Acute renal failure classification: Difference between revisions
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* ''Pre-renal'' (compromise in the renal blood flow): | * ''Pre-renal'' (compromise in the renal blood flow): | ||
** [[Hypovolemia]] (decreased blood volume) | ** [[Hypovolemia]] (decreased blood volume) - | ||
*** [[Shock (medical)|Shock]], [[hemorrhage]], [[burns]], [[dehydration]] | *** [[Shock (medical)|Shock]], [[hemorrhage]], [[burns]], [[dehydration]] | ||
*** Fluid loss from [[diuretic]]s use, [[diabetes mellitus]], [[hypoadrenalism]] | *** Fluid loss from [[diuretic]]s use, [[diabetes mellitus]], [[hypoadrenalism]] | ||
*** Gastrointestinal fluid loss: [[vomiting]], surgical drainage, [[diarrhea]] | *** Gastrointestinal fluid loss: [[vomiting]], surgical drainage, [[diarrhea]] | ||
*** Extra-vascular space sequestration: [[pancreatitis]], [[hypoalbuminemia]], [[peritonitis]], [[trauma]], [[burns]] | *** Extra-vascular space sequestration: [[pancreatitis]], [[hypoalbuminemia]], [[peritonitis]], [[trauma]], [[burns]] | ||
** Low cardiac output - | |||
** [[Hepatorenal syndrome]] in which renal [[perfusion]] is compromised in [[liver failure]] | ** [[Hepatorenal syndrome]] in which renal [[perfusion]] is compromised in [[liver failure]] | ||
** Vascular problems, such as [[atheroembolic disease]] and [[renal vein thrombosis]] (which can occur as a complication of the [[nephrotic syndrome]]) | ** Vascular problems, such as [[atheroembolic disease]] and [[renal vein thrombosis]] (which can occur as a complication of the [[nephrotic syndrome]]) |
Revision as of 23:48, 23 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Acute renal failure can complicate a wide spectrum of disorders, and for the purpose of diagnosis and management is divided according to the mechanism that lead to renal compromise. The three categories are pre-renal azotemia (diseases that cause renal hypoperfusion), renal azotemia (diseases directly affecting the renal parenchyma), and post-renal azotemia (diseases affecting the urinary tract causing obstruction).
Classification
Acute renal failure is usually categorised (as in the flowchart below) according to pre-renal, renal and post-renal causes.
Acute Renal Failure | |||||||||||||||||||||||||||||||||
Pre-renal | Renal | Post-renal | |||||||||||||||||||||||||||||||
- Pre-renal (compromise in the renal blood flow):
- Hypovolemia (decreased blood volume) -
- Shock, hemorrhage, burns, dehydration
- Fluid loss from diuretics use, diabetes mellitus, hypoadrenalism
- Gastrointestinal fluid loss: vomiting, surgical drainage, diarrhea
- Extra-vascular space sequestration: pancreatitis, hypoalbuminemia, peritonitis, trauma, burns
- Low cardiac output -
- Hypovolemia (decreased blood volume) -
- Hepatorenal syndrome in which renal perfusion is compromised in liver failure
- Vascular problems, such as atheroembolic disease and renal vein thrombosis (which can occur as a complication of the nephrotic syndrome)
- Renal (damage to the kidney itself):
- infection usually sepsis (systemic inflammation due to infection),rarely of the kidney itself, termed pyelonephritis
- toxins or medication (e.g. some NSAIDs, aminoglycoside antibiotics, iodinated contrast, lithium)
- rhabdomyolysis (breakdown of muscle tissue) - the resultant release of myoglobin in the blood affects the kidney; it can be caused by injury (especially crush injury and extensive blunt trauma), statins, stimulants and some other drugs
- hemolysis (breakdown of red blood cells) - the hemoglobin damages the tubules; it may be caused by various conditions such as sickle-cell disease, and lupus erythematosus
- multiple myeloma, either due to hypercalcemia or "cast nephropathy" (multiple myeloma can also cause chronic renal failure by a different mechanism)
- acute glomerulonephritis which may be due to a variety of causes, such as anti glomerular basement membrane disease/Goodpasture's syndrome, Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythematosus
- Post-renal (obstructive causes in the urinary tract) due to:
- medication interfering with normal bladder emptying.
- benign prostatic hypertrophy or prostate cancer.
- kidney stones.
- due to abdominal malignancy (e.g. ovarian cancer, colorectal cancer).
- obstructed urinary catheter.