05/10/2023
Acute kidney injury, or AKI
refers to a sudden decrease in kidney function over hours or days. As a result, the kidney’s ability to manage fluid, electrolyte and impaired acid base balance.
Diagnostic criterion for AKI;
It is an abrupt (within 48 hours) reduction in kidney function defined as an absolute increase in the serum creatinine level of at least 0.3 mg/dL.
A 50% increase in the serum creatinine level, or a
documented urine output of less than 0.5 mL/kg per hour for more than 6 hours
Causes of AKI include:
_ systemic shock due to a sudden loss of blood supply to the kidneys from trauma, surgical complications, or sepsis
_ streptococcal infection
_ impaired glucose utilization, protein catabolism,
_ accumulation of metabolic waste, and a rapid decrease in urine output
Nutrition intervention:
Energy: Use 25 to 35 kcal/kg of actual body weight as an estimation of energy requirements.
Protein: The optimal protein intake for patients without dialysis provide 0.8 to 1.2 g/kg of actual body weight. In the presence of catabolism, provide 1.2 to 1.5
g/kg of actual body weight.
Sodium: Intake should be 2,000 to 3,000 mg/day based on the patient’s blood pressure and the
presence of edema. During the diuretic phase, replace sodium losses based on urinary output, edema, renal
replacement therapy, and serum sodium levels.
Potassium: Provide 2,000 to 3,000 mg/day of potassium. During the diuretic phase, replace potassium
losses based on urinary volume, serum and urinary potassium levels, renal replacement therapy, and drug therapy.
Phosphorus: Provide 8 to 15 mg/kg of phosphorus. Closely monitor the phosphorus levels of patients who receive renal replacement therapy.
Calcium: Maintain serum levels of calcium within normal ranges. Closely monitor the calcium levels of
patients who receive renal replacement therapy.
Fluids: The daily fluid intake should be 500 mL plus the volume of urine output. The fluid intake also depends on the serum and urinary sodium level, total fluid output (including urine), and type of dialysis.