ACUTE RENAL FAILURE (Acute kidney injury) Medical Information

Pathophysiology (Symptoms) Decreased urine output, although occasionally urine output remains normal Fluid retention, causing swelling in your legs, ankles or feet Respiratory dyspnea, tachypnea, uremic pneumonitis, lung crackles, Kussmaul respirations, and pulmonary edema Drowsiness Fatigue Confusion Nausea Seizures or coma in severe cases Chest pain or pressure Irregularities in the heartbeat which can be severe and life-threatening. This is from increases in the potassium level. Skin decreased skin turgor, yellow cast to skin, dry, pruritus, bruising, and uremic frost (late) Sometimes acute kidney failure causes no signs or symptoms and is detected through laboratory tests done for another reason. Etiology (Cause) Diseases and conditions that slow blood flow to the kidneys Prerenal ARF is caused by Blood loss, Blood pressure medications, Heart attack, Heart disease, Infection, Liver cirrhosis, Nonsteroidal antiinflammatory drugs, such as aspirin, ibuprofen and naproxen, Severe allergic reaction (anaphylaxis), Severe burns, and Severe dehydration Diseases and conditions that may damage the kidneys Intrarenal, or intrinsic, ARF is caused by Blood clots in the veins and arteries in and around the kidneys, Cholesterol deposits that block blood flow in the kidneys, Glomerulonephritis, Hemolytic uremic syndrome, Infection, Lupus, Medications, Multiple myeloma, Scleroderma, Vasculitis, and alcohol, heavy metals and cocaine Diseases and conditions that block urine from leaving the body Postrenal (postobstructive) ARF is caused by Bladder cancer, Blood clots in the urinary tract, Cervical cancer, Colon cancer, Enlarged prostate, Kidney stones, Nerve damage involving the nerves that control the bladder, and Prostate cancer Being hospitalized, especially for a serious condition that requires intensive care Blockages in the blood vessels in your arms or legs (peripheral artery disease) Diagnostic Tests Urine output measurements. A daily record of intake, output, and weights assists the physician in making treatment decisions. Urinalysis. Granular muddy-brown casts suggest tubular necrosis; tubular cells or tubular cell casts suggest acute tubular necrosis (ATN); reddish-brown urine and proteinuria suggest acute glomerular nephritis; presence of red blood cells may indicate glomerular nephritis; and white blood cells may indicate pyelonephritis Blood tests. A sample of your blood may reveal rapidly rising levels of urea and creatinine two substances used to measure kidney function. 24-hr urine creatinine. Acute damage to the kidney limits ability to clear creatinine, causing a 50% decrease. Urine sodium Prerenal and sometimes intrarenal leads to sodium retention whereas postrenal leads to sodium loss in urine Imaging tests. Imaging tests such as ultrasound and computerized tomography (CT) may be used. Kidney Biopsy. In certain situations, your doctor may recommend a kidney biopsy to remove a small sample of kidney tissue for laboratory testing. To remove a sample of kidney tissue, your doctor may insert a thin needle through your skin and into your kidney. Treatment Treating the underlying cause of your kidney failure Treatment for acute kidney failure involves identifying the illness or injury that originally damaged your kidneys. Intravenous Fluids or Diuretics depending on if your condition is causing fluid retention or lack of fluids. Medications to control blood potassium. Doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate) to prevent the accumulation of high levels of potassium in your blood. Dialysis to remove toxins from your blood. Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods at each meal. Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt Complications Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney function, or end-stage renal disease. People with end-stage renal disease require either permanent dialysis a mechanical filtration process used to remove toxins and waste from your body or a kidney transplant to survive. Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death. The risk of death is highest in people who had kidney problems before experiencing acute kidney failure. Metabolic acidosis Hyperkalemia Pulmonary edema Seizures Hypertension Cardiac dysrhythmias

ACUTE RENAL FAILURE (Acute kidney injury) Nursing Information

Assessment Check PT history for a disorder that can lead to prerenal, intrarenal, or postrenal ARF. Determine the patient s urinary patterns and document information such as frequency of voiding, approximate voiding volume, and pattern of daily fluid intake. The patient appears seriously ill and often drowsy, irritable, confused, and combative because of the accumulation of metabolic wastes. In the oliguric phase, the patient may show signs of fluid overload such as hypertension, rapid heart rate, peripheral edema, and crackles when you listen to the lungs. Patients in the diuretic phase appear dehydrated, with dry mucous membranes, poor skin turgor, flat neck veins, and orthostatic hypotension. Prevention Encourage clients to drink at least 3L daily. Consult with the provider regarding prescribed fluid restriction, if needed. Promote smoking cessation Follow instructions on over-thecounter medications. Follow the instructions on OTC pain medications such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others). Taking doses that are too high may increase your risk of acute kidney failure. Work with your doctor to manage kidney problems. If you have kidney disease or other diseases or conditions that increase your risk of acute kidney failure, follow your doctor's recommendations for managing your chronic conditions. Nursing Diagnosis Fluid volume deficit related to excessive urinary output, vomiting, hemorrhage OUTCOMES. Fluid balance; Circulation status; Cardiac pump effectiveness; Hydration INTERVENTIONS. Bleeding reduction; Fluid resuscitation; Blood product administration; Intravenous therapy; Circulatory care; Shock management Interventions Note the excretory route for medications so that the already damaged kidneys are not further damaged by nephrotoxins. Rest and recovery are important nursing goals. By limiting an increased metabolic rate, the nurse limits tissue breakdown and decreases nitrogenous waste production. A quiet, well-organized environment at a temperature comfortable for the patient ensures rest and recovery. Provide the client a diet that is high in carbohydrates and moderate in fat. If the patient experiences pruritus, help the patient clip the fingernails short and keep the nail tips smooth. Note that one of the most common sources of postrenal ARF is an obstructed urinary catheter drainage system. Before contacting the physician about a decreasing urinary output in an acutely or critically ill patient, make sure that the catheter is patent. Recognize that the irritability is part of the disease process. Keep the environment free of unnecessary clutter to reduce the chance of falls. Priority Notes Notify the physician if the patient s urine output drops below 0.5 mL/kg per hour or if the daily weight changes by more than 2 kg (4.4 lb). Chronic Renal Failure (CRF) is a progressive, irreversible kidney disease. When your kidneys lose their filtering ability, dangerous levels of fluid, electrolytes and wastes accumulate in your body. Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you're otherwise in good health, you may recover normal kidney function. Clinical manifestations occur abruptly with ARF. Oliguric ARF generally has three stages. During the initial phase, when trauma or insult affects the kidney tissue, the patient becomes oliguric. This stage may last a week or more. The second stage of ARF is the diuretic phase, which is heralded by a doubling of the urinary output from the previous 24 hours. During the diuretic phase, patients may produce as much as 5 L of urine in 24 hours but lack the ability for urinary concentration and regulation of waste products. This phase can last from 1 to several weeks. The final stage, the recovery phase, is marked by a return to a normal urinary output (about 1500 to 1800 mL/24 hr), with a gradual improvement in metabolic waste removal.