NUR 2502 Module 1-3 Study Concept Guide AKI Current definition • Increase of creatinine >0.3 mg/dL within 48 hrs • Increase in creatinine >1.5 x baseline • Urine output less than 0.5 ml/kg/hr >6 hrs Categories / causes PRERENAL – Perfusion related! •Injury to the kidney caused by interruption / disruption of flow TO the kidney •This is reversible •Hypovolemia • Blood or fluid loss (trauma, sepsis, surgery) • Hypotension • MI • Dehydration • Renal artery stenosis • Bleeding or clotting in renal blood vessels POSTRENAL – Outflow related •Injury to the kidney caused by interruption / disruption of flow OUT of the kidney •Inability of the kidney to drain, increases hydrostatic pressure in the kidney damaging therenal pelvis initially and progresses to renal tubules •Can be reversed •Obstruction •BPH or prostate cancer •Trauma •Renal calculi •UTI INTRARENAL – injury to the kidney •Damage to the internal structures of the kidney (either directly or as a result of pre or postrenal issues) •Sepsis •Nephrotoxic drugs •Glomerulonephritis •Acute tubular necrosis (Most common cause of intrarenal disease) •Prolonged prerenal ischemia •Bleeding in the kidney •PKD, pyelonephritis •Thrombus •Cancers •Toxin Three phases Phases Oliguric (constricting kidney blood vessels & activating RAAS & releasing ADH)Diuretic – urine output of 1-3 L per day (urine is usually NOT concentrated) Recovery (BMP returns to normal) Prerenal (GFR <65 mmHg) is the most common cause of AKI Oliguria (the most common INITIAL sign of AKI) – Urine output <400ml/day