Acute Kidney Injury

[Future Nurse In Training]

Is it normal for a patient to be diagnosed with AKI, but have a normal BUN, CR, Na and is hypokalemic?

[Cali_RN18, ADN, BSN, RN]

Is this an assignment?

[Future Nurse In Training]

No. It's a question I asked myself when looking at a diagnosis for AKI, but there was no increase in BUN, Cr, K.

[Cali_RN18, ADN, BSN, RN]

It is not normal. For all my AKI patients the BUN and creatinine are elevated. Nephrology is consulted and patients are usually started on dialysis. Some patients truly are AKI and a underlying condition needs to resolve, but the labs are 100% of the time elevated, so very strange that the ones you are implementing were not.

[Future Nurse In Training]

My thoughts exactly, I was thinking misdiagnosis. Thank you!

[Tegridy]

you can have an AKI with a normal BUN/Cr as per the lab ranges. An aki is considered a 1.5 increase in Cr within 48 or so hours. There are a few more definitions such as 0.3 increase In cr or UOP less than .5ml/kg/hr x 6 hours

So it’s likely not a misdiagnosis

9 hours ago, Adri0418 said:

It is not normal. For all my AKI patients the BUN and creatinine are elevated. Nephrology is consulted and patients are usually started on dialysis. Some patients truly are AKI and a underlying condition needs to resolve, but the labs are 100% of the time elevated, so very strange that the ones you are implementing were not.

They only started on dialysis if renal failure not aki

[marienm, RN, CCRN]

Did the AKI diagnosis come from the patient's problem list in the electronic medical record? At my hospital, every current problem as well as chronic but relevant conditions are listed there. It can be helpful (it's good to know that a patient with an acute bowel obstruction also has COPD) or it can be confusing (such as the patient who was hyperkalemic on admission 3 weeks ago due to compartment syndrome and has never been hyperkalemic since their fasciotomy...but the problem list still says "hyperkalemia")

Just speculating about whether the listing of AKI is still a current diagnosis...

[BostonFNP, APRN]

AKI is diagnosed on the basis of a sudden reduction in renal function as measured elevation of serum Cr (>0.3mg/dL or 150% increase in serum Cr), reduction in urine output (<0.5mL/kg/hr for >6hours), or need for renal replacement.

It also may have happened earlier in the hospital course/ED.