09.02 Acute Tubular Necrosis for CCRN Review

Nursing Points

General

1. Acute tubular nephrosis
   1. Emergency
      1. 50% will die
      2. 25% need hemodialysis
      3. 25% recover
   2. Ischemia
      1. Hemorrhage
      2. Burns
      3. Sepsis
      4. Heart failure
      5. Transfusion reactions
   3. Nephrotoxicity
      1.    Ingesting heavy metals
      2. Medications
      3. Street drugs
      4. Rhabdomyolysis
      5. Radiocontrast
   4. Stages
      1. Oliguric
         1. Lasts 10-17 days
         2. Decreased urine output
         3. Increase in labs:
            1.   BUN
            2. Creatinine
            3. Potassium
            4. Fluid overload
      2. Polyuric
         1. Diuretic stage
         2. Not an indication of improvement
            1. Proximal tubule is necrotic
         3. Increase in labs
            1. Urine output
            2. BUN
            3. Creatinine
         4. Decreased labs
            1. Fluid
            2. Potassium
         5. Lasts 2weeks to 3 months
      3. Recovery Stage
         1. Lasts 3 months – 1 year
         2. Want kidneys to regenerate