Overview of Acute Kidney Injury (AKI)

• Acute kidney injury is a condition characterized by a sudden decline in kidney function.

Dietary Management for Patients with AKI

• Protein Restriction: Patients need to avoid specific types of proteins depending on their kidney function.
• Sodium and Potassium: Generally, patients are placed on sodium and potassium-restricted diets to help manage electrolyte levels.
• Intake and Output Monitoring: Continuous monitoring of a patient's intake and output is crucial.
• Serum Electrolytes: Regular checks of serum electrolyte levels help assess the effectiveness of dietary modifications.

Complications and Clinical Manifestations of AKI

• Complications must be differentiated from expected disease processes.
• Expected Symptoms: Initial symptoms such as decreased renal output in the oliguric phase is an expected manifestation, e.g., urine output may be around 300 mL/day.
• Unexpected Complications: Signs of pericarditis or seizures may indicate a deterioration in the patient's condition.
  • Pericarditis: An unexpected finding correlates with worsening of the patient’s health status.
  • Seizures: May occur due to increased sodium levels or elevated blood urea nitrogen (BUN).

Anemia and Its Implications in AKI

• Anemia Development: Anemia can develop with acute kidney injury, although it is more notable in chronic kidney injury due to decreased erythropoietin production.

Considerations for Geriatric Patients with AKI

• Older adults may experience a general decline in bodily functions, leading to a higher risk for AKI.
  • Functional Reserve Decline: Aging reduces the kidneys' ability to retain sodium and concentrate urine due to diminished functional reserve and altered cardiac output.
  • Increased Risk Factors: Hypertension and diabetes mellitus can also exacerbate kidney function decline in older adults.

Chronic Kidney Disease (CKD)

• Progression from AKI to CKD: If AKI is not properly managed, it can progress to chronic kidney disease, leading to irreversible kidney damage.
  • Early recognition of symptoms is crucial to prevent chronic issues.
• End Stage Kidney Disease (ESKD/ESRD): Eventually leads to progressive functional decline, often requiring dialysis or a transplant.

Clinical Manifestations of CKD

• Azotemia and Uremia: Buildup of nitrogenous waste products in the blood signifies worsening kidney function.
  • Azotemia: Elevated nitrogen-based waste products.
  • Uremia: Azotemia with associated symptoms; includes manifestations such as uremic frost and pruritus.
• Stages of Chronic Kidney Disease:
  • Based on glomerular filtration rate (GFR).
  • Stage 1-2: Typically asymptomatic; sufficient nephron function remains.
  • Stage 3: Symptoms begin to manifest.
  • Stage 4: GFR 15-29% indicates preparation for dialysis or transplant.
  • Stage 5: GFR <15% indicates kidney failure requiring dialysis or a transplant.

Electrolyte Imbalances in CKD

• Decreased ability to excrete electrolytes leads to elevated levels of potassium, sodium, phosphorus, and magnesium in CKD patients.
  • Effect of Phosphate: Increased phosphate binds with calcium, leading to hypocalcemia, triggering the release of parathyroid hormone (PTH) to raise calcium levels, often leading to weakened bones (osteodystrophy).

Nursing Care and Management in CKD

• Goal: Manage fluid volume overload due to reduced urine output, which can lead to decreased cardiac function.
• Monitoring: Regular assessment of vital signs, renal function, and electrolyte levels are crucial in patient care.

Dialysis Overview

• Dialysis is a treatment used for patients with advanced kidney failure and is categorized into hemodialysis and peritoneal dialysis.
• Hemodialysis:
  • Requires access via a fistula or graft; typically done 3-4 times a week for 3-4 hours.
  • Risks include bleeding, ischemia, and complications from anticoagulation with heparin.
• Peritoneal Dialysis:
  • Involves instilling fluid into the peritoneal cavity and allowing for waste removal over time.
  • Can be done overnight or continuously, but carries risks of infection such as peritonitis.

Complications of CKD and Dialysis

• Potential complications include electrolyte imbalances, anemia, infection, and cardiovascular problems.

Patient Education and Lifestyle Modifications

• Clients should be educated on dietary restrictions, signs of complications, and the importance of fluid management. Lifestyle modifications may include:

  • Exercise: Moderate physical activity is essential.
  • Alcohol Limitation: Recommend limiting alcohol intake and smoking cessation.
  • Monitoring weight: 1 kg weight gain equals approximately 1 L fluid volume.

• History Taking: Important questions include inquiries about kidney issues, drug use, and chronic health problems.