A.

Prerenal/ Pre • Sudden decrease in BP

azotemia • Caused atherosclerosis, ischemia
- Before the kidney • Includes hypovolemia, ↓ Cardiac
output, ↓ effective circulatory
volume
B. Intrarenal • direct damage to the kidney itself by
- Within the kidney inflammation, toxins, drugs (NSAIDs,
ACE), infection, or reduced blood
supply
• Most common form of acute renal
failure
• 4 main causes:
1. (GLOMERULI) Acute
glomerulonephritis
2. (tubules) Acute tubular
necrosis
3. (interstitium) Acute
interstitial nephritis (AIN)
4. (renal vasculature) Vascular
disease
C. Postrenal/ Post • Main obstruction of urine flow
obstructive acute kidney • Due to benign prostatic hyperplasia,
injury kidney stones, or some form of
- After the kidney bladder injury or tumor
• It is an obstruction anywhere along
the urinary tract from the renal pelvis,
ureter, bladder to the urethra
 Mrs J a 60-year-old widow, had long-standing hypertension
that was unsatisfactorily controlled on a variety of agents. Her drug
therapy included furosemide 40 mg once a day, amlodipine 10 mg
daily and a salt restricted diet. Following a routine review of her
therapy, ramipril 2.5 mg once daily was added to her treatment
regimen in an attempt to improve blood pressure control.
Mrs J was recently diagnosed with gastroenteritis. A week
after her diagnosis she presented to her local hospital accident and
emergency unit, with ongoing diarrhoea. Her BP was found to be
100/60 mmHg and serum biochemistry revealed creatinine levels of
225 mmol/L (50–120 μmol/L), Na+ 125 mmol/L (135–145 mmol/l) and
K+ 5.2 mmol/L (3.5–5.0 mmol/L).
 Patient’s Name: Mrs. J
Age: 60 yrs old
FINDINGS ASSESSMENT RESOLUTION MONITORING

• The patient is • The patient is • The • Investigations should

60 year old suspected to inappropriate use be arranged to
woman have renal of an ACE determine whether the
• long-standing artery stenosis inhibitor should patient has renal artery
hypertension • Pre-renal be stopped stenosis
• Gastroenteritis failure • temporarily • measurements of urine
• Diarrhoea stopped diuresis output, fluid intake,
• Increase intake and weight should be
serum • Rehydrate patient performed. Vital signs
creatinine with NaCl 0.9% should be monitored at
• Hypovolemia least daily
• Hypotension • Conduct ultrasound
scan or abdominal
radiography