AKI Case

Often times we may ignore the signs our body is trying to tell us. Mainly due to fear of the unknown. Our kidneys play an important role in our body. They are used to filter out waste through urination. There are many exams that physicians use

Patient: M.H. 80 year old female experiencing renal failure. Chronic Kidney Disease (CKD) is a disease that is described as a loss of kidney function gradually over time. As kidney function decreases, the waste collection in the body’s blood becomes high and makes the individual feel sick. This disease can lead to other complications in the body such as anemia, poor nutritional health, high blood pressure, and nerve damage. These complications will begin to progress and show as CKD progresses to advanced stages. Early detection of this disease is essential when it comes to treatment. If CKD is diagnosed early enough the disease progression can be slowed down and managed. This disease will eventually lead to failure of the kidneys

Patient Case Question 17. What might the abnormal serum Na+ and K+ levels suggest? Has hypernatremia, decreased GFR and decreased sodium excretion Patient Case Question 18. Explain the abnormal BUN and serum Cr concentrations. The BUN and serum Cr are very low, caused by decreased glomerular filtration rate Patient Case Question 19. What might be causing the elevated serum glucose concentration? Serum levels of inflammatory cytokines and leptin are elevated in patients with heart failure. Patient Case Question 20. Explain the abnormal serum AST level. High levels of AST can be found in cases such as myocardial infarction Patient Case Question 21. Explain the abnormal arterial blood gas findings. A low partial pressure of oxygen (PaO2) suggests that a person is not getting enough oxygen; Metabolic acidosis->Kidney failure, shock, diabetic ketoacidosis

Causes of kidney disease are wide-ranging in number; however diabetes, high blood pressure, inherited disease, and infection remain to be the contenders of cause (Davidson, 2011). Acute kidney disease can be identified by anuria and oedema. CKD is often called a “silent” killer, because instead of a sign, that would render immediate evidence, CKD only provides symptoms that many don’t know to correlate to renal issues. The symptoms may also increase at the latter stages of the

in blood urea nitrogen (BUN) concentration. Symptoms of acute renal failure may include, little or no urine when urinating, swelling in the legs and feet, not feeling like eating,

Prerenal acute renal failure- accounts for 60% of cases of ARF- is the most common cause of ARF and is caused by impaired renal blood flow. The GFR drops because of the decrease in filtration pressure. Poor perfusion can result from hypovolemia, hemorrhage, renal vasoconstricition, hypotension, or inadequate cardiac output. This type of renal failure may occur when chronic renal failure exists if a sudden stress is imposed on already marginally functioning kidneys. If blood volume or blood pressure and oxygen delivery is not restored, cell injury and acute tubular necrosis or acute interstitial necrosis may be caused (Perrin, 2009).

However, acute kidney injury is complications are reversible. Patients with life threatening conditions are more susceptible to developing this disorder. Acute kidney injury is commonly developed after either chronic hypotension or hypovolemia or exposure to a nephrotoxic agent. With increased levels of blood urea nitrogen (BUN), creatinine, and potassium with or without a reduction in urine output develops acute kidney injury over hours or days (Lewis, 2014, p. 1101-1102). High incidents of hospitalized patients develop AKI, one out of five, and a high mortality rate. (Lewis, 2014, pp. 1101-1102)

Acute Kidney Injury This is sudden injury to the kidneys which stops them working instantly or nearly instantly, AKI can range from the kidneys only to stop functioning slightly or to completely stop working. Due to the name of it some people think that it is physical injury or blow to the kidneys however it is a result in complications of other conditions. It is usually seen in older people who are very unwell and get admitted to hospital, it’s vital that AKI is detected quickly as if AKI

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever.

Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of

This is a 50 year-old male who required inpatient hospitalization due to dizziness, abdominal pain, headache, and nausea after taking atenolol. Mr. A came to the Emergency Department with complaints of some dizziness two-day prior to admission and collapsed several times. For the past 2 weeks, he had not been taking his blood pressure medications due to financial reasons. He was given clonidine and atenolol from his dialysis center while he was unable to afford his normal hypertension medication. He was dialyzed three times a week through his arteriovenous fistula and had not missed any sessions. He also had increased dyspnea on exertion over the past 3 weeks, orthopnea and usually sleeps on several pillows which worsened between his dialysis. His medical history is significant for hypertension, diabetes mellitus type II, morbid obesity and end stage renal disease on dialysis.

In patients with heart failure, hypovolemia, cirrhosis, nephrotic syndrome, or hypoalbuminemia, renal function may be further compromised. BUN, creatinine clearance, and urine output should be monitored closely (Lexi-Comp, 2016).

Pathophysiology Chronic Kidney Disease: Chronic kidney disease (CKD) is an irreversible condition that progresses causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥ 90. Stage 2 has mild damage and a GFR of 60-89. Stage 3 has moderate damage and a GFR of 30-59. Stage 4 has severe damage and a GFR of 15-29. Stage 5 is also known as end stage renal disease (ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a major cause. Since most DM patients have HTN,

Kidney failure is a public health problem, which has dramatic effects on patients' health. In some

Mr. Armstrong has a history of renal insufficiency and uncontrolled hypertension, along with symptoms of fatigue, pedal edema, and occasional shortness of breath. He does not have a history of trauma or obstruction to his kidneys, but his creatinine and BUN levels are currently at 3.5 mg/dl and 40 mg/dl. Normal creatinine concentration values are 0.7 to 1.2 mg/dl and normal BUN values are 10 to 20 mg/dl; this reveals that Mr. Armstrong’s kidneys are not removing wastes properly (McCance, Huether, Brashers, & Rote, 2014).  Mr. Armstrong’s history of renal insufficiency and uncontrolled hypertension is commonly found in patients diagnosed with intrarenal (intrinsic) acute renal failure. Intrarenal acute renal failure can be categorized as