acute kidney injury · acute kidney injury (aki) can resolve in 6 weeks if the kidneys are going to...
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ACUTE KIDNEY INJURY
Professor Nicola ThomasProfessor of Kidney Care | School of Health and Social Care|
London South Bank University
| e: [email protected] | @nicolamthomas
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Learning Outcomes
To recap knowledge on kidney disease
To define and explain the progression of acute kidney injury (AKI)
To understand how to prevent and how to manage AKI
To be able to provide information on AKI to patients being discharged from the ward
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RECAP Functions of the kidney – what are they?
• Fluid balance
• Excretion of waste (electrolyte and acid-base balance)
• BP control
• Erythropoeitin production (red blood cells)
• Vitamin D3 (healthy bones)
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Terminology
Chronic kidney disease (CKD) Stages 1-5
Established or Advanced Kidney Disease(used to be called end-stage renal failure)
Acute kidney injury (AKI)Can resolve in 6 weeks if the kidneys are going to recover
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Acute Kidney Injury (AKI)
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NCEPOD
NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) reported on AKI management in 2009
Deficiencies identified in 50% of cases including failures in AKI prevention, recognition, therapy and timely access to specialist services.
30% of cases were thought to be preventable had adequate measures been in place.
http://www.ncepod.org.uk/2009report1/Downloads/AKI_summary.pdf
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Why do we need to Think Kidneys?
https://www.thinkkidneys.nhs.uk/aki/
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Pre Renal
Renal (or intrinsic)
Post Renal
Different categories of acute kidney injury
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More simply…..
• a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
•a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
•a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than 8 hours in children and young
people
(NICE 2013)
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• Initiation/onset Phase (few hours-few days)
• Oliguric Phase (5-15 days)
• Diuretic Phase
• Recovery Phase (up to several months)
Key Reference
Dainton, M (2019) Acute Kidney Injury. Chapter 5 in Renal Nursing. Oxford, Wiley.
Clinical course of AKI
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Assesshttps://www.youtube.com/watch?v=ntqOFj1YqGU
Identify/treat the cause
Manage hyperkalaemia (high potassium levels)Manage volume overload/provide adequate hydration to patients at risk of dehydration
Communication with patient and family
Correct acidosisNutritionInfection
Renal Replacement Therapies
Nursing care
Key Message
Carefully assess urine output – at least 0.5mls per kilo
per hour (rule of thumb 30mls per hour)
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A Care Bundle for patients in hospital
https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2020/03/AKI-
care-bundle-2020.pdf
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https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/acute-kidney-injury.aspx
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COVID guidance and AKI
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The previous slides are just an overview of AKI, but here is a link
to a fuller slide set with activities.
https://www.thinkkidneys.nhs.uk/aki/wp-
content/uploads/sites/2/2016/05/UG-nurses-year-three-
FINAL.pdf
This might be suitable after you have been on a renal ward for at
least 4 weeks
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Further readingDainton, M Chapter 5 in Thomas, N (2019) Renal Nursing Wiley Blackwell
RCGP Toolkithttp://www.rcgp.org.uk/aki
NICE guidelines on AKIhttps://www.nice.org.uk/guidance/cg169
Renal Association guidelines on AKIhttp://www.renal.org/guidelines/modules/acute-kidney-injury
Think Kidneys reporthttps://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2018/03/Reporting-the-rate-of-AKI-January-2018.pdf