Acute kidney injury (AKI) is also known as renal failure, accounts for approximately 7% of all kidney disease diagnoses in Australia (Australian Institute of Health and Welfare [AIHW], 2020). AKI is a condition responsible for acute kidney failure. Sally’s subjective and objective data, including diagnostic findings, manifests AKI symptoms due to kidney stones and urinary tract infections. Given this, Sally’s AKI is the outcome of post-renal factors. Hence, Sally Jones’s treatment will address post-renal factors and other manifestations to minimize adverse health outcomes. This paper discusses Sally’s renal calculi and AKI pathophysiology, including clinical manifestations, nursing management, and medical treatments based on the national guidelines.

Pathophysiology 

Acute kidney injury is a complicated condition that causes the kidney’s functions to deteriorate, resulting in a spike in blood urea nitrogen and creatinine levels (Craft et al, 2019). There are three types of AKI pathophysiology: pre-renal, intrinsic, and post-renal (Craft et al., 2019).

According to her diagnostic test results, Sally has a post-renal kidney injury caused by a blockage caused by kidney stones or infection. She has high levels of creatinine 112umol/L and blood urea nitrogen 22mg/dl. It is widely established that nephrolithiasis can result in post-renal AKI due to restriction of urine outflow, which is frequently accompanied by a fast decline in renal function (Brown et al, 2019). Calcium, uric acid, cystine, and struvite stones are types of kidney stones. Norris (2018) outlines the pathophysiology of renal calculi or kidney stones when the crystal-forming urine components such as uric acid, calcium, and oxalate are more concentrated than the fluid in the urine can dilute. When the crystals are impacted in the ureter, the patient presents with flank pain and abnormal voiding (Shi et al, 2018). While the tubular injury disrupts cell connections, allowing glomerular leakage and impairing glomerular filtration. Also, the drying and sloughing of the related cells to the tubules resulting in GFR reduction.

Kidney stones pass through the ureters, which connect the bladder and kidneys, obstructing urine flow. The blockage then causes the increase in pressure within the kidney tubules and finally leads to the reduced glomeruli filtration rate, reduced water, and sodium reabsorption. This Sally’s to experienced oliguria, hematuria, and proteinuria (Yaklin, 2011). It also causes kidney swelling and ureter spasms, causing pain. Renal colic pain is primarily produced by dilatation, stretching, and spasm resulting from acute ureteral blockage; thus, Sally complains of right flank pain, a score of 8 out of 10, which is a symptom of kidney stones. In addition, decreased renal blood flow exacerbates ischemia and cell death in the kidney’s surrounding tissues. Then, the ischemic injury to the kidneys sets off a chain of events that includes the stimulation of oxygen free radicals, enzymes, and cytokines. The CT of Sally’s Kidneys, Ureters, and Bladder (CT KUB) scan reveals a 6mm stone in the right ureter. If left untreated, she has an increased chance of developing chronic kidney damage.

On the other hand, struvite stones develop due to a urinary tract infection (UTI) (BERMAN et al, 2020). These stones can develop rapidly and become quite large, frequently without symptoms or warning. In the case study, Sally presents a sign of UTI as she has shown increased temperature, experienced chill and hot sweats, and nitrites in her urine sample, indicating the presence of bacteria. Therefore, it is concluded that Sally has most likely to have struvite stones. Escherichia coli is the most common pathogen responsible for UTIs. UTIs can spread upward into the kidneys if left untreated and cause serious complications such as kidney damage or sepsis, a potentially fatal condition (Norris, 2018). Therefore, it is vital to give Sally an immediate medical intervention to avoid this from happening.

Nursing management 

Kidney stones require stringent management to prevent further kidney damage. In Sally’s case, the following health management protocols should be considered to relieve her out of pain (Norris, 2018). Firstly, the nurse should assess the patient’s pain score ranging from 0-10, document the pain scores, and provide the patient with appropriate pain relief such as analgesia (Norris, 2018). Secondly, the patient should encourage to increase oral fluids intake from 8-10 glasses a day; if necessary, start IV fluids to restore electrolyte imbalance (Brown et al., 2019). Optimal hydration may aid in stone movement and prevent further complications (Hill et al, 2017). As Sally represents a sign of urinary tract infection, she should be given antibiotics to kill bacteria (Brown et al, 2019).

Moreover, Sally should encourage increasing ambulation to help the stone pass and alleviate her pain in the flank area. Finally, monitor the patient’s urine output for any signs of stones. Then, it should be sent off to the laboratory to determine the type of stones that the patient has had and provide her appropriate therapy (Hill et al, 2017). If the above management is inadequate, doctors may suggest a surgical intervention to remove the kidney stones (Hill et al, 2017).

Medical management 

The main goal of medical management is to repair biochemical abnormalities, restore normal renal balance, and relieve pain (Brown et al, 2019). As Sally’s blood pressure is within normal limits, the patient’s doctors eliminate the calcium stones in her kidney.

Because high fluid consumption dilutes calcium and oxalate, the caregiver should advise patients to drink enough water. The patient can be described for various medications that will aid in the removal of kidney stones. Citrate, an alkalinizing chemical used when long-term alkaline urine maintenance is desirable, is one example (Palermo et al, 2019). Citrate can be given orally for 30 mL/Eq per day, according to Broyles and McKenzie (2020), because it can form complex compounds with calcium in the urine and thus be eliminated through the kidney tubules.

 Because Sally’s sodium levels are within normal limits, providing her sodium medicines aids in the elimination of stones since an increase in sodium in the bloodstream improves calcium excretion. This can aid in the prevention of stone formation (Palermo et al, 2019). Sally’s calcium elimination will be accelerated; thus, her sodium intake will be reduced to avoid complications (Palermo et al, 2019).

The nurse should deliver the opioid analgesics in addition to Sally’s pain rating scale of 8/10. Opioid analgesics like oxycodone (RPBG, 2020) are good renal colic drugs. Oxycodone is a pain reliever for treating moderate to severe pain (RPBG, 2020). The patient is given 15 mg or 7.5 ml of oxycodone orally (Broyles & McKenzie, 2020). Oxycodone mimics the actions of endogenous opioids by attaching to mu-receptors in the central nervous system (Daoust et al., 2020). Because the opiate receptors interact with the G-protein complex and inhibit adenylate cyclase, camp production is reduced (Fassassi et al., 2021). This drug is a respiratory system depressant. Because it disrupts chemo-sensitive cells, which respond to variations in carbon dioxide and oxygen partial pressures in the blood, the nurse should monitor the breathing rate every 20 to 30 minutes after the medicine is started (Burchum & Rosenthal, 2019).

Abuse and addiction, which lead to overdose and death, are dangers associated with this medicine. Therefore, the nurse must monitor the patient receiving this medication to verify he receives the minimal therapeutic dose that it is used for the period of the patient’s anticipated pain. (Burchum & Rosenthal, 2019).  Since this drug induces constipation, the doctor must encourage the patient to consume a fibre-rich diet. Because oxycodone induces hypotension and dizziness, the caregiver should ensure that Sally is assisted when manoeuvring to avoid falls and harm. (Norris, 2018).

In a nutshell, Sally’s illness shows AKI clinical signs linked with a kidney infection and a urinary tract infection. To keep her from acquiring a chronic renal disease, medication is carefully evaluated. Surgical treatment is an important part of this condition’s management. Sally is likely to recover if the procedures are followed.