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Lectured by:

Michael P. Nonog, BSN-RN, MAN


Instructor
ACUTE
KIDNEY
FAILURE

ACUTE KIDNEY FAILURE
Also known as:
AKI
Acute Kidney Injury
Rapid loss of kidney functioning
FUNCTIONS OF THE KIDNEYS
Main functions:
Filters blood
Waste products
Water
Glucose
Ions
Amino Acids
Reabsorbs useful substances
All unabsorbed substances are excreted outside the
body in form of urine
SPECIAL FUNCTIONS OF THE
KIDNEYS
Blood pressure regulation by
renin secretion
RBC production by
erythropoeitin secretion
Metabolism of Vitamin D
CAUSE
- Causes are categorized depending on the site
affected:
1. Prerenal
aka Prerenal Azotemia
These are causes that decreases effective blood
flow to the kidneys.
Low blood volume
Heart failure, AMI, arrythmias
Local changes to the blood vessels supplying
blood to the kidneys
CAUSE
2. Intrinsic
aka Intrarenal Acute Failure
Cause are due to damage to the kidney, itself
Maybe due to the damage to the glomeruli, renal
tubules or interstitium
Glomerulonephritis
ATN
Acute Tubular Necrosis
AIN
Acute Interstitial Nephritis
Acute pyelonephritis


CAUSE
3. Postrenal
aka Postrenal Obstruction
These are causes as a consequence of urinary
obstruction
Benign Prostatic Hyperplasia
Kidney stones
Bladder stones
Urethral malignancy
Pregnancy
SIGNS AND SYMPTOMS
- Results from the
disturbances of
kidney functions
- S-I-C-K K-I-D-N-E-Y
S- Skin rashes
I- Increased BUN
C- Creatinin elevated
K- Kidney
inflammation

K- K+ is increased
I- Irregular heart beat
D- Discomfort; PAIN
N- Nausea and
vomiting
E- Edema
Y- Yes
DIAGNOSIS
- A Clinical History and Laboratory data is needed to
establish rapid reduction in kidney functioning.

1. Blood Test
BUN : 10-20 mg.dL
Serum Uric Acid : 2.5-8 mg/dL
Albumin : 3.2-5.5 mg/dL
RBC : 4.5-5.5 mg/dL
Hematocrit : 38-54 vol%
Serum Creatinine: : 0.4-1.2 mg/dL

CREATININE CLEARANCE
24 hour urine specimen
Test for renal function
Normal Values (Per 24 hours)
a. Male 20-26 mg/kg
b. Female 14-22 mg/kg
Start collection at 2
nd
voiding

DIAGNOSIS
2. Routine Urinalysis
Color : Amber / Straw
pH : 4.5-8 (Average 6)
Specific Gravity : 1.010-1.025
Protein : Absent
RBC : 0-5 / hpf
WBC : 0-5 / hpf
Pus : Absent
Glucose : Absent
Ketones : Absent
Casts : 0-4

DIAGNOSIS
- To rule out urinary
obstruction in Postrenal AKI
Post Void Residual
Renal UTZ
CT Scan of the Abdomen
DIAGNOSIS
To know the underlying cause
1. USA
Urine Sediment Analysis
2. Renal UTZ
3. Kidney Biopsy
Indications for renal biopsy
Unexplained AKI
AKI with Nephrotic Syndrome
System dse. Associated with AKI
Kidney Biopsy
- To determine malignancies
- Nursing Interventions
NPO 6-8 hours
Check PTT, PT (Bleeding is usual)
Mild Sedation
Local anesthesia
Hold breath during insertion of needle
UTZ to locate kidneys

DIAGNOSIS
Renal Biopsy
Bedrest 24 hours
Monitor V/S
Assess for pain, N/V
Hct and Hgb
No heavy activity 2 weeks
Assess for:
Infection
Bleeding

STAGING
- Follows the RIFLE criteria by Acute Dialysis Quality Initiative (ADQI)

1. Risk
GRF decrease >25%
Serum Creatinine increased 1.5 times
Urine production < 0.5ml/ kg/hour for 6 hours

2. Injury
GRF decrease >50%
Serum Creatinine doubled
Urine production < 0.5ml/ kg/hour for 12 hours

STAGING
3. Failure
GRF decrease >75%
Serum Creatinine tripled
Urine output < 0.3ml/ kg/hour for 24 hours

4. Loss
Persistent AKI or complete loss of kidney
functioning for more than 4 weeks

5. ESRD
Complete loss of kidney functioning for more
than 3 months
Needs Renal Replacement Therapy



MANAGEMENT
Goal of treatment:
1. Avoidance of substances that are toxic to the
kidneys.
2. Monitor renal functioning.
3. Relief of urinary retention and obstruction.
4. Promote measures to ensure normal K+
levels.
5. Maintain fluid balance.
6. Maintain acid-base balance.


SPECIFIC THERAPIES
1.Low blood pressure
2.Wegeners granulomatosis
3.Toxin-induced prerenal AKI
4.Obstruction of the urinary tract
5.Fluid volume overload
6.Complete loss of renal functioning
COMPLICATIONS
1.Metabolic Acidosis
2.Hyperkalemia
3.Pulmonary edema