Skip to Main Content

Chapter 15: Renal System

Jie Chen

KNOWLEDGE COMPETENCIES

  1. Describe the etiology, pathophysiology, clinical presentation, patient needs, and principles of management of acute kidney injury (AKI).

  2. Differentiate between the three types of AKI:

    • Prerenal

    • Intrarenal

    • Postrenal

  3. Compare and contrast the pathophysiology, clinical presentation, patient needs, and management approaches of life-threatening electrolyte imbalances:

    • Sodium (Na+)

    • Potassium (K+)

    • Calcium (Ca++)

    • Magnesium (Mg++)

    • Phosphorus (PO4− −)

  4. Differentiate between the indications for and the efficacy of the different types of renal replacement therapies (RRTs).

  5. Describe the nursing interventions for patients undergoing RRT.

ACUTE KIDNEY INJURY

The most common renal problem seen in critically ill patients is the development of acute kidney injury (AKI), previously termed as acute renal failure (ARF). AKI is the abrupt decrease in renal function with progressive retention of metabolic waste products (eg, creatinine and urea). Oliguria, urine output of less than 400 mL/day, is a common finding in AKI. The development of AKI in acutely ill patients has an estimated mortality of 40% to 50%, and higher among intensive care unit (ICU) patients (> 50% in most of the studies). Patients who develop AKI due to sepsis have higher mortality. A history of chronic kidney disease (CKD) complicates the clinical course of any critical illness.

The RIFLE criteria and Acute Kidney Injury Network (AKIN) criteria are the most commonly used classification systems for AKI (Table 15-1). RIFLE is an acronym for: Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage kidney disease.

TABLE 15-1RIFLE AND AKIN CRITERIA FOR DIAGNOSIS AND CLASSIFICATION OF AKI
View Table||Download (.pdf)
TABLE 15-1 RIFLE AND AKIN CRITERIA FOR DIAGNOSIS AND CLASSIFICATION OF AKI
RIFLE   AKIN
Class SCra Urine Output (common to both) Stage SCrb
Risk Increased SCr to > 1.5 × baseline Urine output < 0.5 mg/kg/h for > 6 h 1 Increase in SCr ≥0.3 mg/dL or increase in SCr to ≥150%-200% of baseline
Injury Increased SCr to > 2 × baseline Urine output < 0.5 mg/kg/h for > 12 h 2 Increase in SCr to >200%-300% of baseline
Failure Increased SCr to > 3 × baseline; or an increase of ≥ 0.5 mg/dL to a value of ≥ 4 mg/dL Urine output < 0.3 mg/kg/h for > 12 h or anuria for > 12 h 3 Increase in SCr to >300% of baseline; or to ≥ 4 mg/dL with an acute increase of ≥ 0.5 mg/dL; or on RRT
Loss Need for RRT for > 4 wk      
End Stage Need for RRT for > 3 mo      

Abbreviations: AKI, acute kidney injury; AKIN, Acute Kidney Injury Network; RIFLE, risk, injury, failure, loss, end-stage disease; RRT, renal replacement therapy; SCr, serum creatinine.

aFor RIFLE, the increase in SCr should be both abrupt (with 1-7 days) and sustained (> 24 hours).

bFor AKIN, the increase in SCr ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close