Acute Kidney Injury in Adults: An Underdiagnosed Condition

Kristy Washinger; MSN; FNP-BC

Disclosures

Journal for Nurse Practitioners. 2017;13(10):667-674. 

In This Article

Risk Assessment

AKI typically occurs as a complication of another medical condition and can occur in a community or hospital setting. Patients who are hospitalized with an acute illness, have a surgical procedure, or are to receive intravenous (IV) contrast are at increased risk.

The common risk factors for AKI include dehydration or volume depletion, advanced age, female sex, black race, CKD, chronic diseases (eg, anemia, liver disease, diabetes, congestive heart failure, cancer, coronary artery disease, hypertension, and multiple myeloma), hypoalbuminuria, sepsis, renal artery stenosis, nephrotoxic drugs, and mechanical ventilation.[10]

Risk factors for AKI related to an acute illness or surgery include emergency surgery, intraperitoneal surgery, underlying CKD, proteinuria, diabetes, congestive heart failure, chronic obstructive pulmonary disease, advanced age, liver disease, and the use of nephrotoxic medications in the perioperative period.[11]

Contrast-induced Nephropathy

Contrast can cause AKI by renal vasoconstriction and direct tubular epithelial toxicity. It can occur in inpatient and outpatient settings. Higher concentrations of contrast can increase the likelihood of kidney damage.[9] Before contrast exposure, evaluate for recent exposures to contrast and consider alternative tests for patients at risk for AKI. If contrast is needed, recommend that the lowest dose and concentration of contrast be administered.

Risk Factors for AKI in the Community Setting

Risks associated to dehydration (diarrhea and vomiting) and medications with nephrotoxic potential (Table 3) are the leading causes of AKI in the community. Higher summer temperatures also increase the risk of hospitalization for AKI with heat stroke as the most common cause.[12] Other risk factors include CKD with an estimated glomerular filtration rate (eGFR) < than 60 mL/min/1.73 m2, neurologic or cognitive impairment, or a disability that limits someone's access to fluid intake.

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