Acute Kidney Injury : Oliguric phase
- Oliguric phase
- Urinary changes- oliguria
- Urinary output less than 400 mL/day
- Occurs within 1 to 7 days after injury
- Lasts 10 to 14 days
- Urinalysis may show casts, RBCs, WBCs
- Fluid volume
- Hypovolemia may exacerbate AKI
- Decreased urine output leads fluid retention
- Neck veins distended
- Bounding pulse
- Edema
- Hypertension
- Fluid overload can lead to heart failure, pulmonary edema, and pericardial and pleural effusions
- Metabolic acidosis
- Impaired kidney cannot excrete hydrogen ions
- Serum bicarbonate production is decreased
- Severe acidosis develops
- Sodium balance
- Increased excretion of sodium
- Hyponatremia can lead to cerebral edema
- Potassium excess
- Impaired ability of kidneys to excrete potassium
- Increased risk with massive tissue trauma
- Usually asymptomatic
- ECG changes
- Hematologic disorders
- Waste product accumulation
- Elevated BUN and serum creatinine levels
- Neurologic disorders
- Fatigue and difficulty concentrating
- Seizures, stupor, coma
- Diuretic phase
- Daily urine output is 1 to 3 L
- May reach 5 L or more
- Monitor for hyponatremia, hypokalemia, and dehydration
- Recovery phase
- May take up to 12 months for kidney function to stabilize
- Diagnostic studies
- Thorough history and physical examination
- Identification of precipitating cause
- Serum creatinine and BUN levels
- Serum electrolytes
- Urinalysis
- Kidney ultrasonography
- Renal scan
- CT scan
- Renal biopsy
- Contraindicated
- MRI with gadolinium contrast medium
- Magnetic resonance angiography (MRA) with gadolinium contrast medium
- Nephrogenic systemic fibrosis
- Contrast-induced nephropathy (CIN)
- Management
