Beruflich Dokumente
Kultur Dokumente
Continuing Nursing
Education
Kristina M. Yaklin
here has been an increase in
the prevalence of acute kidney
injury (AKI) over the past 15
years due to the increased percentage of older adults in the population and increased survival rates with
cardiac disease and diabetes mellitus
(Talbot, 2008). Up to 50% of AKI
cases are thought to develop in the
hospital (Armitage & Tomson, 2003).
Approximately 5% of hospital
patients admitted to medical or surgical floors will have their admission
complicated by the development of
AKI (Cheung, Ponnusamy, &
Anderton, 2008; Talbot, 2008).
Research by Barrantes et al. (2009)
found that development of AKI in
hospitalized patients was associated
with a 7-fold increase in likelihood of
death, a 4-fold increase in length of
stay, and a 4-fold increase in the likelihood of transfer to a critical care unit
than those who did not develop AKI
in the hospital. An evaluation of 13
studies comprehensively found that
mortality for patients without AKI
was 6.9% compared with 31.2% in
patients with AKI (Ricci, Cruz, &
Ronco, 2007).
These findings indicate that AKI
leads to increased risk of mortality of
hospitalized patients. Since the prevalence of AKI is increasing, it is very
likely that most healthcare professionals will encounter patients with AKI.
The purpose of this article is to provide education on the pathophysiology of AKI, aid in identifying risk factors, and discuss current research on
treatment options and interventions.
Goal
To provide an overview of acute kidney injury, its pathophysiology, and treatments.
Objectives
1.
2.
3.
4.
Pathophysiology
AKI is a complex disorder with
varying definitions, most including an
abrupt decline in kidney function
leading to a rise in serum creatinine
and/or blood urea nitrogen levels,
with or without a decrease in urine
output (ADIS International Ltd.,
2009, Barrantes et al., 2009, Cheung
et al., 2008, Talbot, 2008,). AKI can be
classified into three cause categories:
pre-renal, intrinsic, and post-renal.
This offering for 1.3 contact hours is provided by the American Nephrology Nurses
Association (ANNA).
ANNA is accredited as a provider of continuing nursing education (CNE) by the American
Nurses Credentialing Centers Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number
CEP 00910.
Accreditation status does not imply endorsement by ANNA or ANCC of any commercial product.
This CNE article meets the Nephrology Nursing Certification Commissions (NNCCs) continuing nursing education requirements for certification and recertification.
January-February 2011
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January-February 2011
Table 1
RIFLE Classification System for AKI
Glomerular Filtration Rate Criteria
Increased creatinine x 1.5
or GFR decrease greater
than 25%
INJURY
Increased creatinine x 2
or GFR decrease greater
than 50%
FAILURE
Increased creatinine x 3
or GFR decrease greater
than 75% or creatinine
greater than
4 mg/100mL
RISK
LOSS
ESRD
January-February 2011
Current Treatment
Nurses can play a vital role in
identifying patients who are at risk for
AKI and intervening early, possibly
preventing life-threatening complications. It is also important for nurses to
be aware of the currently suggested
treatments and implications for their
practice. This knowledge can be used
for nurses to advocate on behalf of
patients, provide the best care, and be
mindful of current research.
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Table 2
Laboratory and Diagnostic Tests that Aid in the Diagnosis of AKI and in the
Determination of the Possible Cause
Laboratory Test or Diagnostic
Normal Value
Abnormal Value
Possible Indication
Blood Tests
Serum creatinine
Adults: 6 to 20 mg/dL
Elderly (over 60
years): 8 to
23mg/dL
BUN/creatinine ratio
10:1 to 20:1
Cystatin C
Urine Tests
Dipstick
Blood: Negative
Protein: Negative
Hematuria
Protein:+3 to +4
on strip
Osmolality
24-hour specimen:
300 to 900
mOsm/kg of water
Random specimen: 50
to 1200 mOsm/kg
of water
Urine-to-serum ratio:
1:1 to 3:1
Adult: 40 to 220
mEq/24 hours
Diagnostic Tests
Kidney ultrasound
Kidney doppler
Biopsy
Cysts, masses,
obstruction of
ureters, calculi, or
hydronephrosis
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January-February 2011
Nutritional Considerations
When planning for nutritional
needs of the patient experiencing
AKI, it is important to consider both
the severity of AKI and other co-morbidities the patient may have and how
Table 3
Summary of Suggestions of Nutritional Needs for Patients with AKI
Severity of AKI
Mild AKI
Moderate AKI
Severe AKI
Pharmocologics
The use of pharmacological
agents in AKI is a complex process
that may require renal dosing and
careful selection of medications.
Several drugs have been researched
and are still being debated as to the
benefit of their use in patients with
AKI. Those that will be discussed
here are dopamine, atrial natiuretic
peptide, fenoldopam, and pentoxifylline. Diuretics were discussed previously.
Prior to discussing any medications, it is important to once again
stress the avoidance or stopping of
nephrotoxic medications in the
patient with AKI. Naughton (2008)
provides a more comprehensive
guide of nephrotoxic medications
than what is within the scope of this
article. Commonly used nephrotoxic
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Conclusion
AKI is a complex disorder that
affects many body systems and carries a high mortality rate. Research by
Hsu and colleagues (2007) found that
community-based incidence of AKI is
increasing. It is likely that rates of
AKI will continue to increase with
time. As healthcare professionals, it
will become more important to
understand the pathophysiology,
treatments, and risk factors for AKI.
By the brief understanding of these
factors discussed in this article, one
might be able to identify, intervene
earlier, and possibly prevent serious
complications from AKI in a patient
who is at risk.
References
ADIS International, Ltd. (2009). Treatment of acute renal failure (ARF) in
elderly patients requires early recognition and initiation of supportive
treatment. Drugs & Therapy Perspectives, 25(4), 14-17.
Armitage, A.J., & Tomson, C. (2003).
Acute renal failure. Medicine, 31(6),
43-48.
Barrantes, F., Feng, Y., Ivanov, O.,
Yalamanchili, H.B., Patel, J., Buenafe,
X., ... Manthous, C. (2009). Acute
kidney injury predicts outcome of
non-critically ill patients. Mayo Clinic
Proceedings, 84(5), 410-416.
Bellomo, R., Cass, A., Cole, L., Finfer, S.,
Gallagher, M., Lo, S., ... Su, S.(2009).
Intensity of continuous renal-replacement therapy in critically ill patients.
The New England Journal of Medicine,
361(17), 1627-1638.
continued on page 30
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January-February 2011
ANNJ1101
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1. What would be different in your practice if you applied what you have learned
from this activity?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Strongly
disagree
Evaluation
2. By completing this offering, I was able to meet the stated objectives
a. Define acute kidney injury (AKI).
b. Discuss the pathophysiology, including the three categories of AKI.
c. Identify the risk factors associated with AKI.
d. Describe treatment options for AKI.
3. The content was current and relevant.
4. This was an effective method to learn this content.
5. Time required to complete reading assignment: _________ minutes.
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2
2
Strongly
agree
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January-February 2011
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