Acute Kidney Injury, (full description).

Acute Kidney Injury description

1. Acute Renal Failure By : Anita P. Dahanga

2. Outline Introduction Definition Incidence Risk factor Etiology Pathophysiology Phases Clinical manifestation Diagnostic evaluation Medical management Nursing management Complications Patient education

3. Introduction Acute kidney injury also called as acute renal failure. Acute kidney injury occurs when kidneys suddenly become unable to filter waste products from blood when kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and blood’s chemical makeup may get out of balance.

4. Definitions It is a syndrome of varying causation that results in a sudden decline in renal function. It is frequently associated with an increase in BUN and creatinine, oliguria(<500ml urine/24 hours) hyperkalemia and sodium retention. It is a critical condition where excretory function of kidney declines rapidly over a period of hours/ days which is associated with accumulation of waste product and water. Acute kidney injury is a sudden reduction in kidney function that results in nitrogenous wastes accumulating in the blood.

5. Incidence Incidence of AKI is 31.2%for southeast Asian countries. Common contributing causes of AKI in India are diarrheal illness, malaria, snake bite. Contrarily in western countries the main causative factors of AKI are hemolytic uremic syndrome, major complicated surgeries etc.

6. Risk factors Advanced age Blockages in the blood vessels In arms or leg Diabetes High blood pressure Heart failure Kidney diseases Liver disease Certain cancers and other treatment

7. Etiology PRERENAL: Results from condition that decreases renal blood flow such as:- Hypovolemia Shock Blood loss Embolism Burns Cardiovascular disorder Sepsis

8. Etiology: INTRA RENAL Results from injury to renal tissue and are usually associated with- Nephrotoxic agents Infection Ischemia & blockage Polycystic kidney disease

9. Etiology: POST RENAL

10. Pathophysiology: PRERENAL Decreased blood flow leads to hypoperfusion Azotemia Renal blood flow is interrupted Decreased oxygen delivery Hypoxemia and ischemia GFR rate decreases Electrolyte imbalance Tubular reabsorption of sodium and water increases

11. Pathophysiology: Intra renal Parenchymal renal failure Damage to the filtering structure of the kidney. Nephrotoxicity or inflammation damages the delicate layer under the epithelium. Severe or prolonged lack of blood flow causes ischemia. Renal damage + excess nitrogen into he blood.

12. Pathophysiology: Post renal Bilateral obstruction of urine outflow (bladder, ureter, urethra)- post renal failure. Bladder obstruction- anticholinergic drug, infection, tumor. Ureteral obstruction- blood clots, calculi, edema. Urethral obstruction- BPH ,tumor , structures.

13. Phases of AKI

14. Phases continued:

15. Clinical manifestation Prerenal:

16. Clinical manifestation- Intra renal: Edema usually present

17. Clinical manifestation- Postrenal:

18. Diagnostic evaluation

19. Medical management Key treatment areas include prevention strategies, fluid balance, medication and electrolytes balances.

20. Prevention

21. Fluid resuscitation

22. Fluid restrictions Fluid restrictions is used to prevent circulatory overload and development of interstitial edema. Patient with AKI are usually restricted to 1 L of fluid per 24 hours.

23. Renal replacement therapy Hemodialysis:- hemodialysis separates and removes from the blood excess electrolytes, fluids and toxins by means of a hemodialyzer. Indication:- BUN >90mg/dl Sr. create level of 9mg/dl Medication toxicity Hyperkalemia Contra indication:- Hemodynamic instability Inability to anticoagulate

24. Hemodialysis treatment last for 3-4 hours in acute phase of kidney failure hemodialysis is performed daily. Then the frequency decrease to 3 times per week.

25. Peritoneal dialysis Peritoneal dialysis is a less high technology modality used in patients with AKI. PD involves the introduction of sterile dialyzing fluid through an implanted catheter into the abdominal cavity.

26. Peritoneal Dialysis

27. Pharmacological management Diuretics:- diuretics are used to stimulate output in the fluid overloaded patients with functioning kidneys. It is given to dilate renal arteries and to control fluid volume. Loop diuretic-furosemide, torsemide Thiazide diuretic- chlorothiazide Osmotic diuretic-mannitol Potassium sparing diuretic-spironolactone Kayexalate- it removes potassium from blood. Dopamine (2-3MCG/kg/min) is infused to stimulate blood flow to the kidney.

28. Nutrition AKI causes severe nutritional imbalances because nausea and vomiting contribute to inadequate dietary intake. If the patient can not eat enteral nutrition is recommended. Encourage to take high calorie, high protein diet. Foods and fluids containing potassium or phosphorus (Bananas, citrus fruits, and juices, coffee are restricted).

29. Nursing management Assessment Assess urine output- varies from scanty to a normal volume. Assess blood in the urine hematuria may be present in patient with AKI. Assess laboratory results-Lab results may increase or decrease or stabilize and these may indicate each phase of AKI. Assess intake and output. Assess for risk for infection. Assess the skin turgor.

30. Nursing diagnosis

31. Nursing diagnosis: Continued

32. Nursing intervention

33. Nursing interventions: Continued Providing skin care- skin may be dry and susceptible to breakdown because of edema therefore keep the skin clean and well moisturized. Provide safety measures- patient with CNS involvement may be dizzy or confused.

34. Complications Infection Arrhythmias due to hyperkalemia. Electrolytes( sodium, potassium, calcium ,phosphorus) abnormalities. Multiple organ system failure. GI bleeding due to stress ulcers.

35. Patient education Explain the treatment and possible complications. Explain diet and fluid restrictions. Demonstrate how to check BP, pulse, respiration and weight. Discuss personal hygiene and how to avoid infection. Describe medication and adverse effects. Explain need for ongoing follow up with health care professional.

36. Summarization

37. Assignment Write the RIFLE classification for acute kidney injury .

38. Thank you