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In the United States, renal disease has continued to be a prevalent problem. Current data suggest 1% of patients admitted to the hospital are diagnosed initially with acute kidney injury (AKI), while about 2%-5% of hospitalized patients develop AKI secondarily (Workeneh, 2013). An estimated 1%-25% of patients in intensive care settings are affected by AKI with a mortality rate of 15%-60% (Singbartl & Kellum, 2012). Dirkes (2011) suggested the mortality rate is closer to 40%-90%. The cost of treatments required for AKI is astonishing; hemodialysis is approximated to cost $32 million annually (Jorgensen, 2013). In fact, nearly 95% of nephrologist consults are related directly to AKI (Workeneh, 2013).
Acute kidney injury is "a sudden decline in kidney function, causing disturbances in fluid balance, electrolyte shifts, acid base imbalance, and a loss in kidney function that causes a decline in the glomerular filtration rate" (Dirkes, 2013, p. 125). Acute kidney injury, previously known as acute renal failure, can be caused by three different injury pathways: prerenal, intrarenal, and postrenal. Prerenal causes are the most common as they are related directly to lack of blood flow to the kidneys; examples would include sepsis, severe hypotension, renal artery stenosis, and hypovolemia from severe blood loss (Kache & Trinkus, n.d.). Intrarenal injury occurs inside the kidney, such as acute tubular necrosis or contrast-induced nephropathy. Postrenal injury is caused by an obstruction below the kidneys; examples include calculi, blood clot, enlarged prostate, and strictures (Yaklin, 2011).
The outcome for an affected patient will depend on the cause of AKI and the glomerular filtration rate (GFR) (Dirkes, 2011). Acute kidney injury can be reversible, although recovery does take a significant amount of time (Russell, 2009). In many cases, however, AKI can result in chronic kidney injury, "a gradual and progressive reduction of functioning kidney mass" (Russell, 2009, p. 328), or death. As nephrons do not regenerate, early identification and treatment are essential to reverse AKI. Goldberg and Dennen (2008) found 12.5% of patients who survived AKI became dependent on long-term dialysis.
Case Study
Mr. Benning, age 57, presented to the emergency department with altered mental status, oliguria, hypertension, and nausea. In triage, his vital signs were as follows: temperature 97.0°, pulse 123 beats/minute, respirations 10 breaths/minute, blood pressure 240/118 mm Hg,...