Acute Kidney Injury Paper

Cardiogenic shock is a frequently fatal complication that occurs when the heart cannot pump an adequate amount of blood in order to perfuse tissues. This hypoperfusion causes multiple organ dysfunction and damage which classifies cardiogenic shock a medical emergency. In the past, cardiogenic shock had a poor prognosis. However, currently approximately half of the people that go into cardiogenic shock survive (National Heart, Lung, and Blood Institute [NHLBI], 2011).

Injury to the glomerulus and the tubules presents the onset of Intra-renal failure (Matzke, 2011). Some of the frequent causes for Intra-renal failure are glomerulonephritis; pyelonephritis; and tubular injury. Post-renal failure develops from things like ureteroliths, tumors, or anatomic impediments. Opposite of the acute form, the chronic form has a slow onset that has no early stage symptoms. It is important to know that following an acute episode a chronic renal episode often follows, and at this juncture the damage is irreversible. Glomerulonephritis and pyelonephritis combined, has been reported to be the forerunner in as much as half the cases from acute to chronic renal failure. Diabetes mellitus, renal vascular disease, such as atherosclerosis, hypertension, polycystic kidney disease, drug damage, and nephrolith are all examples of other causes of CKD (Pradeep, 2014). Biopsies of kidneys that suffered with CKD reveal smaller kidneys with scarring on the tubules.

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

Intrarenal acute renal failure- accounts for 30% to 40% of the cases of ARF- generally results from acute tubular necrosis due to disturbances within the glomerulus or renal tubules. ATN most often occurs after surgery but is also associated with sepsis, severe trauma, including severe burns,

Due to weaken immune system, declining organ function, poor sensory perception, and multiple prescribed and over the counter medications, and comorbidities elderly patients are at risk for infections. For many elderly patients the possibility of developing an infection is extremely high, on account of hospitalization or living in long-term care facilities. The most common type of infection acquired in these facilities is urinary tract infections. A urinary tract infection most likely affects the bladder or urethra; more serious urinary tract infections occur in the kidneys. There may be symptoms such as urinary urgency or frequency, but in other cases there are no symptoms at all. This urine infection is caused by gram-negative sepsis.

Dugdale, D. (2012, June 22). Cardiogenic Shock. U.S National Library of Medicine. Retrieved November 23, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/000185.htm

The patient may have a hard time breathing because she is in pain after having surgery. Since they patient doesn’t want to breath due to the pain it can cause atelectasis and later sepsis if not treated in time. It would be important to teach the patient about splinting and to use an incentive spirometry in order to help her be able to breath. Another risk factor for the patient not being able to oxygenate would be hypovolemia since there is less blood volume which can also lead to less oxygen being able to travel in the blood or able to perfuse throughout the body.

Mr. Steward’s priority problems include impaired cardiac tissue perfusion, impaired gas exchange, and pain. We are concerned about impaired cardiac tissue perfusion because the pt. is exhibiting signs of myocardial ischemia including chest pain and shortness of breath (Gillespie, 2012). Although we acknowledge that impaired cardiac tissue perfusion can decrease the function of the heart and will have the potential to affect the perfusion and delivery of oxygen to other end organs, our primary focus will be a focused cardiovascular assessment (House-Kokan, 2012). At 1800, Mr. Steward was SOB, had shallow and rapid breathing (RR = 44), and a SaO2 of 72% on RA. Due to the fluid buildup in his lungs, Mr. Steward has impaired gas exchange, and requires supplemental oxygen to maintain his SaO2; this warrants a focused respiratory assessment.

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

Transfusion related lung injury is a form of acute lung injury and is an important cause of transfusion-associated morbidity and mortality. A Transfusion Related Lung Injury (TRALI) is defined as an acute lung injury with hypoxemia and PaO2/FiO2 less than or equal to 300 or SpO2 less than 90 percent on room air, presence of bilateral pulmonary edema with no evidence of left atrial hypertension, no preexisting lung injury before transfusion, onset of symptoms within six hours of transfusion and no temporal relationship to an alternative risk factor for acute lung injury. The transfusion related lung injury is mostly transient and will improve within 48 to 96 hours. Unlike other transfusion related circulatory overload, TRALI is non cardiogenic

Ischemia-reperfusion (I/R) is a major cause of acute kidney injury (AKI). Ischemic AKI greatly contributes to patient morbidity and mortality in various clinical settings such as cardiac surgery and renal transplantation.1 Transplanted organs struggle with ischemia and subsequent reperfusion but also require pharmacological strategies to prevent graft rejection. Therefore immunosuppressive substances e.g. mTOR inhibitors had to be used in addition. Nevertheless, an effective therapy of ischemic AKI is still lacking. Ischemic preconditioning (IPC) is an intriguing phenomenon since it indicates the existence of intrinsic mechanisms that may be targeted for rendering the kidney resistant to ischemic stress. IPC can be achieved by pretreating the kidney itself (local IPC) or a remote organ (remote IPC). The conditioning stimulus may consist of one or several brief I/R cycles. This maneuver confers resistance against I/R injury upon subsequent long-lasting ischemia (“index ischemia”). IPC-mediated renoprotection occurs within the so-called early (minutes to few hours after IPC) and late windows of protection (24 hours to several days after IPC).

The risk of readmission and mortality in reverse AKI group is similar to traditional AKI as shown in our study. Hence the increase in creatinine is not only a marker of severity of heart failure but also represents a pathway for accelerated cardiovascular injury.

Postoperative hypertension may cause serious adverse events with both cardiac and non-cardiac patients.1-3 Postoperative hypertension generally occurs within 30 minutes after surgery has been completed and may last up to two hours. Acute perioperative hypertension occurs in 80% of people undergoing cardiac surgery and 25% of people undergoing non-cardiac surgeries, such as head and neck surgery or renal transplantation. If not treated appropriately, an acute increase in blood pressure may be related to further undesired complications, such as myocardial ischemia, stroke, bleeding, and heart failure. Hypertensive emergencies such as postoperative hypertension are more common in patients with uncontrolled hypertension, diabetes mellitus, or renal disease. The main risk factor

Ischemia-reperfusion injury is seen in strokes, myocardial infarctions, acute kidney injury, mesenteric ischemia, shock liver and systemic shock. Both clinical and experimental data revealed that transplant IRI has deleterious long- and short -term effects, manifesting as augmented incidents of chronic allograft damage and acute rejection[1] Renal ischemia–reperfusion (IRI) is a main cause of acute kidney injury (AKI), which leads to many death in patients and may possibly development to chronic renal disease. Pathologically, ischemic AKI is characterized by lethal and sublethal damages in kidney tubules, especially the proximal tubules of the

Nephrotoxins, acute interstitial nephritis, glomerular damage, and vascular damage also correlate with intrarenal acute renal failure (Singh, Levy, & Pusey, 2013). Postrenal acute renal failure is usually a result of a urinary tract obstruction that affects the kidneys bilaterally, which causes the intraluminal pressure upstream from the site of the obstruction to increase with a progressive decrease in the glomerular filtration rate (McCance, Huether, Brashers, & Rote, 2014). A pattern consisting of several hours of anuria with flank pain followed by polyuria is typically found in individuals with postrenal acute renal failure (McCance, Huether, Brashers, & Rote, 2014).