Key Points from NCLEX Review on Acute Kidney Injury (AKI)

Overview

• Presenter: Stares Westerners
• Topic: Weekly NCLEX question on acute kidney injury (AKI).
• Reminder: Check out other free resources for NCLEX preparation.

Clinical Scenario

• Patient: 36-year-old male
• Condition: Diagnosed with acute kidney injury
• 24-hour Urine Output: 4.5 liters

Key Questions for Consideration

• Normal urine output: 1-2 liters per day
• Determine the stage of AKI the patient is in based on urine output and symptoms.

Stages of Acute Kidney Injury (AKI)

1. Initiation Stage

   • Cause of injury occurs
   • Pre-renal, intra-renal, post-renal causes
   • Signs and symptoms begin to appear

2. Oliguric Stage

   • Urine Output: Less than 400 ml/day
   • Pathophysiology:
     • Glomerular filtration rate (GFR) severely decreased
     • Normal GFR: >90 ml/min
     • Accumulation of waste (BUN, creatinine) in blood
     • Patient may experience acidosis, confusion, fluid overload, hypertension, edema, heart failure
     • Electrolyte imbalances (e.g., hyperkalemia, hyperphosphatemia, hypocalcemia, hypermagnesemia)
     • Urine specific gravity: High (concentrated urine)

3. Diuretic Stage

   • Urine Output: 3-6 liters/day (patient’s output indicates this stage)
   • Pathophysiology:
     • Glomerulus begins to recover
     • GFR starts improving but still abnormal
     • Waste (urea, creatinine) begins to be removed
     • Osmotic diuresis causes large urine output
     • Fluid volume decreases: Hypotension
     • Electrolyte imbalances (e.g., hypokalemia)
     • Urine specific gravity: Low (dilute urine)

4. Recovery Stage

   • Urine output normal
   • Normal GFR, BUN, creatinine levels
   • Normal fluid and electrolytes

Analysis of Options for the NCLEX Question

• A. Water Intoxication: No, patient is fluid volume depleted
• B. Hypotension: Yes, due to fluid volume depletion
• C. Low Urine Specific Gravity: Yes, indicates dilute urine
• D. Hypokalemia: Yes, due to excessive urination
• E. GFR > 90 ml/min: No, GFR is abnormal
• F. Normal BUN and Creatinine: No, not yet normal
• G. Profound Confusion: No, improvement in cognitive status

Conclusion

• Correct answers: B (Hypotension), C (Low Urine Specific Gravity), D (Hypokalemia)

Additional Resources

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