Acute Renal Failure
Causes of Acute Renal Failure
RenalperfusionSudden causesaffectingInduce CalledParenchymalstructuresUrineoutputPrerenalParenchymatousAcuterenalfailureGFRObstructive
Characteristics of acute renal failure. Acute renal failure is asyndrome characterized by a sudden decrease of the glomerularfiltration rate (GFR) and consequently an increase in bloodnitrogen products (blood urea nitrogen and creatinine). It isassociated with oliguria in about two thirds of cases. Dependingon the localization or the nature of the renal insult, ARF is classi-fied as prerenal, parenchymatous, or obstructive (postrenal).
CAUSESOF PRERENAL ACUTE RENAL FAILURE
Decreased effective extracellular volumeRenal losses: hemorrhage, vomiting, diarrhea, burns, diureticsRedistribution: hepatopathy, nephrotic syndrome, intestinal obstruction, pancreatitis,peritonitis, malnutritionDecreased cardiac output: cardiogenic shock, valvulopathy, myocarditis, myocardialinfarction, arrhythmia, congestive heart failure, pulmonary emboli, cardiac tamponadePeripheral vasodilation: hypotension, sepsis, hypoxemia, anaphylactic shock, treatmentwith interleukin L2 or interferons, ovarian hyperstimulation syndromeRenal vasoconstriction: prostaglandin synthesis inhibition,
-adrenergics, sepsis, hepa-torenal syndrome, hypercalcemiaEfferent arteriole vasodilation: converting-enzyme inhibitors
Causes of prerenal acute renal failure (ARF).
ARF, alsoknown as prerenal uremia, supervenes when glomerular filtrationrate falls as a consequence of decreased effective renal blood supply.The condition is reversible if the underlying disease is resolved.
CAUSESOF PARENCHYMATOUSACUTE RENAL FAILURE
Acute tubular necrosisHemodynamic: cardiovascular surgery,* sepsis,* prerenal causes*Toxic: antimicrobials,* iodide contrast agents,* anesthesics, immunosuppressive orantineoplastic agents,* Chinese herbs, Opiaceous, Extasis, mercurials, organicsolvents, venoms, heavy metals, mannitol, radiationIntratubular deposits: acute uric acid nephropathy, myeloma, severe hypercalcemia,primary oxalosis, sulfadiazine, fluoride anesthesicsOrganic pigments (endogenous nephrotoxins):Myoglobin rhabdomyolisis: muscle trauma; infections; dermatopolymyositis;metabolic alterations; hyperosmolar coma; diabetic ketoacidosis; severehypokalemia; hyper- or hyponatremia; hypophosphatemia; severe hypothy-roidism; malignant hyperthermia; toxins such as ethylene glycol, carbonmonoxide, mercurial chloride, stings; drugs such as fibrates, statins, opioidsand amphetamines; hereditary diseases such as muscular dystrophy,metabolopathies, McArdle disease and carnitine deficitHemoglobinuria: malaria; mechanical destruction of erythrocytes with extracorporealcirculation or metallic prosthesis, transfusion reactions, or other hemolysis;heat stroke; burns; glucose-6-phosphate dehydrogenase; nocturnal paroxystichemoglobinuria; chemicals such as aniline, quinine, glycerol, benzene, phenol,hydralazine; insect venomsAcute tubulointerstitial nephritis (
Fig. 8-4)Vascular occlusionPrincipal vessels: bilateral (unilateral in solitary functioning kidney) renal arterythrombosis or embolism, bilateral renal vein thrombosisSmall vessels: atheroembolic disease, thrombotic microangiopathy, hemolytic-uremicsyndrome or thrombotic thrombocytopenic purpura, postpartum acute renalfailure, antiphospholipid syndrome, disseminated intravascular coagulation,scleroderma, malignant arterial hypertension, radiation nephritis, vasculitisAcute glomerulonephritisPostinfectious: streptococcal or other pathogen associated with visceral abscess,endocarditis, or shuntHenoch-Schonlein purpuraEssential mixed cryoglobulinemiaSystemic lupus erythematosusImmunoglobulinA nephropathyMesangiocapillaryWith antiglomerular basement membrane antibodies with lung disease(Goodpasture is syndrome) or without itIdiopathic, rapidly progressive, without immune depositsCortical necrosis, abruptio placentae, septic abortion, disseminated intravascularcoagulation
Causes of parenchymal acute renal failure (ARF). When the sud-den decrease in glomerular filtration rate that characterizes ARF issecondary to intrinsic renal damage mainly affecting tubules,interstitium, glomeruli and/or vessels, we are facing a
. Multiple causes have been described, some of themconstituting the most frequent ones are marked with an asterisk.