AKI Flashcards
a) What is AKI?
b) AKI criteria
a) A rapid loss of kidney function
b) Inc SCr by 0.3 or more w/in 48hs
Inc Scr to 1.5 times or more baseline within prior 7 days
Dec urine output less than 0.5mL/kg/hr for 6 hrs
serum creatinine=SCr
Risk factor
sepsis
Age +65
CKD
DM
heart or liver failure
contrast die used
polypharmacy(multiple drugs to treat)
Pre renal AKI
a) Patho?
b) Restoration of renal?
a) reduced circulation & blood flow to kidneys
b) blood flow returns to normal
but renal tubules suffer damage from
hypoperfusion
Pre renal AKI
Causes?
Prolonged hypotension (sepsis, vasodilation)
Prolonged low CO (HF, cardiogenic shock)
Prolonged volume depletion (dehydration, hemorrhage)
Renovascular thrombosis (VTE)
NSAIDS (cause afferent arteriole vasoconstriction)
Pre-renal AKI
S/S
Hypotension
Hypovolaemia
Low cardiac output
HF symptoms
Severe dehydration
Internal AKI
a) Patho?
b) Causes?
a) impairing nephron function
b) Prolonged ischemia
Nephrotoxins
-aminoglycosides antibiotics(gentamicin)
-contrast media
-NSAIDS
Hemoglobin release from hemolyzed RBCs (could occur from blood transfusion reaction)
Myoglobin released from necrotic muscle cells (ex: rhabdomyolysis)
Hemoglobin & myoglobin can block the tubules and cause renal vasoconstriction
Primary renal disease
-glomerulonephritis
-systemic lupus erythematosus (SLE))
a) Most common cause of AKI?
b) Causes?
a) Acute tubular Necrosis
b)Ischemia(MAP under 50)
Nephrotoxic agents
Antibiotics(neomysic,gentamicin)
NSAIDS
Contrast dyes
Sepsis
Internal AKI
S/S
Glomerulonephritis
-hematuria
-proteinuria
Muscle pain
Edema
Confusion
Postrenal AKI
a) Patho?
a) Causes?
a) obstruction
least common
b) kidney stones
bladder tumor
urethral/bladder injury
mechanical obstruction
BPH
Prostate cancer
Trauma
Postrenal AKI
a) removal obstruction w/in 48hr?
b) At 12 weeks or greater?
a) GFR recovery
b) GFR recovery unlikely
Postrenal AKI
S/S
BPH s/s
-Nocturia
-polyuria
-Urgen to urinate
Stone
-abdominal pain
-hematuria
-cloudy urine
Phases of AKI
Oliguric phase
a) Define?
b) when oliguria occurs d/t Ischemia?
c) when oliguria occurs d/t nephrotoxins?
a) Usually pre-renal causes
less than 400mL /24hrs
b) oliguria occurs w/in 24hrs
c) May take 1 week
Oliguric phase
Manifestations
fluid overload (JVD, HTN, bounding pulse, HF, edema, pleural effusion)
Metabolic acidosis(cannot rid of H, Kussmaul respirations)
Hyperkalemia (peaked T waves, ST depression)
Inc risk of infection
Mental manifestations d/t buildup of nitrogenous waste
Lab result/urine
a) Na
b) Protein
c) specific gravity
Lab result/serum
d) K
e) Na
f) Ca
a) inc
b) present(never be present)
c) dec (pre-renal cause)
normal(internal cause)
d) Inc
e) Dec
f) Dec
Diuretic phase
a) define?
b) duration?
c) Sr K and Na?
a) renal tissue recovers itself
Inc urine output 1-3L
b) 1-3weeks
c) dec
Diuretic phase
What watch for?
hypovolemia & hypotension d/t sudden fluid loss
electrolyte losses (hyponatremia, hypokalemia, dehydration)
hyperkalemia symptoms?
hypokalemia symptoms?
a) cardiac arrhythmias
heart palpitations
muscle weakness
b) severe muscle weakness
Recovery phase?
Inc GFR recovery
BUN,cr plateau then decline
Major improvement first 1-2 weeks
Stable kidney function may take up tp 12M
RIFLE classifications
R,I,F,L,E?
R risk
I injury
F Failure
L loss complete loss > 4 weeks
E ESRD complete loss >3M
Dx
Cr clearance
a) how?
b) estimate?
a) 24-hr urine
First voiding is discarded
Keep ice or refrigerator
b) GFR
normal 84-138
DX serum
a) Cr
b) BUN
c) BUN Cr ratio
normal?
a) more stable
b) affected by catabolism,bleeding,hydration
c) 10-20:1
->20.1 prerenal
-<10.1 ATN Acute tubular necrosis
Dx
procedure
a) CT scan
b) renography
c) renography post
a) use contrast die
b) measure GFR
radioactive IV
-this doesn’t cause nephrotoxicity
c) assess BP
orthostatic hypotension
inc fluid if hypotension occurs
Urinalysis
a) Abnormal findings
b) Noraml finding?
a) abundant cells
casts
protein
hematuria
b) pre+post renal
What assessment to find to AKI?
Mental status
Lung sounds
Heart rhythem
Hydration status
Skin
-color
-edema
-JVD
-uremic frost
Diet?
Inc carbohydrates and fats
Adequate(inc) protein
Restrict K
Ca supplements
Nursing DX
Electrolyte imbalance
Fluid imbalance
Risk for infection
Anxiety
a) RIFLE defines the first 3 stages of AKI based on?
b) During the oliguria phase, the nurse monitors the pt for?
c) If a pt is in the diuretic phase, which electrolyte must be watched?
a) Cr or urine output from baseline
b) ECG, pulmonary edema
-Na pee out
-hyperkalemia
-fluid retention
c) hypokalemia and hyponatrimia
-hypotension
-hypovolemia
