Acute Kidney Injury

Introduction

Acute Kidney Injury, initially known as acute renal failure is a disorder characterized by a rapid loss of kidney function. The disease has various causes such as, but not limited to exposure to substances that are harmful to the kidney, low volume of blood and obstruction of urinary tract. The diagnosis of Acute Kidney Injury is based on the characteristics of laboratory findings that include high amounts of nitrogen, creatinine and urea, or the incapability of the kidney to release adequate amounts of urine (Alez 2012). The disease might result in various complications such as high levels of potassium and metabolic acidosis, changes in balance of body fluids, uraemia and impacts on other organ system. With regard to this, the paper focuses on cancer patients who have an incident of Acute Kidney Injury following obstructive hydronephrosis.

Hydronephrosis refers to the dilation and distention of the renal calyces and pelvis due to the obstruction of the free flow of urine from the kidney (Benoit & Depuydt 2005). Left untreated, obstructive hydronephrosis results in progressive atrophy of the kidney. The causes of obstruction can arise from blood clots, stones or retroperitoneal fibrosis. According to Brenner (2002), some of the causes of the hydronephrosis comprise the causes of post-renal AKI, which is also a result of obstruction of the urinary tract. In general, hydronephrosis constitutes one of the causes of AKI. In addition, according to Darmon, Ciroldi & Thiery (2006), these obstructions might be either complete or partial and can occur at any place from urethral meatus to the calyces of renal pelvis.

The diagnosis of cancer patients has significantly improved over the past twenty years. According to Jain (2010), these improvements have been majorly achieved by the deployment of intensive or new therapeutic treatment coupled with a good risk stratification of patients because of advances in immunohistology, radiology and cytogenetic. Unfortunately, this has also resulted in increased incidences of latent life-threatening complications that require treatment in the Intensive Care Unit (ICU) (Darmon, Ciroldi & Thiery 2006). One of the complications among cancer patient is the Acute Kidney Injury (AKI). Cancer patients admitted to the ICU because of AKI during their ICU period characteristically have worse outcomes, particularly in the failure of multiple organs. Until lately, it remained an issue of controversy if these patients would benefit from improved life-supportive therapy such as renal replacement therapy (Kroschinsky, Weise & Illmer 2002).

Various studies worldwide have demonstrated that the presence of cancer alone can no longer be a reason for referring patients to the ICU. In addition, while the survival of cancer patients requiring RRT in the presence of failure of multiple organs was exceptional until a decade ago, this is no longer the case presently. A noteworthy exception remains the crucial ill allergenic peripheral stem cell transplantation recipient (Kroschinsky, Weise & Illmer 2002).

AKI might also have severe effects on critically ill survivors of cancer. The duration of mechanical ventilations seems to be longer in cancer patients suffering from AKI than in those without AKI. The impairment in the functional conditions arising from ICU stay coupled with delayed recovery in renal function might interfere with the ideal administration of possibly life-saving chemotherapy. Consequently, this further affects the long-term prognosis of cancer patients with AKI (Larche `, Azoulay & Fieux 2003). Therefore, early identifications of patients vulnerable to AKI followed by early interventions or preventive measures can be of importance in reducing the related morbidity, mortality and economic burden in cancer patients with AKI.

According to Leach (2010), the preventive measures targeting to enhance the outcome of crucially ill cancer patients developing AKI are principally specific in terms of causes. Most frequently, several nephrotoxic insults cause AKI in cancer patients, though the primary cause is usually noticeable in daily practice. Mendoza (2011) points out that AKI might occur as a direct consequence of cancer itself, its treatment or related complications such as cardiac failure or septic shock. Septic shock is by far the most popular cause of AKI in cancer patients. In addition, AKI resulting from septic shock is much less easy to stop that AKI resulting from tumour lysis syndrome (TLS) (O’Callaghan 2009).

In relation professional and ethical dimensions of nursing, Ronco, Bellomo & Kellum (2009) point out that, there are crucial and explicit ethical concepts related to nursing AKI patients, which include respect, and confidentiality. These concepts are interdependent and do not act as an exhaustive list of concepts for nursing practice (Schrier 2008). Customarily, using codes of ethics and practicing nursing help nurses develop a moral foundation by which to function. Since nursing focuses on nurturing patients, including AKI patients, these concepts are applicable to all aspects of care.

Giving respect as a dimension of ethics in nursing is a crucial concept in decision-making, developing relationships and boundary issues encountered by typical nurses on a daily basis. Tisdale & Miller (2010) defines giving respect as an action of esteeming another person. However, the action requires an individual to have a sense of integrity, authenticity, and self-knowledge. AKI patients similar to any other patient need respect. As such, this ethical dimension requires nurses to honour the essence, wholeness and uniqueness of not only AKI patients but also other patients. With regard to professional dimension, giving respect involves maintaining authenticity in all relationships with others such as nurse-physician, nurse-to-nurse and nurse-to-patient (Soares, Salluh & Carvalho 2006).

The ethical dimension of maintaining confidentiality implies that nurse keeps information disclosed by the patients or families private unless the information falls under a limit of confidentiality. This ethical dimension is at the centre of establishing a trusting relationship with other patients, nurses and families. Nurses might encounter temptations that might prompt them to infringe the trust that patients have established with them (Silfvast et al. 2003). This might be because of vulnerability to situations other than for limits of confidentiality. For instance, a nurse might withhold a patient’s information as directed by the patient or family, though he or she feels that it is necessary to reveal such information. Many patients suffering from the kidney disorders, including AKI, would want to hide such information from their relatives. Consequently, they would direct the nurse not to disclose their condition to their relatives. In such circumstances, nurses would have to keep the information private though he or she might be prompted to disclose it eventually (Schrier 2008).

Performing an Electrocardiography (ECG) test on patients suffering from AKI following cancer can be of considerable significance. The obstruction of the free flow of urine from the kidney can increase the potassium level in the kidney to six, which can cause problems. While researches evaluating respective biomarkers have been informative, some have focused on developing a panel for diagnosing Acute Kidney Injury. In the field of cardiology, consecutive elevations of creatinine kinase, myoglobin and troponin and ECG changes enable physicians to decide on which treatment to administer to AKI patients. In nephrology, the same framework is adopted. Nevertheless, there is no ordinary ECG in nephrology (Ronco, Bellomo & Kellum 2009). Accordingly, further research will be significant in clearly tracking changes in potassium levels in the urine. According to Schrier (2008), the basic chemistries of urine can also provide an understanding of the “ECG” of Acute Kidney Injury.

In conclusion, incidences of AKI are higher in cancer patients than normal patients. AKI results in various complications such as high levels of potassium, metabolic acidosis, changes in balance of body fluids, and impacts on other organ system. Most frequently, several nephrotoxic insults cause AKI in cancer patients, though the primary cause is usually noticeable in daily practice. In relation to professional and ethical dimensions of nursing, there are crucial and explicit ethical concepts related to nursing AKI patients, which include respect, and confidentiality. Performing an Electrocardiography (ECG) test on patients suffering from AKI following cancer can be of considerable significance.

References List

Alez, G 2012, Acute Kidney Injury: Everything You Need to Know about the Disease Including Causes, Diagnosis, Treatment and More, Webster’s Digital Services, London.

Benoit, DH, & Depuydt, P 2005, ‘Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparisonbetween patients with and those without haematological malignancies’, Nephrol Dial Transplant, vol 20, no. 3, p. 552–558.

Brenner, H 2002, ‘ Long-term survival rates of cancer patients achieved by the end of the 20th century : a period analysis’, Lancet , vol 360, no. 9340, p. 1131–1135.

Darmon, M, Ciroldi, M & Thiery, G 2006, ‘Clinical review: specific aspects of acute renal failure in cancer patients’, Crit Care , vol 10, no. 2, p. 211.

Jain, K 2010, The Handbook of Biomarkers, Springer, London.

Kroschinsky, F, Weise, M & Illmer, T 2002, ‘Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies’, Intensive Care Med, vol 28, no. 9, p. 1294–1300.

Larche `, J, Azoulay, E & Fieux, F 2003, ‘Improved survival of critically ill cancer patients with septic shock’, Intensive Care Med , vol 29, no. 10, p. 1688–1695.

Leach, R 2010, Acute and Critical Care Medicine at a Glance, John Wiley and Sons, New York.

Mendoza, J 2011, Acute kidney injury : causes, diagnosis, and treatments, Nova Biomedical/Nova Science Publishers, New York.

O’Callaghan, C 2009, The Renal System at Glance, John Wiley & Sons, New York.

Ronco, C, Bellomo, R & Kellum, R 2009, Critical care nephrology, Saunders/Elsevier, Philadelphia.

Schrier, R 2008, Manual of Nephrology: Diagnosis and Therapy, Lippincott Williams & Wilkins, London.

Silfvast, T, Pettila, V & Ihalainen, A 2003, ‘Multiple organ failure and outcome of critically ill patients with haematological malignancy’, Acta Anaesthesiol Scand, vol 47, no. 3, p. 301–306.

Soares, M, Salluh, J & Carvalho, M 2006, ‘ Prognosis of critically ill patients with cancer and acute renal dysfunction’, J Clin Oncol, vol 24, no. 24, pp. 4003-4010.

Tisdale, J & Miller, D 2010, Drug-Induced Diseases: Prevention, Detection, and Management, ASHP, Bethesda, Md.

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