UNIT 3- ACUTE KIDNEY INJURY Flashcards
Using the acronym A WET BED what are the functions of the kidney?
A: Acid-Base Balance
W: Water removal
E: Erythropoiesis
T: Toxin Removal
B: Blood pressure control
E: Electrolyte balance
D: Vitamin D activation
What is renal failure?
Inability of the kidneys to excrete waste products and water from blood stream through filtration
- AKI and CKD
What is the patho of AKI?
- Acute, rapid loss of renal function
-oliguria may be present
-Uremia may be present
AKI is characterized by?
- Rapid decrease in renal function
- Increase in serum, BUN, K+
- Decrease of urine output
- Azotemia- biochemical abnormality, defined as elevation or buildup of nitrogenous products
What are the 3 major categories of AKI?
- Prerenal- coming before the kidneys
- Intrarenal- within the kidney
- Postrenal- After the kidneys
What causes prerenal AKI?
Due to decreased blood flow into the kidneys
- absolute loss of fluid
-hemorrhage
-Vomiting
-Diarrhea
-Severe burns - Relative loss of fluid (fluid stays the same
-Distributive shock- Congestive heart failure– cant pump blood which leads to less blood delivered to kidneys
- renal artery issues- renal artery stenosis
What causes post renal AKI?
- Obstruction from the outflow of the kidney
What are two ways obstruction can cause post-renal AKI?
- Compression- intra-abdominal tumors or tumors
- Blockage-Kidney stones
What is intrarenal AKI?
- Damage to the tubules, the glomerulus, or the in interstitum (the space between the tubules)
What is the most common cause of intrarenal AKI?
- Acute tubular necrosis
What is acute interstitial nephritis?
Inflammation that can happen w/in days to weeks and damage the kidneys interstitum
What are the 4 phases of AKI?
- Initiating phase
- Oliguric phase
- Diuretic phase
- Recovery phase
What is important to know about the initiating phase of AKI?
Renal blood flow decreases to a level resulting in severe cellular depletion that in turns leads to acute cell injury and dysfunction
Renal tubular epithelial cell injury is a key feature.
What is important to know about the oliguric phase?
- Decreased urine output (<400/day) occurs within 10-14 days lasts typically
What does the GFR look in the oliguric phase?
Increased GFR and
increased BUN & Cr
What is important to know about the diuretic phase in AKI?
“kidneys waking up phase”
- output increases to about 1-3L/day can be up to 5L
- Nephrons not fully functional even w/output
- 1-3 wks, monitor electrolytes
What would you expect the GFR during the diuretic phase to looking like in AKI
- Decreased BUN, CR
- Increased GFR
What does the recovery phase look like with AKI?
- Lasts 1-2 weeks but may take up to 12 months
- Some do not recovery.
True or False: AKI will have an increased blood pressure on initial visit?
True
AKI s/s
1.decreased urine out put
2. Swelling of the legs, ankles, feet (edema)
3. SOB (dyspnea)
4. Fatigue
5. Loss of appetite
6. N/V
7. Irregular heartbeat
8. Chest pain/pressure
9. Easy or unusual bleeding (decreased platelets)
10. Confusion