Adult Health 2 - AKI 10.1

Prerenal AKI

Sudden and severe reduction in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness

Prerenal Kidney Injury Causes

Emboli

Burns

Dehydration

HF

Sepsis

MI

Anaphylaxis

Prerenal Kidney Injury Tx

Monitor EKG

Intrarenal/Intrinsic AKI

Direct injury to the kidneys by inflammation, drugs, toxins, infection, or reduced blood supply

Intrarenal Kidney Injury Causes

Toxins/infections

Contrast media

Hemolytic blood transfusion

Crush injuries

Intrarenal Kidney Injury Tx

Fluid bolus

Postrenal AKI

Sudden obstruction of urine flow d/t enlarged prostate, kidney stones, bladder injury or tumor

Postrenal Kidney Injury Causes

BPH

Bladder/cervical/prostate Cancer

Calculi

Trauma to Perineum

Postrenal Kidney Injury Tx

Foley cath

RIFLE

Classification for AKI

R: Risk

I: Injury

F: Failure

L: Loss of function

E: End Stage Renal Disease

RIFLE defines AKI stages based on changes in what things?

SCr or GFR or both

Urine Output

Risk Class Criteria

SCr increased by 1.5

OR

GFR decreased by 25%

Urine Output <0.5ml/kg/hr for 6 hours

Injury Class Criteria

SCr increased by 2

OR

GFR decreased by 50%

Urine Output <0.5ml/kg/hr for 12 hours

Failure Class Criteria

SCr increased by 3

OR

GFR decreased by 75%

Urine Output <0.3ml/kg/hr for 24 hours

OR

Anuria for 12 hours

Loss of Kidney Function Class Criteria

Complete loss of kidney function for >4 wks

End Stage Renal Disease Class Criteria

Complete loss of kidney function for >3 months

Normal GFR

60-120

GFR with kidney disease

15-60

GFR with Kidney Failure

<15

Nephroptoxic Drugs

Gentamycin

Vancomycin

NSAIDs

ASA

4 Phases of AKI

Initial

Oliguric

Diuretic

Recovery

Initial Phase of AKI

Initial insult or injury to the kidneys

Oliguric Phase of AKI

UO < 400ml/day

Assess for fluid and electrolyte imbalances

Retaining fluid

ALL electrolytes are high

Diuretic Phase of AKI

Gradual increase in urine output signaling beginning of glomerular filtration recovery

Assess for fluid and electrolyte imbalances

Fluids and electrolytes are ALL low

Recovery Phase of AKI

Major improvements occur in the first 1-2 weeks of this phase

May take up to 12 months for kidney function to stabilize

Tell tale sign of kidney injury

Periorbital edema

Chronic Kidney Failure s/s

Poor appetite

Low protein, K+ and Na+ diet

EPO & Iron supplements

Anemic (no EPO)

DAILY WEIGHTS