Nutrition/Elimination

Chapter 71: Kidney Disorders

Acute Kidney Injury

Etiology and Pathophysiology
Prerenal
Causes are factors external to the kidneys that reduce
renal blood flow

Intrarenal
Causes include conditions that cause direct damage to
kidney tissue

Postrenal
Involve mechanical obstruction in the outflow of urine. As
the flow of urine is obstructed, urine refluxes into the renal
pelvis, impairing kidney function.

 J.K. is a 37-year-old man who fell off the roof of a

house he was constructing. He sustained severe
lacerations of his face and left leg, with substantial
blood loss.

Which type of kidney injury is J.K. at risk for?

 What are the contributing factors for this?

 What signs and symptoms of renal involvement would

you assess for?

Acute Kidney Injury

Clinical Manifestations
RIFLE classification

Risk (R)
Injury (I)
Failure (F)
Loss (L)
End-stage kidney disease (E)

Acute Kidney Injury

Clinical Manifestations
Oliguric phase
Urinary changes
Fluid volume
Hypovolemia may exacerbate AKI
With decreased urine output, fluid retention occurs
Metabolic acidosis
Sodium balance?
Potassium?

 J.K.s injuries have been repaired, but his urine output

has dropped below 350 mL/day.

J.K.s laboratory results reveal BUN 53 mg/dL and

serum creatinine 2.7 mg/dL.

He complains of fatigue.
His BP has risen to 178/98.

 What other manifestations should you observe for?

 What other laboratory results should you monitor?

 J.K.s urine output suddenly increases to 2 L overnight.

Is this a positive sign?

Acute Kidney Injury

Clinical Manifestations
Diuretic Phase

Recovery Phase

Audience Response Question

Which assessment would indicate to the nurse that
a patient has oliguria related to an intrarenal acute
kidney injury?

1. Urinary sodium levels are low.

2. The serum creatinine level is normal.
3. Oliguria is relieved after fluid replacement.
4. Urine testing reveals a specific gravity of 1.010.

Acute Kidney injury

Diagnostic studies
Thorough history
Serum creatinine
Urinalysis
Kidney ultrasonography
Renal scan

Computed tomography (CT) scan

Renal biopsy

Acute Kidney injury

Diagnostic studies
Contraindicated
Magnetic resonance imaging (MRI)
Magnetic resonance angiography (MRA) with gadolinium
contrast medium
Nephrogenic systemic fibrosis
Contrast-induced nephropathy (CIN)

 J.K.s urinalysis reveals slight hematuria and a low

specific gravity.

Renal ultrasound findings are normal.

What is the overall goal in the management of J.K. at
this point?

Acute kidney injury

Collaborative care
Indications for renal replacement therapy (RRT)

Volume overload
Elevated serum potassium level
Metabolic acidosis
BUN level higher than 120 mg/dL (43 mmol/L)
Significant change in mental status
Pericarditis, pericardial effusion, or cardiac tamponade

 J.K. continues to improve, but he has lost 6 lb since

admission.

He expresses concern regarding maintaining muscle

mass and his ability to perform his job as a
construction worker after discharge.

Nursing assessment?

 Nursing assessment?

 Nursing diagnoses?

 Nursing implementation
Acute intervention

 J.K. progresses well and is preparing for discharge.

His BUN is 19 mg/dL, serum creatinine is 1.4 mg/dL,
and urinalysis is normal.

J.K. has gained 2 lb since his nutritional needs were

addressed.

Acute Kidney Injury

Gerontologic Considerations
Acute Kidney Injury
More susceptible to AKI

Polypharmacy
Hypotension
Diuretic therapy
Aminoglycoside therapy
Obstructive disorders
Surgery
Infection