ACTIVITY 2 about kidney disease related.

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1. ACTIVITY 2 BY: 220257534 CARIAS, TIFFANY

2. WHAT IS ACUTE KIDNEY INJURY? Acute kidney injury (AKI), also known as acute renal failure, is a sudden loss of kidney function that occurs over a period of hours to days. AKI is a serious and potentially life-threatening condition that can lead to a build up of waste products and fluids in the body, which can affect various organ systems.

3. ACUTE KIDNEY INJURY There are three stages of AKI: Stage 1: The serum creatinine level is increased by 0.3 mg/dL (26.5 μ mol/L) or more within 48 hours, or the serum creatinine level is 1.5 to 1.9 times the baseline level. Stage 2: The serum creatinine level is increased by 2.0 to 2.9 times the baseline level. Stage 3: The serum creatinine level is increased by 3.0 times or more the baseline level, or the serum creatinine level is greater than or equal to 4.0 mg/dL (353.6 μ mol/L), or the patient requires renal replacement therapy, or there is evidence of renal parenchymal disease on imaging.

4. ACUTE KIDNEY INJURY AKI can be caused by a variety of factors including: Dehydration Sepsis M edication toxicity O bstruction of the urinary tract

5. SYMPTOMS OF ACUTE KIDNEY INJURY Decreased urine output S welling in the legs or ankles Fatigue Confusion S hortness of breath.

6. HOW TO DETECT EARLY SIGNS OF ACUTE KIDNEY INJURY (AKI) Decreased urine output: One of the earliest signs of AKI is a decrease in urine output. This may be noticed as a decrease in the amount of urine produced or a decrease in the frequency of urination. Fluid retention: AKI can lead to fluid retention, which may cause swelling in the legs, ankles, or feet. Fatigue and weakness: AKI can cause fatigue and weakness, as the body accumulates waste products and fluids.

7. HOW TO DETECT EARLY SIGNS OF ACUTE KIDNEY INJURY (AKI) Nausea and vomiting: AKI can cause nausea and vomiting, as the body tries to rid itself of waste products. Confusion or decreased alertness: In severe cases, AKI can cause confusion or decreased alertness, as toxins build up in the body. High blood pressure: AKI can cause high blood pressure, which may be detected during routine blood pressure checks. Abnormal blood tests: AKI may cause abnormalities in blood tests such as elevated levels of creatinine and blood urea nitrogen (BUN).

8. NURSING MANAGEMENT Monitoring fluid and electrolyte balance: The nurse should closely monitor the patient's fluid intake and output, as well as electrolyte levels, to prevent dehydration and electrolyte imbalances. Medication management: The nurse should review the patient's medication list and ensure that medications that can cause kidney injury, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are avoided or used with caution. Assessing for and treating infections: The nurse should assess the patient for signs and symptoms of infection, such as fever or urinary tract symptoms, and ensure prompt treatment with appropriate antibiotics.

9. NURSING MANAGEMENT Monitoring and treating hypotension: The nurse should monitor the patient's blood pressure and provide prompt treatment for hypotension, which can decrease renal blood flow and cause AKI. Monitoring and treating hyperglycaemia: The nurse should monitor the patient's blood glucose levels and provide prompt treatment for hyperglycaemia, which can cause osmotic diuresis and increase the risk of dehydration and AKI.

10. NURSING MANAGEMENT Preventing and managing urinary tract obstruction: The nurse should monitor the patient for signs and symptoms of urinary tract obstruction and provide prompt treatment, such as catheterization or stent placement, to relieve obstruction. Educating the patient and family: The nurse should educate the patient and family about AKI, its causes and risk factors, and the importance of adhering to prescribed treatments and following up with healthcare providers.

11. STAGES OF ACUTE KIDNEY INJURY (AKI) Prerenal AKI: This type of AKI occurs when there is a reduction in blood flow to the kidneys, leading to decreased perfusion and oxygenation of the renal tissues. Prerenal AKI is usually caused by conditions that reduce blood flow to the kidneys, such as dehydration, hypovolemia, or decreased cardiac output. The decreased blood flow can lead to ischemia and injury to the renal tubular cells, resulting in decreased urine output and increased serum creatinine levels.

12. STAGES OF ACUTE KIDNEY INJURY (AKI) Intrarenal AKI: This type of AKI occurs when there is damage to the renal parenchyma, such as the glomeruli, tubules, or interstitium. This can be caused by a variety of factors, including nephrotoxic medications, sepsis, acute glomerulonephritis, acute interstitial nephritis, or acute tubular necrosis. Intrarenal AKI is characterized by decreased urine output, increased serum creatinine levels, and the presence of casts in the urine.

13. STAGES OF ACUTE KIDNEY INJURY (AKI) Postrenal AKI: This type of AKI occurs when there is obstruction of urine flow from the kidneys, usually due to an obstruction in the ureters, bladder, or urethra. Postrenal AKI can be caused by conditions such as kidney stones, bladder or prostate cancer, or trauma. The obstruction can lead to increased pressure within the urinary tract, causing backflow of urine and damage to the renal parenchyma. Postrenal AKI is characterized by decreased urine output, increased serum creatinine levels, and hydronephrosis on imaging studies.

14. TREATMENT OPTION FOR ACUTE KIDNEY INJURY (AKI) Fluid and electrolyte management: The primary goal of AKI management is to maintain fluid and electrolyte balance, which may involve providing intravenous fluids and electrolytes to correct imbalances. Discontinuing or adjusting medications: If AKI is caused by medications, stopping or adjusting the dose of the offending medication may help to improve kidney function. Managing infections: Treating any infections that may be contributing to AKI, such as urinary tract infections, is important in managing the condition. Addressing underlying conditions: Treating underlying conditions, such as heart failure, liver disease, or diabetes, can help to improve kidney function.

15. TREATMENT OPTION FOR ACUTE KIDNEY INJURY (AKI) Renal replacement therapy (RRT): RRT is a form of treatment that replaces the normal filtering function of the kidneys. There are two main types of RRT: haemodialysis and peritoneal dialysis. These therapies may be used in patients with severe AKI or in cases where conservative measures have failed. Nutritional support: Patients with AKI may require specialized nutritional support to help maintain adequate protein and calorie intake while minimizing waste products that accumulate in the blood. Avoiding nephrotoxic agents: Avoiding exposure to medications and substances that can further damage the kidneys is important in managing AKI.

16. RENAL REPLACEMENT THERAPIES Renal replacement therapy (RRT) is a form of treatment for acute kidney injury (AKI) that replaces the normal filtering function of the kidneys. There are two main types of RRT: haemodialysis and peritoneal dialysis.

17. HAEMODIALYSIS Haemodialysis: Haemodialysis involves the use of a machine to filter the blood outside of the body. The patient's blood is passed through a filter called a dialyzer, which removes waste products and excess fluid from the blood. Haemodialysis is typically performed in a hospital or outpatient dialysis centre and requires the placement of a vascular access device, such as a catheter, in a large vein .

18. PERITONEAL DIALYSIS Peritoneal dialysis: Peritoneal dialysis involves the use of the lining of the patient's abdominal cavity to filter the blood. A catheter is inserted into the patient's abdomen, and a special fluid is introduced into the abdominal cavity. The fluid absorbs waste products and excess fluid from the blood, and is then drained out of the abdomen. Peritoneal dialysis can be performed at home, but requires a significant amount of patient education and training.

19. OTHER RENAL REPLACEMENT THERAPIES Continuous renal replacement therapy (CRRT) is commonly used to provide renal support for critically ill patients with acute kidney injury, particularly patients who are hemodynamically unstable. A variety of techniques that differ in their mode of solute clearance may be used, including continuous venovenous hemofiltration with predominantly convective solute clearance, continuous venovenous hemodialysis with predominantly diffusive solute clearance, and continuous venovenous hemodiafiltration, which combines both dialysis and hemofiltration. The present article compares CRRT with other modalities of renal support and reviews indications for initiation of renal replacement therapy, as well as dosing and technical aspects in the management of CRRT.

20. OTHER RENAL REPLACEMENT THERAPIES Intermittent hemodialysis (IHD) is highly effective in achieving solute removal by solute clearance and fluid removal by ultrafiltration. However, IHD achieves this over a short period of time, typically 3–5 hours.

21. REFERENCES References Gibney, R. T. N. (2016). Continous renal replacement therapy and intermittent hemodialysis in acute kidney injury: equivalent or complementary? Journal of Thoracic Disease , 8 (9), 2397–2399. https:// doi.org /10.21037/jtd.2016.08.98 KDIGO Clinical Practice Guideline for Acute Kidney Injury. (2012). Kidney International Supplements , 2 (1), 1. https:// doi.org /10.1038/kisup.2012.1 National Institute for Health and Care Excellence. (2019, December 18). Overview | Acute kidney injury: prevention, detection and management | Guidance | NICE . Www.nice.org.uk . https:// www.nice.org.uk /guidance/ng148 Tandukar , S., & Palevsky, P. M. (2019). Continuous Renal Replacement Therapy. Chest , 155 (3), 626–638. https:// doi.org /10.1016/j.chest.2018.09.004 Terada, Y., Wada, T., & Doi, K. (2020). Acute Kidney Injury and Regenerative Medicine . Springer Nature.

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