GASTROINTESTINAL DISEASES: • Myocardial infarction

ACUTE KIDNEY INJURY (AKI) Vasodilation resulting from:

• Anaphylaxis
• Antihypertensive medications or
DESCRIPTION other medications that cause
vasodilation.
Acute Kidney Injury (AKI) is a rapid • Sepsis
loss of renal function due to damage to the
kidneys. Depending on the duration and Intrarenal Failure
severity of AKI, a wide range of potentially Prolonged renal ischemia resulting from:
life-threatening metabolic complications can • Hemoglobinuria (transfusion
occur, including metabolic acidosis as well as reaction, hemolytic anemia)
fluid and electrolyte imbalances. • Rhabdomyolysis/myoglobinuria
A widely accepted criterion for AKI is (trauma, crush injuries, burns)
a 50% or greater increase in serum creatinine • Pigment nephropathy (associated
above baseline (normal creatinine is less than with the breakdown of blood cells
1mg/dL). Urine volume may be normal, or
• containing pigments that in turn
changes may occur including nonoliguria
occlude kidney structures)
(greater than 800 mL/day), oliguria (less than
400 mL/day or 0.5 mL/kg/h over 6 hours), or
Nephrotoxic agents such as:
anuria (less than 50 mL/day).
• Aminoglycoside antibiotics
(gentamicin, tobramycin)
ETIOLOGY
• Angiotensin-converting enzyme
AKI is primarily brought on by inhibitors
ischemia, hypoxia, or nephrotoxicity. A rapid • Heavy metals (lead, mercury)
loss in GFR, which is typically accompanied • Nonsteroidal anti-inflammatory
by reductions in renal blood flow, is an drugs
underlying characteristic. Although renal • Radiopaque contrast agents
stones are not a common cause of AKI, some • Solvents and chemicals (ethylene
recurrent types may increase the risk of AKI. glycol, carbon tetrachloride, arsenic)
Infectious processes such as:
CAUSES OF AKI • Acute glomerulonephritis
• Acute pyelonephritis
Prerenal Failure
Volume depletion resulting from: Postrenal Failure
• Gastrointestinal losses (vomiting, Urinary tract obstruction, including:
diarrhea, nasogastric suction) • Benign prostatic hyperplasia
• Hemorrhage • Blood clots
• Renal losses (diuretic agents, osmotic • Calculi (stones)
diuresis) • Strictures
Impaired cardiac efficiency resulting • Tumors
from:
• Cardiogenic shock PATHOPHYSIOLOGY
• Dysrhythmias • The urinary system functions as a
• Heart failure drainage for the body to excrete
 wastes such as urine and extra fluids
along with it.
• It consists of the kidneys, ureters,
bladder, and urethra.
• With the use of the kidney, blood
enters it and filters it.
• The kidneys are made up with
filtering units, which are the
nephrons, each nephron contains a
filter which is the glomerulus,
together with a tubule.
• Glomerulus filters the blood, while
the tubule puts back substances to the
blood and eliminates wastes.
The pathophysiology of Acute kidney injury
is divided into three types:
Pre-Renal Kidney Injury– There is a
decreased blood flow in the kidney.
Itrarenal Kidney Injury– There is a cast
formation within the kidney.
Post-Renal Kidney Injury– Obstruction
within the urinary tract.
DIAGNOSTICS AND LAB STUDIES
• Blood tests: ↓ blood pH, ↑ BUN level,
↑ creatinine
• Urine test: ↑ creatinine level, ↑
potassium level, ↓ sodium level
• 24-hour urine output measurements:
<0.5 mL/kg/hour for 6 hours
• Renal ultrasound: changes in kidney
size
TREATMENT AND MODALITIES
PHARMACOLOGIC:
• Diuretics: Furosemide (Lasix) or
osmotic diuretics such as mannitol is
used to wash out nephrons and
reduces azotemia and electrolytes
imbalance by preceding oliguria
• Osmotic Diuretics: Mannitol
• ACE inhibitors (antihypertensive) to
limit renal injury
• IV fluids: given if kidney failure is
caused by a lack of fluids in the blood
• Dopamine (Inotropin) IV infusion
improves cardiac output and increase
renal blood flow
• For possible complications such as:
GI Bleeding
▪ Antacids
▪ H2 receptor antagonists
▪ Proton-pump inhibitors
Hyperkalemia
▪ Calcium chlorides
▪ Bicarbonate
▪ Insulin and glucose
▪ Sodium polystyrene
sulfonate (Kayexalete)
Hyperphosphatemia
▪ Aluminum Hydroxide
(AlternaGEL, Amphojel,
Nephrox) medication used
for hyperphosphatemia
where it binds to phosphate
in the GI tract and is
eliminated from the bowel.
PROCEDURAL:
Hemodialysis:
Short-term Renal Replacement Therapy -To
manage complications of AKI such as
nonresponsive hyperkalemia until kidney
function is stable.
Continuous Renal Replacement Therapy-
Alternative for patients who experience
hypotension with short-term renal information/kidney-disease/kidneys-how-
replacement therapy. they-
work#:~:text=Each%20of%20your%20kidn
NURSING MANAGEMENT eys%20is,your%20blood%20and%20remov
es%20wastes.
• Monitor Vitals including urine output Hinkle, J. L., Cheever, K. H., & Overbaugh,
• Weigh patient daily to determine fluid K. J. (2022). Brunner & Suddarth's textbook
retention of medical-surgical nursing. 15th edition.
• Assess heart and lung sounds Philadelphia, Wolters Kluwer Health.
• Review chest x-ray and laboratory
parameters
• Administer diuretics as prescribed
• Limit intake of fluids
• Encourage a low sodium diet, limit
food with high potassium like
bananas, oranges and tomatoes
• Monitor mental status changes and
level of consciousness

REFERENCES
Acute kidney failure - Diagnosis and
treatment - Mayo Clinic. (2022, July 30).
https://www.mayoclinic.org/diseases-
conditions/kidney-failure/diagnosis-
treatment/drc-20369053
Belleza, M. (2023, August 15). Urinary
System Anatomy and Physiology. Acute
kidney failure - Diagnosis and treatment -
Mayo Clinic. (2022, July 30).
https://www.mayoclinic.org/diseases-
conditions/kidney-failure/diagnosis-
treatment/drc-20369053
Goyal, A., Daneshpajouhnejad, P., Hashmi,
M. F., & Bashir, K. (2023, June 12). Acute
kidney injury. StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK44
1896/
Moses, A., & Fernandez, H. (2022).
Ultrasonography in Acute Kidney Injury.
POCUS Journal, 7(Kidney), 35–44.
https://doi.org/10.24908/pocus.v7ikidney.14
989
National Institutes of Health. (2018). Your
Kidneys & How They Work.
https://www.niddk.nih.gov/health-