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Regulatory: AKI (focusing on prerenal), Decrease in UOP - Coggle Diagram
Regulatory: AKI (focusing on prerenal)
Pathophysiology & Etiology
Caused by hypoperfusion (hypovolemia= hemorrhage, dehydration, excessive loss of GI fluids, burns; decreased vascular filling= anaphylactic and septic shock; HF and cardiogenic shock)
Hypoperfusion of the kidneys → decreased GFR & UOP → decreased filtration → tubules need to reabsorb less substances → renal cells require decreased O2 & energy → ischemic changes
Decreased filtration is a protective measure of the kidneys but is not viable for the long-term
Risk Factors
Infection
Severe HF
Surgery
Lower urinary tract obstruction
Major trauma
Toxic drugs
Elderly
Diagnostics & Labs
Increase creatinine
BUN/CR ratio > 20:1
Increase urine osmolality
Low fractional Na+ excretion
Low GFR
Increase urine specific gravity
Collaborative Treatments
Correcting the underlying cause= improve renal perfusion
D/C nephrotoxic drugs
Focus is on prevention and early diagnosis
Hemodialysis
Continuous renal replacement therapy
Fluid administration (carefully)
Kidney transplant
Complications
Electrolyte imbalances
ATN
Metabolic acidosis
Pulmonary edema
Secondary infections
WORST= death
Manifestations
Sharp decrease in UOP is the earliest sign- nurses need to be aware!
Weight loss
Poor skin turgor
Ascites
Tachycardia
Orthostatic hypotension
Decrease in UOP