AKI is a ______ reduction of kidney function causing:
- retention of ____________
- disruptions in ______ , ______ , ______
- increased ____________
- decreased ______
AKI is a sudden reduction of kidney function causing:
- retention of nitrogenous waste products
- disruptions in fluid, electrolyte, acid base balances
- increased serum creatinine
- decreased GFR
A decrease in GFR will increase ____________
A decrease in GFR will increase serum creatinine
______: elevated levels of nitrogenous waste products (blood urea nitrogen (BUN) and serum creatinine levels)
azotemia
______: a buildup of toxins in your blood. It occurs when the kidneys stop filtering toxins out through your urine
uraemia
3 sites of disruption (types of AKI)
1.
2.
3.
- Renal perfusion (pre-renal)
- Urine flow distal to the kidney (post-renal)
- Circumstances within the kidney blood vessels, tubules, glomeruli, or interstitium (intrinsic/intra-renal)
Renal perfusion (pre-renal):
what conditions can cause diuresis?
- hypovolemia
- hypotension
- heart failure
- fever, vomiting, diarrhea
- burns
- overuse of diuretics
- drugs: ACE inhibitors, angiotensin II blockers, NSAIDs
- diet pills
- caffeine
- alcohol
Renal perfusion (pre-renal):
characterised by
- low GFR
- oliguria (low urine output)
- high urine specific gravity and osmolality
- low urine sodium
Prolonged renal perfusion (pre-renal) leads to ___________
acute tubular necrosis (intrinsic/intra-renal)
Post-renal AKI is due to
due to obstruction within the urinary collecting system distal to the kidney; elevated pressure in Bowman’s capsule; impedes glomerular filtration
Prolonged Post-renal AKI leads to ___________; and if continues leads to ________
acute tubular necrosis (intrinsic/intra-renal);
irreversible kidney damage
Intrinsic/intra-renal AKI is due to
pri disfunction of nephrons and kidney
What are the causes of intrinsic/intra-renal AKI?
- nephrotoxic insults (eg. contrast media)
- ischaemic insults (eg. sepsis)
Sepsis produces ________ by provoking a combi of systemic ________ & intra-renal ________.
Sepsis produces ischemia by provoking a combi of systemic vasodilation & intra-renal hypoperfusion.
Sepsis also results in production of ________ & ________
toxin & fats
Pathological processes in Intrinsic/intra-renal AKI:
- ________ & ________ intraluminal pressure, thus ________ glomerular filtration
- Afferent arteriolar ________, thus ________ glomerular capillary filtration pressure
- Tubular injury & ________ intraluminal pressure, thus ________
- Obstruction & increased intraluminal pressure, thus decreased glomerular filtration
- Afferent arteriolar vasoconstriction, thus decreased glomerular capillary filtration pressure
- Tubular injury & increased intraluminal pressure, this back leak
3 phases of acute tubular necrosis (intrinsic/intra-renal)
- prodromal
- oliguric
- postoliguric
prodromal phase:
- normal or decreased ______
- increased ______ and ______
- duration: ______
prodromal phase:
- normal or decreased urine output
- increased BUN and creatinine
- duration: depends on cause of injury, severity of hypertension, etc
oliguric phase:
- vol. ______
- hyperkalemia
- azotemia/uremia
- metabolic acidosis
- duration: ______
- urine output: ______mls/day
- fluid excess
- ______ may be required
oliguric phase:
- vol. overload
- hyperkalemia
- azotemia/uremia
- metabolic acidosis
- duration: up to 8 wks
- urine output: 50-400mls/day
- fluid excess
- dialysis may be required
postoliguric phase:
- fluid vol ______
- labs begin to ______
postoliguric phase:
- fluid vol deficit
- labs begin to normalise
Prerenal vs intra renal/intrinsic:
- Proteinuria
- Urine sodium conc.
Prerenal–
- Proteinuria: absent
- Urine sodium conc.: <10 mmol/L
Intrinsic–
- Proteinuria: possible
- Urine sodium conc.: >20 mmol/L
Is AKI reversible?
Yes, but could progress to renal failure, which is irreversible
Impt AKI nursing management (pt 1)
- vital signs (esp for ______, ______)
- I/O
- urine colour
- daily weight (increase in ______kg/day indicate ______)
- monitor for altered lvl of ______ caused by uremia
- monitor blood results such as BUN creatinine, electrolyte lvls
- vital signs (esp for hypertension, tachy)
- I/O
- urine colour
- daily weight (increase in 1-2kg/day indicate fluid retention)
- monitor for altered lvl of consciousness caused by uremia
- monitor blood results such as BUN creatinine, electrolyte lvls
Impt AKI nursing management (pt 2)
- monitor urinalysis for protein lvl, hematuria casts & gravity
- monitor for signs of ______ (high WBC)
- monitor lungs for ______ and ______ (indicate ______)
- provide ______ protein diet to decrease workload on kidneys
- monitor urinalysis for protein lvl, hematuria casts & gravity
- monitor for signs of infection (high WBC)
- monitor lungs for wheeze and rhonchi edema (indicate fluid overload)
- provide moderate protein diet to decrease workload on kidneys
