Acute kidney injury and Hyperkalaemia

What is the definition of acute kidney injury?

A condition with low urine output accompanied by rising serum creatinine

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What are the potential risk factors of acute kidney injury?

History of AKI
Cardiac/liver disease
Diabetes
Hypovolaemia
Use of nephrotoxic drugs
Sepsis

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A minimum, of how many, mL/kg/hr is required to indicated good renal perfusion and function?

0.5-1mL/kg/hr

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What are the 3 types of acute kidney injury?

Prerenal
Intrinsic
Postrenal

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Describe prerenal AKI

Decrease in renal blood flow due to:
severe blood loss
severe infection
pancreatitis and liver disease that shift fluid in abdomen
burns
injury

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Describe intrinsic AKI

damage to structures within the kidney, due to:
renal artery/vein obstruction
acute tubular necrosis
structural injury

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Describe postrenal AKI

Obstruction of urine outflow from the kidney, due to:
kidney stones
enlarged prostate
blood clots
thrombosis
tumours

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Outline the nursing management of a patient with AKI

- monitoring regularly
- monitor urine output (report if below 0.5mL/kg/hr)
- monitor breathing - respiratory function may deteriorate due to pulmonary oedema
- close monitoring of circulatory status - urine output, fluid balance
- avoid diuretics

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What is the immediate nursing care of a patient with elevated potassium in blood?
(hyperkalaemia)

ABCDE assessment
12-lead ECG
seek medical help
insulin-glucose IV infusion
monitor serum K+ (potassium) and blood glucose

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What nursing interventions are needed for a patient with hyperkalaemia?

Calcium chloride IV
Insulin-glucose IV
salbutamol nebulised
dialysis

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How would you treat a patient with low blood sugars, but are conscious and orientated?

- ABCDE assessment
- stop insulin infusion immediately (if insitu)
- give rapid-acting carbohydrate (eg: dextrose, juice shots, fruit juice, sugar water)
- repeat BM after 10 mins
- administer glucagon IV

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How do you know if a patient is at RISK of AKI?
Stage 1

Increased creatinine x 1.5
GFR decreased >25%
Decreased urinary output (<0.5ml/h/kg) for 6 hours

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How do you know if a patient has acute kidney INJURY?
Stage 2

Increasing creatinine x 2
GFR decreased >50%
Decreased urine output (<0.5ml/h/kg) for 12 hours

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How do you know if a patient has acute kidney FAILURE?
Stage 3

Increased creatinine x 3
GFR decreased >75%
Decreased urine output <0.3mL/h/kg for 24hours

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How do you know if a patient has acute kidney LOSS?

Loss of renal function for more than 4 weeks

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What is worse than acute kidney loss?

end-stage kidney disease

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What are the normal serum ranges for urea and creatinine?

Urea: 2.5-6.6mmol/L

Creatinine: 55-120mmol/L

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What investigations can be done for acute kidney injury?

- urinalysis
- haematology and biochemistry (blood tests)
- radiological investigations: ultrasound and angiography
- renal biopsy

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What are some complications of AKI?

- elevated urea = seizure, coma, cardiac arrest
- risk of pulmonary oedema due to fluid retension
- risk of cardiac arrhythmia due to rising potassium
- risk of peripheral oedema
- risk of metabolic acidosis
- haematuria
- risk of anaemia

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What drugs cannot be given to patients with acute kidney injury?

Diuretics

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What are the ranges of potassium in blood for hyperkalaemia to be diagnosed?

Mild = 5.5-5.9mmol/L
Moderate = 6.0-6.4mmol/L
Severe = over 6.5mmol/L

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What is the normal potassium ranges?

3.6 - 5.4 mmol/L

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Acute kidney injury and Hyperkalaemia

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