenchyma
nephrons - urine
loops of Henle, the vasa recta, and the collecting ducts
is a triangular-shaped structure that contain tiny tubes and blood vessels that help filter the blood to produce urine.
▪ Each kidney contains approximately 8 to 18 pyramids.
▪ The pyramids drain into minor calyces, which drain into major calyces that open directly into the renal pelvis.
Renal Pyramid
is the beginning of the collecting system and are designed to collect and transport urine.
Renal Pelvis
→ An abrupt decrease within 48 hours in kidney function
▪ ____ in serum creatinine, ___ than 0.3 mg/dL.
▪ ___ in urine output (___ than 0.5 mL/kg/hr) for more than 6 hours
ACUTE KIDNEY INJURY
Increase - greater
Decrease - less
Normal Urine Output
1-1.5L per day
increased urination
Polyuria
decreased urination
Oliguria
excreting only 50mL/24hrs, kidneys are destroyed.
Anuria
glucose in the urine
Glycosuria
excessive urination due to glucose
Osmotic Diuresis
❖ RISK FACTORS
→ Age 75 or older
▪ Renal function may decline by 50% or more by age 70.
▪ At age 60, there will be less blood supply going to the brain as well as the kidneys.
▪ Prolonged sitting
❖ RISK FACTORS
→ Heart or Liver Failure
▪ If heart is destroyed, there will be less contraction of the heart resulting to less cardiac output. The body will compensate by perfusing the blood to the primary organs and the kidneys will be damagedbecause it is a secondary organ.
▪ If liver is destroyed, there will be a decrease in albumin. Albumin is produced in the liver, and it maintains the oncotic pressure. If fluids leak out there will be less circulating blood volume, and there will be less blood going to the kidneys since it is a secondary organ.
❖ RISK FACTORS
→ Diabetes
▪ It is the No.1 cause of kidney failure.
❖ RISK FACTORS
→ Hypertension
▪ There is high pressure in the blood vessels making the lumen of the arteries smaller causing the blood circulation to be sluggish and less blood will go to the kidneys
❖ RISK FACTORS
→ Sepsis (Multiorgan Dysfunction Syndrome – MODS)
▪ If there is an infection, microorganisms destroy the tissues. Chemical mediators will be released and it will increase capillary permeability; therefore, albumin with fluids leaks out, resulting to less circulating blood volume, and kidneys will not receive blood because it is a secondary organ.
▪ Patient will be hypotensive (less blood in the brain) that’s why IV Fluids are given immediately to increase blood pressure to give more blood to the brain.
❖ 3 MAJOR MECHANISMS
means a decrease of blood supply in the kidneys caused by hypertension, surgery, bleeding, burns.
→ Hypoperfusion (Prerenal AKI)
❖ 3 MAJOR MECHANISMS
chemical mediators are released causing increased capillary permeability, albumin and fluids are released causing a sluggish blood circulation.
→ Direct Tissue Injury (Intrarenal AKI),
❖ 3 MAJOR MECHANISMS
that cause Renal Inflammation
→ Hypersensitivity Reactions (Postrenal AKI)
In Postrenal AKI, patient will undergo cardiac catheterization (explain)
Nursing Intervention
▪ The patient will undergo cardiac catheterization, a catheter is inserted into an artery, often in the groin or wrist, and advanced through blood vessels to reach the heart. While in the heart, a contrast dye is injected to help visualize the blood vessels and the heart’s chambers. This procedure, known as coronary angiography or angiogram, can carry a risk of kidney injury.
➢ NI: increase fluid intake to help the
kidneys remove the dye
In Postrenal AKI,
▪ Results from obstruction of urine outflow by:
Obstruction (explain)
Tumors, Calculi, and BPH.
➢ Obstruction in the flow of urine can
damage the kidneys because the
urine will go up to the kidneys and
cause damage.
In Postrenal AKI,
▪ Possible Complications:
➢ Benign Prostatic Hypertrophy – can obstruct the flow of urine and can go back to the kidneys, destroying them.
➢ Renal Tumor