AKI Flashcards
What results from the kidneys not being able to filter blood normally?
Build up of waste, fluid and electrolyte imbalance
What occurs in the prerenal stage that results in reduced kidney function
Issue with perfusion of blood to the kidneys - reduced amount of blood going to the kidneys to be filtered so kidneys deprived of nutrients
What leads to reduce perfusion of blood to the kidneys?
-reduced cardiac output
- bleeding (internal/external)
- dehydration- hypovolemia
- burns
What are the intrarenal causes ?
Damage to the nephrons - reduced ability to filter blood, remove waste and ++ H2O and maintain electrolyte lvls
What can cause damage to the nephron?
-nephrotoxic drugs eg. NSAIDS
- infection
-injury
What occurs during the postrenal stage?
Blockage in urinary tract that prevents draining out of urinary system
What does a blockage in urinary tract result in ?
Increased pressure on the kidneys and build up of waste
What does a normal adult void per day
1-2l/day
What does urine consist of ?
Ions, urea, creatinine, H2O
What is creatinine ?
Waste product from muscle breakdown
How is creatinine filtered
Solely filtered from the blood via the glomerulus an is not re absorbed/secreted in the nephron
What does creatinine measurement tells us
Shows kidney filtering ability
What does an increased lvl of creatinine in the blood indicate ?
Reduced kidney function
What is the creatinine clearance lvl
Amount of blood kidneys make per min that is free of creatinine
Females- 85-123ml/min
Males- 95-140ml/min
What does GFR show?
How well the glomerulus is filtering
What are the stages of AKI
-initiation
-oliguric
-diuresis
- recovery
When does the initiation stage start and end ?
Starts when something causes damage to the kidneys and ends when S&S begin to show
How do we know when the oliguric stage has started
Urine output <400ml/day
Why is there reduced urinary output in the oliguric state ?
Glomerulus loses its ability to filter blood which results in a reduced GFR
What are the S&S during the oliguric stage ?
-^BUN and creatinine lvls
-change in neuro status eg.confusion
-itching
-hyperkalemia - reduced excretion of k+ in urine
-^ fluid in body - oedema, risk of pul + cardiac issues, HTN
- metabolic acidosis - pH<7.35 - confusion, kussmauls breathing
- very concentrated urine
- risk of infection
- GIT- anorexia, nausea, vomiting,
- bruising nd bleeding
What occurs during the diuresis stage ?
- nephrons on their way to recovery- ability 2 filter blood again but can’t concentrate urine
- GFR improves
- ^ mental status - pt starts to become more alert + orientated
-last 1-3 wks
What is osmotic diuresis ?
High amounts of urea in newly filtered filtrate - causes increased urination
- lasts 1-3 wks
What does osmotic diuresis lead to ?
Hypovolemia, dehydration, htn, hypokalemia, rlly diluted urine
When does the recovery stage start ?
When GFR returns back to norm
What are the indications of GFR returning back to norm?
- voiding 1-2l/day
- norm BUN and creatinine lvls
- norm electrolytes
What is the treatment of AKI
-reduce protein in diet ( ^ BUN + creatinine)
-safety measures in place ( neuro changes eg.confusion)
- restrict K+ rich foods, monitor ECG and labs ( hyperkalemia)
- limit fluid intake - I&O chart (oliguric stage)
- daily wgts
- monitor vitals regularly
- check for signs of swelling
- IV access ( fluid resuscitation if needed)
- Meds - loop diuretics, ACE inhibitors 4 HTN,
- breathing- look for signs of kussmals breathing, using accessory muscles etc
What are some of the mobilising and psychological care involved ?
- early mobilisation
- assess 4 signs of DVT, PE
- assess anxiety lvls
- pt education
