ACUTE IN THE HOSPITAL

The old Proverb is true;Prevention surpasses cure.

Today I may sound a little technical with a lot of English friends but bear with me.I will reset I along the way. Statistics display that 10-20% of emergency hospital admissions in the United Kingdom are related to Acute kidney injury and tagged onto this is a poor prognosis.(Selby NM et al defining the cause of death in hospitalized patients with acute kidney injury 2012;7(11).

This is a country that has embraced research and accurate data entry. If the same situation were transplanted in Kenya, the figures are worse if not close. This is occasioned partly due to lack of know-how on kidney disease and majorly due to ignorance of both the patient and the healthcare provider on this ravaging disease.

Acute kidney injury (AKI) happens in almost all long term patients in our wards. The causes are many and varying. The commonest sign is an acute dehydration attributable to the underlying co-morbidities.0.5mls/kg/hr of urine is what the National Kidney Foundation identifies as the cut off for an adult; all factors constant.

Hospitalized patients develop AKI because their illness—the primary cause of the admission—has robbed them of the ability to drink fluids as they normally would.

That explains the frequent ‘monitor input/output’ clinicians write in the patient’s record of care. The interesting thing with our set up is that as far as it involves urine, most of us deem it too ‘lowly’ and demeaning.It is even hard enough to get the patient to understand the rationale of regular fluid balance checks if we do not understand it ourselves.

Acute kidney injury has a good prognosis if detected early enough. The reality however is that more than 50% of cases are diagnosed in the most advanced stages of the disease. Recuperation maybe great but it leaves the patient with some degree of diminished renal function.

It is imperative that we take kidney disease with the seriousness it deserves. You as the client needs to take care of your kidneys. They really are the most vital organs if you think about it.The kidneys maintain our electrolytes, our minerals, our blood pressure among many other functions. I am sure we have covered them in previous #KidneyWednesday series.

Watch the color of your urine too. Urine should be amber in color. Amber sasa ni rangi gani… bamboo-straw maybe? Straw-colored? I need to borrow some English from people. Any creditors?

As clear as pure water means you have taken too much fluid hence diluting your urine. That or you have an underlying medical condition which I don’t intend to cover today. Too concentrated and it means you are dehydrated.Folks, anything that is reducing the fluid content in your blood will ultimately make you have concentrated urine. That or you have underlying medical condition which I have no solid plan to delve into either.

#TeamPhoenix, take a day to walk in the shoes of patients suffering kidney disease. You probably would understand why I am all for prevention. We have acute shortage of hemodialysis machines in Kenya.The available ones are excellent at regular mechanical breakdowns yet the number of patients on the waiting list is growing exponentially.

We refused to practice peritoneal dialysis in adults (because we are generally a selfish people) and kidney transplantation is taking a whole century to take place on at least one eligible candidate.

What’s more, the hefty cost of anti- rejection medication post-transplant discourages many a patient from undertaking this life saving operation. Preventing acute kidney injury and intervening at its earliest onset is the way to make sure that we do not continue condemning more and more patients on chronic hemodialysis.

My hope is that nurses being the first point of contact with all patients are empowered to recognize signs of deteriorating kidney function and do something about it.We do not need to wait until the situation is dire for us to act. This is why we need nephrology nurses at every point of contact. That is the role the new scope of practice is aiming to introduce –clinical nurse specialists.

In a community set up, in nursing homes, in maternity departments, in new born units, prevention of acute kidney injury is multi-agency. A good referral system ensures that whatever is reversible is reversed and we maintain some healthy kidneys.

It is important to note however that patients with chronic kidney disease can and will suffer acute kidney injury. If we miss this we end up worsening an already bad situation. With this in mind therefore, acute reduction in urine production should alert you and me on the state of the kidneys. That coupled with a few cheap tests are enough to help us correctly identify at-risk patients.

I can’t overemphasize how vulnerable all hospitalized patients are. It does not matter what initiated the admission but as far as we have altered that person’s normal routine, we have positioned them on the path to acute kidney injury and subsequent sequelae.

However, some of the problems we face in the quest to maintain adequate fluid volume in our patients are self-inflicted. It will be very foolhardy to initiate the patient on fluid intake and output monitoring without their knowledge.

Just let the patient know what you are doing and why. That is the one of the strategies I have always seen to work with even the most difficult of patients.

Explain in the simplest language you can afford. Unless they start Google-name-dropping on you. If they do that, by the powers vested in me by nobody in particular, unleash all pathophysiology on their souls. Hahaha.

To the general public, whenever you are hospitalized, your intake of fluids is acutely reduced. It is hence vital for whoever is taking care of you to encourage you to drink more water if only to reduce the formidable statistics.

Sigh…

Is it too late to hope Kenyans will be proactive in matters kidney health?

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