What practice nurses need to know about acute kidney injury
Acute kidney injury is commonly seen in the community. Peter Ellis looks at the issues practice nurses might want to consider in its management in the community and when referral is necessary
The true prevalence of acute kidney injury (AKI) is uncertain, but the incidence is on the increase. The signs and symptoms of AKI vary according to the exact cause of the injury, but in the community the presenting signs will usually include the patient complaining of a reduced urine output. The signs and symptoms of AKI, including oliguria, tend to have a rapid onset. There are a large number of potential causes of AKI. An understanding of the cause and classification of a particular presentation of AKI will provide the practice nurse with useful clues as to its management. The key to management of AKI in the primary care setting is the removal, or reversal, of its cause, if possible. There is a degree of clinical interpretation that needs to be applied to the referral criteria, which will be informed by the patient's age and comorbidities and the nurse's experience of their care needs and the clinical support available in the general practice. People who recover from AKI require life-long monitoring for complications.
Acute kidney injury (AKI) is common in the UK, with a reported prevalence of 15% among people admitted as emergencies to hospitals (National Institute for Health and Care Excellence (NICE), 2021a). Community acquired AKI is even more prevalent at approaching 600/100 000 population, although in the absence of blood testing this figure is probably inaccurate (NICE, 2021a). One study reports an incidence rate across the UK of approximately 150/10 000 of the population per year (Sawhney et al, 2018).
The truth is no one is certain what the prevalence or incidence rates for AKI are, because they cannot easily be measured. What is known is that the incidence of AKI is on the increase and that this increase is likely to be related to the increased age of the population and attendant increase in the prevalence of chronic conditions, which contribute to the risk of acquiring AKI (Yokota et al, 2018). Therefore, practice nurses need to be aware of the signs and symptoms of AKI, as well as the characteristics of people most at risk from it. Sometimes people still term AKI as acute renal failure, although this terminology is no longer in mainstream use.
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