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Acute Kidney Injury | 마이메르시 MyMerci
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Acute Kidney Injury

NCLEX Review Guide: Acute Kidney Injury (AKI)

Pathophysiology & Classification

Types of AKI

  • Prerenal AKI: Decreased blood flow to kidneys due to hypovolemia, hypotension, or decreased cardiac output. Most common and reversible type.
  • Intrarenal AKI: Direct damage to kidney tissue from nephrotoxins, contrast dye, or acute tubular necrosis (ATN).
  • Postrenal AKI: Obstruction of urine flow from kidney stones, enlarged prostate, or tumors.

AKI Types Comparison

TypeCauseReversibilityPriority Action
Prerenal↓ Blood flowMost reversibleFluid resuscitation
IntrarenalKidney damageVariableRemove nephrotoxins
PostrenalObstructionReversible if promptRelieve obstruction

Key Points

  • AKI definition: Rapid decline in kidney function over hours to days
  • Serum creatinine increases ≥0.3 mg/dL within 48 hours or ≥50% from baseline
  • Urine output <0.5 mL/kg/hr for 6+ hours indicates oliguria

Assessment & Diagnostics

Clinical Manifestations

  • Oliguria or anuria: Decreased urine output is hallmark sign, though some patients maintain normal output initially.
  • Fluid retention: Peripheral edema, pulmonary edema, weight gain, and hypertension develop as kidneys fail to excrete excess fluid.
  • Electrolyte imbalances: Hyperkalemia (most dangerous), hyperphosphatemia, hypocalcemia, and metabolic acidosis.
  • Uremic symptoms: Nausea, vomiting, altered mental status, and uremic frost in severe cases.
CRITICAL ALERT: Hyperkalemia >6.5 mEq/L can cause fatal cardiac arrhythmias. Monitor for peaked T-waves, widened QRS, and bradycardia.

Key Points

  • BUN:Creatinine ratio >20:1 suggests prerenal cause
  • Fractional excretion of sodium (FENa) <1% indicates prerenal AKI
  • Daily weights are most accurate indicator of fluid status

Nursing Management

Priority Interventions

  1. Monitor fluid balance: Strict I&O, daily weights, assess for edema and lung sounds
  2. Prevent further injury: Avoid nephrotoxic medications, maintain adequate perfusion
  3. Manage complications: Monitor electrolytes, especially potassium levels every 6-8 hours
  4. Prepare for dialysis: If conservative management fails or life-threatening complications occur

Memory Aid: "AEIOU" Dialysis Indications

  • Acidosis (severe metabolic)
  • Electrolyte imbalances (hyperkalemia)
  • Intoxication (drug overdose)
  • Overload (fluid)
  • Uremia (severe symptoms)

Clinical Scenario

A 68-year-old patient post-cardiac catheterization develops decreased urine output (20 mL/hr), elevated creatinine (2.8 mg/dL from baseline 1.2), and BUN 45 mg/dL. Priority nursing action is to assess fluid status and notify provider for possible contrast-induced nephropathy management.

Key Points

  • Fluid restriction typically 500-600 mL plus previous day's output
  • Protein restriction to 0.6-0.8 g/kg/day to reduce uremic toxins
  • Phosphate binders given with meals to prevent hyperphosphatemia

Commonly Confused Concepts

AKI vs CKD Comparison

AspectAcute Kidney InjuryChronic Kidney Disease
OnsetHours to daysMonths to years
ReversibilityOften reversibleProgressive, irreversible
Kidney sizeNormal or enlargedUsually small, shrunken
AnemiaRare initiallyCommon due to ↓ EPO
Bone diseaseUncommonCommon (renal osteodystrophy)

Common Pitfalls

  • Mistake: Thinking all AKI patients need fluid restriction from start
  • Reality: Prerenal AKI often needs fluid resuscitation initially
  • Mistake: Focusing only on creatinine levels
  • Reality: Urine output changes occur before creatinine rises

Study Tips & Memory Aids

Memory Aid: "RIFLE" Criteria for AKI Staging

  • Risk: Creatinine ↑ 1.5x or UO <0.5 mL/kg/hr × 6hr
  • Injury: Creatinine ↑ 2x or UO <0.5 mL/kg/hr × 12hr
  • Failure: Creatinine ↑ 3x or UO <0.3 mL/kg/hr × 24hr
  • Loss: Complete loss of function >4 weeks
  • End-stage: Loss of function >3 months

Quick Check Questions

  • ☐ Can you identify the three types of AKI and their causes?
  • ☐ Do you know the AEIOU indications for dialysis?
  • ☐ Can you differentiate between prerenal and intrarenal AKI?
  • ☐ Do you understand fluid management principles in AKI?

Remember: You're not just memorizing facts—you're learning to save lives! Every concept you master brings you closer to becoming the nurse your patients need. Keep pushing forward, future nurse! 💪

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