Acute Kidney Injury Causes Symptoms Diagnosis Management Complications Prevention Nursing Diagnosis

Acute Kidney Injury (AKI)

Acute Kidney Injury (AKI), previously known as acute renal failure, is a sudden decline in kidney function that occurs over hours to days. It results in the accumulation of waste products, electrolyte imbalance, and disturbances in fluid and acid–base balance.

What Is Acute Kidney Injury?

Acute Kidney Injury is characterized by a rapid reduction in glomerular filtration rate (GFR), leading to increased serum creatinine and urea levels. AKI is a common medical emergency, especially in hospitalized and critically ill patients.

Causes of Acute Kidney Injury

1. Prerenal Causes (Reduced Blood Flow to Kidneys)

• Dehydration
• Hemorrhage
• Shock
• Sepsis
• Heart failure
• Excessive diuretic use
• NSAIDs and ACE inhibitors

2. Intrinsic (Renal) Causes

• Acute tubular necrosis (ischemia or toxins)
• Glomerulonephritis
• Acute interstitial nephritis
• Vasculitis
• Contrast-induced nephropathy

3. Postrenal Causes (Urinary Tract Obstruction)

• Benign prostatic hyperplasia
• Renal or ureteric stones
• Urinary tract tumors
• Urethral strictures
• Blood clots

Signs and Symptoms of Acute Kidney Injury

Early Symptoms

• Reduced urine output (oliguria)
• Fatigue and weakness
• Nausea and vomiting
• Loss of appetite

Late Symptoms

• Edema and rapid weight gain
• Hypertension
• Shortness of breath
• Confusion and altered mental status
• Cardiac arrhythmias due to hyperkalemia

Diagnosis of Acute Kidney Injury

Investigation	Diagnostic Findings
Serum creatinine	Increased
Blood urea nitrogen (BUN)	Increased
Electrolytes	Hyperkalemia, hyponatremia, metabolic acidosis
Urinalysis	Protein, blood, casts
Ultrasound KUB	Hydronephrosis or urinary obstruction

Treatment and Management of AKI

• Identify and treat the underlying cause
• Restore and maintain adequate renal perfusion
• Correct fluid and electrolyte imbalance
• Stop nephrotoxic medications
• Adjust drug dosages according to renal function

Indications for Dialysis (AEIOU)

• Acidosis
• Electrolyte imbalance (severe hyperkalemia)
• Intoxication
• Overload (fluid overload)
• Uremia

Complications of Acute Kidney Injury

• Life-threatening hyperkalemia
• Pulmonary edema
• Metabolic acidosis
• Uremic encephalopathy
• Progression to chronic kidney disease

Prevention of Acute Kidney Injury

• Ensure adequate hydration
• Avoid unnecessary nephrotoxic drugs
• Early management of sepsis and shock
• Regular monitoring of renal function in high-risk patients

Nursing Diagnosis in AKI

• Impaired urinary elimination
• Excess fluid volume
• Risk for electrolyte imbalance
• Risk for infection
• Activity intolerance

Nursing Care and Considerations

• Strict intake and output monitoring
• Daily weight measurement
• Monitor vital signs and ECG
• Assess for edema and lung sounds
• Administer medications safely with renal dose adjustment
• Educate patient on hydration, diet, and avoiding NSAIDs

Conclusion: Early recognition and prompt nursing intervention in Acute Kidney Injury are crucial to prevent complications and progression to chronic kidney disease.