Acute Kidney Injury: Causes (Nursing)

00:00 Now I want to talk about some causes of acute kidney injury.

00:04 This means if any of your patients are experiencing these things you need to really be on your toes knowing that they're at risk for injury.

00:13 Now, the first one is low blood pressure.

00:16 Low blood pressure for any reason means your kidneys are not going to be perfused well.

00:22 Now, this was actually the source of acute kidney injury for me.

00:26 See, I got extremely dehydrated after a period of about three days of just intractable nausea and vomiting.

00:34 My blood pressure was down in the 80s.

00:36 So my blood pressure was so low because I was severely dehydrated.

00:41 I didn't have enough volume on board that I actually had acute kidney injury.

00:45 My serum creatinine went up, my urine output went down.

00:49 So I really got scared at what I had to go through and experience.

00:53 Now, when I went into the hospital mine was reversible because all I needed was a lot of IV fluids But once I had several leaders of fluids my kidneys responded and so I don't suffer from chronic kidney disease because I had great nurses that caught it quickly and we dealt with it.

01:13 So anytime you have a patient that has low blood pressure, I had low pressure because I was severely dehydrated.

01:20 But people can have low blood pressure for lots of reasons.

01:24 Now when we say low blood pressure, I want you to know that's a relative term meaning some people run a low blood pressure.

01:31 They run in the 100's and they're absolutely fine.

01:35 It depends on what the patient's normal is.

01:38 So your job as a nurse is to look at trends.

01:40 What's the patient's normal, and what does their blood pressure look like now.

01:45 Now, here's a cause of major fluid shifting burns.

01:49 When you have a patient who's experienced significant Burns, there's ginormous fluid shifting and when I say fluid shifting, I mean normally, my flute is supposed to stay in my intravascular space my arteries in my veins and then my tissues are kind of moist to write the interstitial spaces around my cells, but when a patient goes through Burns, they have rapid fluid shifting into these space that tissue swell and they get edematous and that can limit the profusion of your kidneys because we're pulling that fluid out of the intravascular space remember your arteries and veins that deliver blood to your kidneys and we're shoving it into the tissues.

02:29 So that's why patients with low blood pressure for whatever reason or Burns can experience acute kidney injury.

02:37 Now dehydration ties right back to my reason for low blood pressure at the beginning.

02:41 But when we say dehydration, we mean intravascularly dehydrated, Now, I was just all over dehydrated when I was so sick in fact, I ended up having a pulmonary embolism.

02:54 I was so dehydrated an immobile, but dehydration means you have less volume in your intravascular space, you have less blood supply being delivered to the kidney And that's another possible cause for acute kidney injury.

03:09 Now hemorrhage, if I'm losing a lot of blood again, I have less blood being delivered to my kidneys and they're going to be not perfused enough to keep them functioning well, and that's a risk of acute kidney injury.

03:22 So really looking at this first side now, we've got four more options to talk about, but I don't want you to get overwhelmed by list.

03:30 Look at what all of those things have in common.

03:33 It's perfusion.

03:35 When there's a perfusion problem in your body the kidneys were one of the first systems to take a hit I say.

03:42 So those are the ones that are going to suffer first.

03:44 See your brains pretty smart.

03:46 It makes sure that it always gets what it needs and the heart gets what its needs as much as possible.

03:51 So it starts taking it from other parts of your body.

03:54 So when pressure is low for any reason, your kidney is one system thats really going to take a hit.

04:01 Now the next one's obvious, right? We talked about perfusion issues all the way down here for different reasons.

04:07 Blood pressures low, fluid volumes are shifting.

04:09 You don't have enough fluid on board, you're hemorrhaging so you really don't have enough volume on board, but injury, it could be something traumatic.

04:17 It might be from a medication, It might be from a physical trauma, but at the actual kidney itself is injured that can be an episode of acute kidney injury.

04:26 Now septic shock is life-threatening, but the word shocked right there at the end tells you that the body is not receiving a body as a whole is not receiving enough oxygen to meet its metabolic needs.

04:41 Now, remember we talked the brains pretty smart and real selfish.

04:45 So we're going to try to shunt everything to our brain in her heart and the kidneys are going to get shortchanged.

04:50 So anybody in shock is going to end up having poorly perfused kidneys.

04:56 Septic shock is a really difficult and Troublesome diagnosis because you can lose a patient in septic shock if we're not able to catch it early enough and turn it around.

05:07 Now any serious illness can also cause acute kidney injury and a patient after surgery we're going to watch really closely.

05:15 So there you go.

05:16 That is a wide range of patients, right? We're talking about acute kidney injury an old term used to be acute renal failure, but this is when the kidneys have experienced some type of injury from loss of perfusion or actual damage to the kidney itself.

05:34 Those are probably the two best chunks or ways to categorize that information for you to remember it.