Acute Kidney Injury (AKI)

Overview

Acute Kidney Injury (AKI) is a rapid loss of renal function characterized by an increase in serum creatinine and a decrease in urine output. It is categorized as prerenal, intrarenal, or postrenal based on the cause of the injury. Management focuses on identifying the underlying cause, managing fluid balance, and preventing electrolyte imbalances.

Key nursing concepts

• Prerenal injury results from decreased perfusion to the kidneys.
• Intrarenal injury involves direct damage to the kidney tissue or nephrons.
• Postrenal injury is caused by mechanical obstruction of urine outflow.
• The oliguric phase is characterized by a sudden drop in urine output.
• The diuretic phase carries a high risk for dehydration and hypokalemia.
• Recovery can take up to a year for renal function to stabilize.

Important nursing considerations

• Maintain strict fluid intake and output records every hour.
• Assess lung sounds frequently for crackles indicating fluid overload.
• Monitor serum potassium and creatinine levels daily.
• Review medication list for nephrotoxic agents like NSAIDs or aminoglycosides.
• Assess for signs of uremia such as pruritus and confusion.
• Ensure cardiac monitoring is active if hyperkalemia is present.

Patient teaching

• Explain the importance of a low-protein and low-potassium diet during the acute phase.
• Instruct the patient to report a weight gain of more than two pounds in one day.
• Teach the patient to avoid over-the-counter NSAIDs which can damage kidneys further.

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