ACUTE KIDNEY FAILURE Also known as: AKI Acute Kidney Injury Rapid loss of kidney functioning FUNCTIONS OF THE KIDNEYS Main functions: Filters blood Waste products Water Glucose Ions Amino Acids Reabsorbs useful substances All unabsorbed substances are excreted outside the body in form of urine SPECIAL FUNCTIONS OF THE KIDNEYS Blood pressure regulation by renin secretion RBC production by erythropoeitin secretion Metabolism of Vitamin D CAUSE - Causes are categorized depending on the site affected: 1. Prerenal aka Prerenal Azotemia These are causes that decreases effective blood flow to the kidneys. Low blood volume Heart failure, AMI, arrythmias Local changes to the blood vessels supplying blood to the kidneys CAUSE 2. Intrinsic aka Intrarenal Acute Failure Cause are due to damage to the kidney, itself Maybe due to the damage to the glomeruli, renal tubules or interstitium Glomerulonephritis ATN Acute Tubular Necrosis AIN Acute Interstitial Nephritis Acute pyelonephritis
CAUSE 3. Postrenal aka Postrenal Obstruction These are causes as a consequence of urinary obstruction Benign Prostatic Hyperplasia Kidney stones Bladder stones Urethral malignancy Pregnancy SIGNS AND SYMPTOMS - Results from the disturbances of kidney functions - S-I-C-K K-I-D-N-E-Y S- Skin rashes I- Increased BUN C- Creatinin elevated K- Kidney inflammation
K- K+ is increased I- Irregular heart beat D- Discomfort; PAIN N- Nausea and vomiting E- Edema Y- Yes DIAGNOSIS - A Clinical History and Laboratory data is needed to establish rapid reduction in kidney functioning.
1. Blood Test BUN : 10-20 mg.dL Serum Uric Acid : 2.5-8 mg/dL Albumin : 3.2-5.5 mg/dL RBC : 4.5-5.5 mg/dL Hematocrit : 38-54 vol% Serum Creatinine: : 0.4-1.2 mg/dL
CREATININE CLEARANCE 24 hour urine specimen Test for renal function Normal Values (Per 24 hours) a. Male 20-26 mg/kg b. Female 14-22 mg/kg Start collection at 2 nd voiding
DIAGNOSIS - To rule out urinary obstruction in Postrenal AKI Post Void Residual Renal UTZ CT Scan of the Abdomen DIAGNOSIS To know the underlying cause 1. USA Urine Sediment Analysis 2. Renal UTZ 3. Kidney Biopsy Indications for renal biopsy Unexplained AKI AKI with Nephrotic Syndrome System dse. Associated with AKI Kidney Biopsy - To determine malignancies - Nursing Interventions NPO 6-8 hours Check PTT, PT (Bleeding is usual) Mild Sedation Local anesthesia Hold breath during insertion of needle UTZ to locate kidneys
DIAGNOSIS Renal Biopsy Bedrest 24 hours Monitor V/S Assess for pain, N/V Hct and Hgb No heavy activity 2 weeks Assess for: Infection Bleeding
STAGING - Follows the RIFLE criteria by Acute Dialysis Quality Initiative (ADQI)
1. Risk GRF decrease >25% Serum Creatinine increased 1.5 times Urine production < 0.5ml/ kg/hour for 6 hours
2. Injury GRF decrease >50% Serum Creatinine doubled Urine production < 0.5ml/ kg/hour for 12 hours
4. Loss Persistent AKI or complete loss of kidney functioning for more than 4 weeks
5. ESRD Complete loss of kidney functioning for more than 3 months Needs Renal Replacement Therapy
MANAGEMENT Goal of treatment: 1. Avoidance of substances that are toxic to the kidneys. 2. Monitor renal functioning. 3. Relief of urinary retention and obstruction. 4. Promote measures to ensure normal K+ levels. 5. Maintain fluid balance. 6. Maintain acid-base balance.
SPECIFIC THERAPIES 1.Low blood pressure 2.Wegeners granulomatosis 3.Toxin-induced prerenal AKI 4.Obstruction of the urinary tract 5.Fluid volume overload 6.Complete loss of renal functioning COMPLICATIONS 1.Metabolic Acidosis 2.Hyperkalemia 3.Pulmonary edema