VS
RISKS
Electrolytes imbalance (potassium and sodium) -need to check hyper or hypo
Low blood pressure (have to check vitals before and after) Risk
... [Show More] for infection
Long-term mobidity Life threatening
Cardiovascular disease remained the most common cause of death in ESRD patient
▪ Acute Kidney Injury- Three phases- Prodromal- Oliguric- Postoliguric
Prodomal Phase
- Normal or declining urine output
- Serum blood urea nitrogen (BUN) and creatine levels rise Oliguric phase (10-14 days) range from 1 day to 8 weeks
- Oliguria – Small abnormal amount of urine
- Edema, Hypertension, Hypervolemia
- Distended neck veins, weight gain
- Crackles, possibly heart faily
- WBC and RBC in urine
- Protein in urine
- Hyperkalemka
- Volume overload
- Azotemia and uremia
- Metabolic acidosis Postoliguric phase (5% recover)
- Fluid volume deficit
- Labs begin to normalize
- Polyuria – sodium waste
▪
▪ Acute Tubular Necrosis and the causes of Acute Tubular Necrosis
ATN is the result of tubular cell injury
- Ischemia: Exposure to nephrotoxic substances
- ½ of all cases of AKI
Nephrotoxins leading cause of ATN (aminoaglycosides, NSAIDS, amphotericin B, cisplatin, tetracycline.
CI- AKI or Contrast-induced nephropathy
▪ Cystitis- signs and symptoms
(inflammation of the bladder) no fever or flank pain If fever is present – Might be infection (UTI)
Confusion Cloudy urine Frequency Urgency Dysuria
Intrarenal Kidney Injury- Toxic causes of
Box 28.1
Types of Acute Kidney Inj ury Prerenal
• • Absolute decrease in circulating volume
o • Hemorrhage
o • Dehydration
o • Burns
• • Relative decrease in circulating volume
o • Distributive shock (neurogenic, anaphylactic, septic)
o • Third-spacing and edema
o • Decreased cardiac output
▪ • Cardiogenic shock
▪ • Dysrhythmias
▪ • Cardiac tamponade
▪ • Heart failure
▪ • Myocardial infarction
• • Primary renal hemodynamic abnormalities
o • Occlusion or stenosis of renal artery*
o • Drug-induced impairment of renal autoregulation in susceptible persons†
Postrenal
• • Benign prostatic hyperplasia
• • Kinked or obstructed catheters
• • Intraabdominal tumors
• • Strictures
• • Calculi
Intrarenal/Intrinsic
• • Tubular (acute tubular necrosis)
o • Ischemic
▪ • Prolonged prerenal failure
▪ • Transfusion reactions
▪ • Rhabdomyolysis
o • Nephrotoxic
▪ • Prolonged postrenal failure
▪ • Certain antimicrobials (antibiotics; antifungal and antiviral drugs)
▪ • Radiographic contrast media
▪ • Certain cytotoxic chemotherapy agents
▪ • Recreational drugs (amphetamines, heroin)
▪ • Environmental agents (heavy metals, carbon tetrachloride, insecticides)
▪ • Snake and insect venom
• • Glomerular
o • Acute glomerulonephritis
• • Interstitial
o • Acute allergic interstitial nephritis
o • Acute pyelonephritis
• • Vascular
o • Vasculitis
o • Emboli
o • Nephrosclerosis (due to primary hypertension, hypertensive emergencies, and urgency) [Show Less]