Module 8 Renal & Urologic Acute Kidney Injury & Chronic Kidney Disease

AKI

Rapid loss of kidney function from kidney damage

AKI diagnostic criteria

50% or greater rise in creatinine above baseline

AKI reversibility

Often reversible if underlying cause found and treated

Pre-renal AKI

Caused by hypoperfusion to kidneys

Intra-renal AKI

Actual damage to kidney tissue itself

Acute tubular necrosis (ATN)

Type of intra-renal AKI damage

Post-renal AKI

Caused by obstruction of urine flow

AKI causes

Hypovolemia, hypotension, low cardiac output, obstruction

Initiation phase

First phase of AKI, kidney injury occurs

Oliguric phase

Urine output less than 400 mL/day, wastes build up

Uremia

Buildup of waste products in blood from kidney failure

Diuretic phase

Urine output normal or high, watch for dehydration

Recovery phase

Kidney function improves, may take 3-12 months

AKI CNS symptoms

Lethargy, drowsiness, headache, muscle twitching, seizures

Uremia symptoms

Nausea, vomiting, fatigue, itching, confusion, metallic taste

Oliguria

Low urine output

Anuria

No urine output

AKI lab tests

BUN, creatinine, GFR, electrolytes, ABGs

AKI imaging

Ultrasound, non-contrast CT scan

Why monitor cardiac in AKI

Risk of high potassium causing arrhythmias

Hyperkalemia ECG signs

Peaked T waves, flat P wave, wide QRS

AKI mortality rate

10-80% depending on patient

AKI risk factors

Nephrotoxic drugs, contrast dye, older age, diabetes, prior kidney disease

AKI fluid management

Maintenance IV fluids, diuretics, blood transfusions, albumin

Hyperkalemia treatment

Kayexalate, insulin with D50, calcium replacement

Metabolic acidosis treatment

Sodium bicarbonate

Hyperphosphatemia treatment

Phosphate binders like PhosLo, Renvela

AKI diet early stage

High carbohydrate diet

AKI diet recovery stage

High protein, high calorie diet

AKI nursing care

Strict intake and output, daily weights

CKD

Chronic, progressive loss of kidney function over time

CKD Stage 1

Normal kidney function

CKD Stage 2

Mild loss of function

CKD Stage 3

Moderate loss of function

CKD Stage 4

Severe loss of function

CKD Stage 5

End stage kidney disease, needs renal replacement therapy

ESKD

End stage kidney disease

RRT

Renal replacement therapy (dialysis or transplant)

CKD common causes

Hypertension and diabetes

Calciphylaxis

Rare, painful skin complication of ESKD

CKD lab findings

Sodium and water retention, low GFR, acidosis, anemia

CKD calcium/phosphorus issue

Imbalance due to poor kidney regulation

CKD vitamin issue

Vitamin D deficiency

CKD medications

Phosphate binders, calcium, vitamin D, erythropoietin

Erythropoietin use in CKD

Treats anemia from kidney disease

CKD nutrition therapy

Limit protein, fluid, potassium, and sodium

CKD treatment options

Dialysis or renal transplant

CKD nursing care

Track intake/output, vitals, nutrition, labs, patient education