Acute Kidney Injury
- Rapid loss of Kidney Function
- 3 stages
- Prerenal: Reduction in systemic circulation aka reduction of blood to the kidneys that causes a decrease in glomerular perfusion and filtration. Examples are severe dehydration, reduction in CO, and Heart failure.
- Intrarenal: Direct injury to the kidney, Examples, prolonged ischemia, nephrotoxins ( aminoglycoside, antibiotics, contrast), hemoglobin and myoglobin ant the most important ATN also SLE and acute glomerulonephritis.
- Postrenal: Mechanical obstruction Ex. BPH, Prostate Cancer, tumors, trauma, kidney stones. Obstruction needs to be fixed within 48 hours or can cause irreversible kidney fibrosis.
Risk- Increase in CR X1.5, Decrease in GFR 25%; <0.5 ml/kg X 6h
Injury- Increase in CR X 2, Decrease in GFR 50%; < 0.5 ml/gk X12
failure- Increase in CR X 3 Decrease in GFT 75%; <0.3 ml/kg X24 or anuria X 12 hrs.
loss- Complete loss of Renal function at 4 weeks or more
ESRD- End stage renal disease
- Urinary changes: <400 mL/day, occurs within 1-7 days and lasts 10-14 days but can last months
- anuria is usually seen with urinary tract obstructions
- oliguira is usually seen in prerenal causes
- nonoliguirc AKIs are seen with acute interstitial nephritis and ATN
- Fluid Overload due to oliguria can cause; NVD with bounding pulse and Hypertension
- Fluid Overload can lead to Hear Failure, Pericardial and pleural effusions.
- SPG 1.010, normal range is 1.003-1.030
- Urinanalysis: casts, rbc, wbc
- Metabolic Acidosis- Kussmal Respirations (Rapid deep respirations)
- Neurological Disorders: fatigue and malaise
- Hyperkalemia, hyponatremia
- Elevated BUN/CR
Increase in Urinary Output 1-3 L/Day up to 5L
Monitor Fluid Electrolytes due to Increase UO Hyponatremia, hypokalemia and dehydration. Hypotension and Hypovolemic will also occur since you are peeing everything out.
BUN/CR start to stabilize
- GFR increase causing a decrease in BUN and CR
- Kidney Function improvement may be seen in 1-2 weeks but may take up to 12 months
- Some individuals do not recover and progress to the
- Reverses many of pathophysiologic changes associated with renal disease
- Eliminates dependence on dialysis
- Less expensive than dialysis after first year
- Being HIV-positive or having hepatitis B or C is not a contraindication to transplant.
- ECG, Chest x-rays, renal ultrasound, renal arteriogram, 3D ct, crossmatch during evaluation and 1 week before donation
- social worker or psychologist also makes sure you are good to donate
Kidney Transplant- Deceased Donor
- Even if the donor carried a signed donor card, permission from the donor’s legal next of kin is still requested after brain death is determined
- In deceased kidney donation, the kidneys are removed and preserved for up to 72 hours
Kidney Transplant - UNOS
- The United Network for Organ Sharing (UNOS) distributes deceased donor kidneys using an objective computerized point system. The ABO group, HLA typing, age, antibody level, and length of time waiting are entered into the national computer for each candidate.
- Extra points are given for high antibody
- The only exception to the previous plan is if a client needs an emergency transplant or if a donor and recipient match on all six HLA antigens (zero antigen mismatch). The client meeting either one of these criteria goes to the top of the list. Emergency transplants are given priority because the client is facing imminent death if not transplanted.
Diabetic Ketoacidosis (DKA)
- Insulin deficient
- hyperglycemia >250
- Usually in DM1
- Caused by: infections poor self management, neglect, not enough insulin
- Fruity breath, ketonuria, Abdominal pain, N/V, Metabolic acidosis, kusmal respirations
- ortohostatic hypotenstion, tachy cardia
- dry, loose soft sunken eyes.
- Inverventions: Ensure paten airway, give O2, fix fluid electrolytes .45% or .9 % NaCl, Give IV insulin, watch out for hypokalemia
Hyperosmolar Hyperglycemic Syndrome (HHS)
- Enough insulin to prevent DKA
- insufficient insulin
- hyperglycemia >600
- NO ketoacidosis
- usually older than 60 with T2DM
- COmmon Causes: UTI, sepsis, acute illness, pneumonia
- Severe neurologiacl: somnolence, coma, seziures, hemiparesis, aphasia