Causes of Acute Kidney Injury (AKI) – High Level of BUN (Nursing)

00:00 Alright so we just look at some other causes besides acute kidney injury because we wanted to take some time now and really focus in on acute kidney injury.

00:10 The reason acute kidney injury is important and let's just call it aki from here on out because that's what you will most likely see in your textbooks and in the literature.

00:20 So the reason you care about AKI is because the earlier you recognise it, the quicker we can do an intervention to reverse it.

00:28 because if AKI goes on to long, you're gonna end up with chronic renal problems.

00:34 Youre gonna really end up damaging that person's body systems so it's important that you recognise it early and intervene quickly.

00:42 Now three categories,we're gonna break it out so it's easy for you to remember: before the kidney, right in the middle of the kidney and after the kidney Now before the kidney think about blood flow that's coming down to the kidney For whatever reason, if that kidney is not getting adequate blood supply, that's gonna be a possible prerenal cause of AKI.

01:06 The second reason is you have excessive protein in the body and it just overwhelms the system.

01:13 So when you're thinking of things before the kidney, either blood supply or everything that's going on here with the protein breakdown because remember, it breaks that down, it sends it right down to the kidneys, if I've got excessive protein, I've just overwhelmed to the body.

01:31 Those of the two most important things you want to remember about prerenal but let me give you some specific examples of times where you'll be looking at why a patient wouldn't have adequate perfusion.

01:43 So one reason I can't have adequate perfusion is, I don't have enough in the tank.

01:50 I don't have enough fluid volume in my intravascular space.

01:55 Now that could be because of severe dehydration or fluid-volume shifting right? I've got fluid in there but it's gotten right from the intravascular space intomy tissues.

02:06 That would be something like it could be burns or somebody who's in shock or I could be losing that intravascular volume cause I'm hemorrhaging somewhere in my body.

02:15 Okay so those would be reasons for decreased renal perfusion.

02:20 So for whatever reason your patient is not getting enough blood with oxygen to the kidneys, they're gonna suffer and that's a possible prerenal cause so what do we do? Well it depends on what the underlying cause is, if they're dehydrated, we replace volume, if they're hemorrhaging, we're gonna replace the blood right? If the heart isn't pumping, we're probably gonna give some vasoactive type of medications that will help that heart pump harder.

02:46 Now what about the extra protein? Well you're gonna have to look at the source of that, is it a GI bleed? because remember hemoglobin is part of red blood cells and that's a protein.

02:56 Did the patient have a crush injury? Did they have a fever? Are they on specific medications like corticosteroids, etcetera? So those are all episodes that you want to be keeping a close eye on your patient for acute kidney injury If you've known they have any of these prerenal causes, you want to be watching closely how their kidney is functioning.

03:18 Now let's talk about intrarenal causes that's right to the tissue, that's damage to the kidneys' tissue and that maybe because something was toxic to the kidney, either it was a drug or something they ingested.

03:31 They might have damage to the kidney because they've had long-standing severe hypertension, They also may have glomerulonephritis, that's an inflammation of the glomerulus or even tubular necrosis.

03:42 Those are some pretty heavy duty kidney diagnoses, should you memorize all these? No, it's not possible at this point.

03:51 What you want to be thinking about as a nurse, "I just need to know, if that kidney, before the kidney is not getting enough of what it needs or I've got excessive protein, if the kidney itself has been damaged and there's lots of ways the kidney can be damaged by disease or by drugs and you know hypertension, diabetes, any one of those diseases can cause damage to the kidney.

04:13 And the third category is after, Now that's an obstruction, so think anything, any of the plumbing that is involved in your urinary tract.

04:23 If it becomes obstructed, we're gonna have a problem.

04:26 So you can either have a kidney stone or maybe you've got a growth that does it, but that is what's gonna cause an obstruction.

04:34 If it's not relieved and it's significant enough, that can lead to an acute kidney injury.