AKI/chronic kidney injury Flashcards
Acute renal failure
Sudden (hours to days)
Situation-limited
Prognosis favorable with Early recognition & treatment
Duration of oliguria determines outcome
!!Increase in serum Creatinine by 1.5 times baseline in 48 hours
acute on chronic- AKI with CKD
Chronic renal failure
Gradual > 3 months
(months to years)
Permanent
Prognosis poor
Treatment slows progression
AKI
Reduced perfusion to kidneys, damage to kidney tissue, obstruction of urine outflow
Risk factors – shock, cardiac surgery, hypotension, prolonged mechanical ventilation, sepsis,DEHYDRATION, NEPHROTOXIC DRUGS(NSAIDS,VANCOMYACIN, RADIOGRAPHIC MATERIALS(ANY DYE GOING THRU IV TO READ FOR PERFUSION NUCLEAR MEDICINE, MAYBE CT , SO FLUIDS AND LABS NEED TO BE GOOD BEFORE
Older adults or adults with chronic diseases are at higher risk- DM, HTN, HISTORY AKI
COMPLICATIONS- METABOLIC ALKALOSIS- BUILD UP UREMIA
classification of AKI
Prerenal – reduced perfusion
Heart failure, Shock, MI, dehydration (begins to affect kidney function)
Intrarenal – damage to kidney tissue/necrosis
Inflammatory/immunologic/infectious
Nephrotoxic drugs
Postrenal – obstruction of urine flow- URINE BACKUP TO KIDNEY
BPH, growths/CA/Stones/Clots
RIFLE classification system
Classification of AKI based on serum Creatinine, GFR, & hourly urine output
R Risk
I Injury
F Failure
L Loss of Kidney Function
E ESRD/ESKD
Phases of acute renal failure
RISK AKI- HEART FAILURE EXCERBATION, RESP INFECTION, DRUG TOXICITY, UNCONTROLLED BLOOD GLUCOCSE IN DM, DEHYDRATION, HYPOVOLEMIC BLOOD LOSS
1.Onset (hours to days)
2.Oliguric (less than 400/day)
May order IV Fluid Bolus
Changes in BUN/Creatinine (1.5 X Baseline/48 hours-7 days)
0.5ml/kg/hour for 6 hours(KNOW THIS
Increase K/Decreased Na
2. AZOTEMIA-BUILD UP NITROGENOUS WASTE FROM PROTEIN BUILD UP?
3.FLUID OVERLOAD- EDEMA IN PULMONARY- CRACKLES,
3.Diuretic(CAN SIGNAL RECOVERY)-Lasix but can damage kidney IV push
fluid challenge-a bunch of fluid running at once
fluid overload-if sob give oxygen, slow bolus stop bolus, high fowlers
IMMUNE AND INFLAMMATORY CAUSE (POLYURIA), LOSS OF ELCTROLYTES, HYPOVOLEMIA
OLIGURIA-LESS 100 ML/DAY ?
4.Recovery (Months but ongoing vulnerabilitiy)
AKI primary prevention
teach drink 2-3L of water daily
Avoid exposure to nephrotoxic drugs (dyes for tests)
Educate on early signs and potential health risks (HTN,T2DM, HF)
History assessment AKI
Changes in urine appearance, frequency, volume
Thirst changes WITH CHRONIC- METALLIC TASTE
Recent surgery or trauma, transfusions, allergic reactions
Drug history
Coexisting conditionsDM,HTN
Immunity-mediated/Inflammatory AKI
Anticipate AKI after hypotension or shock
History of obstructive problems
Evaluate Fluid Status
Hourly urine output
Note color & clarity-are things in urine, QUANTITY
Assess for fluid overload/fluid shifts
Daily weights-SAME EVERYDA IN MORNING, SIMILAR CLOTH, SAME SCALE IF GAIN 1 KG EQUAL 1 L FLUID
Evaluate vital signs for hypoperfusion and hypoxemia(cyanocis, diminished pulses)
prevent CAUTI-foley care
look up policy for pushing IV meds- pharm home page, all departments, p pharmacy,
AZOTEMIA- MIGHT HAVE GOUT, SKIN ITCH
Labs AKI
Increases in Creatinine by 1.5 times baseline in 48hr(takes time to increase), BUN
K and Phosphorous increased (arrythmias-increased t wave)
Calcium decreased
GFR overall kidney function not accurate on acute illness
note changes in urine tests
INCREASE BUN
NOT ANEMIA LIKE CKD
Interventions AKI
Avoid hypotension(lead to decreased perfusion), maintain normal fluid balance
Reduce exposure to nephrotoxic agents and drugs
Frequently monitor laboratory values
Closely watch I/O-Restrict,Liberal
Drug therapy-lasix and fluid challenge
Nutrition
Kidney replacement therapy (At end of CKD)-CKRT Dialysis in ICU setting
Nutrition
High catabolism (PRO breakdown)/High Calories to meet energy needs
Restrict K, Na & Po4
I=O
Poor appetite-Supplemental Nutrition
oral first
Enteral
Parenteral TPN or PPN (More for ESRD)
Lipids
Chronic kidney disease/failure
Progressive, irreversible disorder
End-stage kidney disease (ESKD)
Azotemia-toxins in blood
Uremia
Uremic syndrome
3 Sub-stages (Albumin to Creatinine Ratio in Urine)
Microalbuminuria
stage 5-excessive urea and creatinine build up, cant maintain homeostasis
When urine albumin increases mortality rate increases! PRO in URINRE!
two main causes CKD leading to dialysis or kidney transplant
HTN and DM
Primary and tertiary prevention CKD (promotion and maintenance
Control diseases that lead to CKD
Dietary adjustments
Weight maintenance
Smoking cessation
Exercise
Limit use of drugs & alcohol
