AKI
What is an Acute Kidney Injury?
Rapid loss of kidney function with: Rise in serum creatinine and/or reduction in urine output, Elevated BUN and K+, & Azotemia
What are postrenal injuries?
Causes: mechanical obstruction of outflow which results reflux into renal pelvis, impairing kidney function
What are some interprofessional approaches of care for AKIs?
Ensure adequate intravascular volume and cardiac output, closely monitor fluid intake during oliguric phase, hyperkalemia therapies, renal replacement therapy, nutritional therapy, etc.
How are recipients selected for a transplant?
Candidacy determined by a variety of medical and psychosocial factors that vary among transplant centers
Possible exclusions: obesity, smoker
Preemptive transplant (before dialysis is required) is possible if recipient has a living donor
Name the types of rejection for transplants & describe them
Hyperacute (antibody-mediated, humoral) rejection • Occurs minutes to hours after transplant
Acute rejection
• Occurs days to months after transplant
Chronic rejection
• Process occurs over months or years and is irreversible
• May go back on transplant list
What is Azotemia?
Accumulation of nitrogenous waste products
What are examples of prerenal injuries?
• Severe dehydration, heart failure, decreased CO
Indications for Renal Replacement Therapy?
Volume overload, Elevated serum potassium level, Metabolic acidosis, BUN level > 120 mg/dL (43 mmol/L), Significant change in mental status, Pericarditis, pericardial effusion, or cardiac tamponade, Clinical status of patient
What are contraindications for recipient selection for a kidney transplant?
Advanced cancer, Refractory/untreated heart disease, Chronic respiratory failure, Extensive vascular disease, Chronic infection, Unresolved psychosocial disorders
Infection, cardiovascular disease, cancer, recurrence of original kidney disease, and corticosteroid-related complications.
What are the causes of acute kidney injuries?
There are various causes of kidney injuries that range can either be prerenal, intrarenal, or postrenal.
What are examples of intrarenal injuries?
Prolonged ischemia, Nephrotoxins, Hemoglobin released from hemolyzed RBCs, Myoglobin released from necrotic muscle cells, Kidney diseases—acute glomerulonephritis and SLE, Acute tubular necrosis (ATN)
What are the types of Renal Replacement Therapy?
Peritoneal dialysis (PD), Intermittent dialysis (ID), & continuous renal replacement therapy (CRRT)
What are the donor sources available for kidneys?
Deceased donors with compatible blood type, Blood relatives, Emotionally related living donors, Altruistic living donors, or Paired organ donation
What are prerenal injuries?
Causes: factors that reduce systemic circulation causing reduction in renal blood flow which leads to oliguria
Autoregulatory mechanisms attempt to preserve blood flow
Prerenal azotemia results in Na+ excretion, increased Na+ and H2O retention and urine output
Describe Acute Tubular Necrosis
Results from ischemia, nephrotoxins, or sepsis
Severe ischemia causes disruption in basement membrane and patchy destruction of tubular epithelium
Nephrotoxic agents cause necrosis of tubular epithelial cells—clog tubules
Potentially reversible
Acute care for AKIs?
Accurate intake and output, Daily weights, Assess for hypervolemia or hypovolemia, Assess for potassium and sodium disturbances, Meticulous aseptic technique, Careful use of nephrotoxic drugs, Skin care measures/mouth care
Postoperative care after a kidney transplant donor vs recipient?
Donor:
• Care is similar to that for open or laparoscopic nephrectomy
• Closely monitor renal function
• Closely monitor hematocrit
• Donors usually experience more pain than recipient
• Acknowledge their gift
Recipient:
• Maintenance of fluid and electrolyte balance is first priority
• Dehydration must be avoided
• Assess for hyponatremia/hypokalemia
• Acute tubular necrosis can occur
• Monitor urine output; maintain catheter patency
• Patient education: signs and symptoms of rejection, infection, and surgical complications; follow-up care
What are intrarenal injuries?
Causes: conditions that cause direct damage to kidney tissue
What are examples of postrenal injuries?
Benign prostatic hyperplasia, prostate cancer, calculi, trauma, and extrarenal tumors
Drug therapy to use for AKIs?
For issues with anemia, we give erythropoietin.
Goals of immunosuppressive therapy?
Adequately suppress immune response to prevent rejection
Maintain sufficient immunity to prevent overwhelming infection