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.
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.
So the reason you care about AKI is because the earlier you
recognise it, the quicker we can do an intervention to reverse it.
because if AKI goes on to long, you're
gonna end up with chronic renal problems.
Youre gonna really end up damaging that person's
body systems so it's important that you recognise it early
and intervene quickly.
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.
The second reason is you have excessive
protein in the body and it just overwhelms the system.
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.
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.
So one reason I can't have adequate
perfusion is, I don't have enough in the tank.
I don't have enough fluid
volume in my intravascular space.
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.
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.
Okay so those would be reasons
for decreased renal perfusion.
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.
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.
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.
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.
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.
Those are some pretty heavy duty kidney
diagnoses, should you memorize all these?
No, it's not possible at this point.
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.
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.
If it becomes obstructed, we're gonna have a problem.
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.
If it's not relieved and it's significant
enough, that can lead to an acute kidney injury.