exam 1: acute kidney injury (renal)

AKI

sudden loss of kidney function over period of hrs-days

causes of AKI

prerenal

intrarenal

postrenal

prerenal

blood supply decreased, drop in BP from severe injury or illness

shock, dehydration, vasoconstriction

intrarenal

kidney tubule function decreased/necrosis

ischemia, toxins, infection, NSAIDs, IV contrast, nephrotoxic meds

nephrotoxic meds

aminoglycoside

antibiotics

platinoid chemo

nsaids

contrast medi

AKI nursing interventions

VS q4h

i&o every shift

monitor weight

monitor fluid and electrolytes

postrenal

urine flow blocked

stones, tumors, enlarged prostate, neurogenic bladder, spinal cord injr

AKI manifestations

hypervolemia, hypertension, tachycardia, HF

oliguria

disorientation, coma (older ppl)

metabolic acidosis

anemia, thrombocytopenia

fluid overload (reduced Na+)

crackles, kussmaul breathing

hepatomegaly

less than 0.5ml/kg/hr

AKI etology

lupus - autoimmune

alcohol

DM - inflammed blood vessels from sugar

HTN - vasoconstriction

AKI tx

0.9% NS for fluids bc of reduced Na+

dialysis for hyperkalemia, metabolic acidosis, fluid overload, uremic encephalopathy, pulm edema

hypercatabolism

protein restriction, high carbs, restrict potassium and sodium

hemodialysis

remove waste products and excess fluid

peritoneal dialysis

peritoneal membrane used to exchange fluid and solutes

AKI meds

volume expanders - renal perfusion for hypotension

loop diuretics - reduce toxic concentration

ACE inhibitors - hypertension

antacids or histamin. - gastric ulcers

sodium polystyrene sulfonate - reduce serum levels

sodium bicarbonate - metabolic acidosis

erythropoietin inj

diagnostics for AKI

hyperkalemia

hyperphosphatemia

hypocalcemia

hyponatremia

ABGS, metabolic acidosis

CBC; anemia, thrombocytopenia

elevated creatinine, BUN

azotemia (elevated levels of nitrogenous waste: urea and creatinine)

SG; proteinuria, renal tubular epithelial cells

renal biopsy

renal ultrasound and doppler

KUB, abd and pelvic CT