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Acute Kidney Injury: Nursing Diagnosis

Nursing Knowledge

Acute Kidney Injury: Nursing Diagnosis

Acute kidney injury (AKI) is a common and serious condition that affects many clients in clinical practice. It is characterized by a sudden loss of kidney function or damage to the kidneys, which can lead to a buildup of waste products in the blood and fluid imbalances in the body. Nurses play a critical role in the prevention, early detection, and management of acute kidney injury, so should be familiar with the causes, symptoms, and nursing interventions.

Last updated: October 9, 2024

What is acute kidney injury?

Acute kidney injury is a sudden instance of kidney failure or kidney damage. While being usually reversible, without prompt treatment, acute kidney damage can lead to chronic kidney disease or renal failure.

https://youtu.be/Qw31PC3HWi0

Criteria for acute kidney injury

Rise in serum creatinine (> 0.3 mg/dL or > 50%)
Reduction in urine output (< 0.5 mL/kg for > 6 hours)

Note: The expected range for creatinine is 0.7–1.4 mg/dL (62–124 mmol/L).

What is the most common cause of acute kidney injury?

One of the most common causes of acute kidney injury is decreased blood flow to the kidneys, for example due to dehydration, blood loss, burns, or sepsis.

Other causes include:

Damage to the kidney tissue (e.g. acute tubular necrosis, glomerulonephritis, vasculitis, or acute intestinal nephritis)
Obstruction of urine outflow (e.g. kidney stones or tumors)

Related videos

Causes of Acute Kidney Injury

Acute Kidney Injury vs Chronic Kidney Disease

Risk factors

Injury
Burns
Dehydration
Hemorrhage
Sepsis
Surgery
Pregnancy

Symptoms and pathophysiology of acute kidney injury

Signs and symptoms of acute kidney injury

Peripheral edema
Fatigue
Confusion
Shortness of breath
Nausea
Chest pain or pressure

Pathophysiology

Pathophysiologic effects of acute kidney injury on electrolytes and acid-base balance:

Hyperkalemia
Hyperphosphatemia
Metabolic acidosis

Nursing interventions for acute kidney injury

Monitor for changes in vital signs, intake and output, mood, edema, and blood loss, overall health lab values (e.g. CBC)
Observe client’s mental state
Obtain labs regarding kidney function: creatinine, glomerular filtration rate
Restore fluid balance
Prevent infection
Improve nutritional intake

Nursing diagnoses for acute kidney injury

Acute pain: due to inflammation and increased pressure within renal capsule
Excess fluid volume: monitor weight/output, assess for signs of fluid overload like edema; possible orders: diuretics, fluid restriction
Impaired urinary elimination: monitor intake/output, electrolytes
Risk for electrolyte imbalance: monitor serum electrolyte levels and assess for signs or electrolyte imbalances
Knowledge deficit: provide education on disease, management, medications, dietary restrictions

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