Acute Kidney Injury

(AKI)

Bima AS
Objective
1. Describe cause of acute kidney injury.
2. Describe the management of the patient with acute renal failure/acute
kidney injury.
 Lukas 6:17-19
6:17 Lalu Ia turun dengan mereka dan berhenti pada
suatu tempat yang datar: di situ berkumpul sejumlah
besar dari murid-murid-Nya dan banyak orang lain
yang datang dari seluruh Yudea dan dari Yerusalem
dan dari daerah pantai Tirus dan Sidon. 6:18 Mereka
datang untuk mendengarkan Dia dan untuk
disembuhkan dari penyakit mereka; juga mereka yang
dirasuk oleh roh-roh jahat beroleh
kesembuhan. 6:19 Dan semua orang banyak itu
berusaha menjamah Dia, karena ada kuasa yang
keluar dari pada-Nya dan semua orang itu
disembuhkan-Nya.
Definition?
• AKI refers to a loss in kidney function, which
can occur over a number of hours to days.
• Rapiddecline in kidney function as manifested
by a reduction in glomerular filtration rate
(GFR).
Causes of acute kidney injury
1. Pre-renal Failure
2. Intrinsic renal failure
2. Post renal failure
Classification
Assessment
• Most of the main organs are affected by AKI, and nurses must be
able to assess how the disease affects the patient holistically.
• Their urinary pattern must be established.
• Haematuria, dysuria or pyruia, or if the patient has any urgency,
and incontinence.
• Biomarker are creatinine and GFR.
Nursing Management and Prevention
• Fluid management  The goal is to restore renal
perfusion, reduce ischemic time and prevent the
development of intrinsic renal failure  Volume
resuscitation is vital in the management (first choice usually being
crystalloids, along with colloids or blood as necessary later)
• Electrolyte management  electrolytes, including sodium
and potassium levels, fluid balance and weight must
be monitored
• Immune system management --> Haematological
manifestations can occur in AKI, exposing the patient to bleeding
tendencies, including reduction in clotting factors, and platelet
synthesis. This may cause haematemesis, malaena and anaemia
• Nutritional management --> Supplemental nutritional support with enteral
versus parenteral nutrition may enhance nutritional status, reduce infections
and sepsis along with producing a better survival rate in critically ill patients.
Therefore, enteral feeding is the preferred method of nutritional support
• Personal care management --> Issues such as mouth care are
imperative, tongue can become coated with saliva excretion, dry
mucosa, regularly encrusted lip, dysgeusia, Mouth lesions can lead to further
complications. The nurse may encourage the patient to rinse out their mouth
with ice cold mouthwashes or water rather than lukewarm solutions, and
suggest applying petroleum jelly to the lips
• Patient education management --> The patient with AKI will need
emotional support from the nurse and members of the multidisciplinary team.
• Renal replacement therapy --> haemodialysis (HD), continuous renal
replacement therapy (CRRT), sustained low-efficiency dialysis (SLED)
or peritoneal dialysis (PD)
Algorithm AKI
(AJKD, 2018)