II. Causes: Prerenal Failure (70% of causes)
- See Acute Prerenal Failure
- See Medication Causes of Prerenal Failure
- Mechanism: Decreased renal perfusion
- Intravascular volume depletion (e.g. Dehydration, third-spacing)
- Decreased arterial pressure (e.g. CHF, Sepsis)
- Extracellular fluid loss (Volume depletion)
- Burn Injury
- Diarrhea
- Vomiting
- Diuresis (e.g. Diuretics, DKA)
- Diaphoresis
- Hemorrhage (e.g. Trauma, major upper gastrointestinal Hemorrhage)
- Extracellular fluid volume sequestration
- Pancreatitis
- Muscle crush injury
- Systemic vasodilation (e.g. Septic Shock, Neurogenic Shock)
- Inadequate Cardiac Output
- Intra-Renal Vasoconstriction
III. Causes: Intrinsic Renal Failure - Vascular Injury
- Afferent arteriolar Vasoconstriction
- Results in decreased driving force
- Decreased Glomerular filtration
- Causes (Microvascular and Macrovascular)
IV. Causes: Intrinsic Renal Failure - Glomerulonephritis
- See Acute Glomerulonephritis
- Associated with Hematuria and Proteinuria
- Causes
- Hematologic Disorders (e.g. Hemolytic Uremic Syndrome, Thrombotic Thrombocytopenic Purpura)
- Systemic Inflammation (e.g. Systemic Lupus Erythematosus, IgA Nephropathy, Henoch-Schonlein Purpura)
- Pulmonary-Renal Syndromes (e.g. Granulomatosis with Polyangiitis, Goodpasture Syndrome)
V. Causes: Intrinsic Renal Failure - Acute Interstitial Nephritis
- Associated with erythematous maculopapular rash, fever, Arthralgias (30% of cases)
- Analogous to an Allergic Reaction within the Kidney
- Medication Causes
- See Medication Causes of Interstitial Nephritis
- See Medication Causes of Acute Tubular Necrosis
- Most common cause of Acute Interstitial Nephritis
- Acute Interstitial Nephritis typically occurs >2 weeks after drug started
- Typically secondary to a Drug Hypersensitivity or other allergic or autoimmune disorder
- Example: Penicillins or Cephalosporin Hypersensitivity Reaction
- Infectious Causes (5-10% of Acute Interstitial Nephritis causes)
- Diphtheria (classic)
- Group A beta hemolytic Streptococcus (classic)
- Legionella
- Yersinia
- Staphylococcus or Streptococcus infection
- Mycobacterium
- Toxoplasmosis
- Mycoplasma
- Leptospira
- Rickettsia
- Syphilis
- Herpes viruses (e.g. CMV, EBV, HSV)
- Human Immunodeficiency Virus (HIV)
- Hantavirus
- Hepatitis C
- Mumps
- Candidiasis
- Histoplasmosis
- Miscellaneous conditions
- Glomerulonephritis
- Necrotizing Vasculitis
- Systemic Lupus Erythematosus
- Acute kidney Transplant Rejection
- Sarcoidosis
VI. Causes: Intrinsic Renal Failure - Tubular Injury
- See Acute Tubular Necrosis
- Most common cause of intrinsic Acute Renal Failure cases
- Final common pathway of Kidney injury resulting in cell death and necrosis (analogous to ARDS)
- Mechanism
- Tubules injured in most but not all acute failure
- Renal ischemia (hypoperfusion with <500 ml urine/day)
- Trauma with Hemorrhage (common)
- Sepsis (common)
- Cardiac Arrest
- Interrupted renal Blood Flow during surgery
- Toxins: Nephrotoxic Drugs, pigmenturia and crystals (typically not oliguric)
- See Medication Causes of Acute Tubular Necrosis
- Rhabdomyolysis
- Intravascular Hemolysis
- Calcium Phosphate precipitation
- Uric Acid crystals
- Tumor Lysis Syndrome
- Multiple Myeloma
- Renal ischemia (hypoperfusion with <500 ml urine/day)
- Tubular obstruction
- Abnormal material inspissates and plugs flow
- Back-leak
- Tubular cells loose integrity
- Back-leaks ultrafiltrate
- Results in poor waste clearance
- Tubules injured in most but not all acute failure
- Course (3 phases)
- Initiation phase (minutes to hours)
- Maintenance phase
- Established loss of Renal Function
- Kidney unresponsive to simple interventions
- Recovery phase (weeks to months)
- Complete recovery in Acute Tubular Necrosis
VII. Causes: Postrenal Failure (Renal outflow obstruction)
- See Acute Postrenal Failure
- Intrarenal (distal tubules)
- Nephrolithiasis
- Multiple MyelomaProtein
- Medications predisposing to Uric Acid crystals (Hyperuricemia, Gout)
- See Medication Causes of Postrenal Failure
- Includes Methotrexate, Acyclovir, and Protease Inhibitors (e.g. Indinavir or Crixivan)
- Extra-Ureteral Obstruction
- Prostate Cancer
- Bladder Cancer
- Cervical Cancer
- Retroperitoneal fibrosis
- Accidental ureteral ligation during pelvic surgery
- Ureteral Obstruction (Bilateral in Renal Failure)
- Nephrolithiasis
- Thrombosis
- Pyogenic debris or sloughed papillae
- Edema from retrograde pyelography
-
Bladder neck obstruction
- Benign Prostatic Hypertrophy (BPH)
- Neurogenic Bladder
- Prostate Cancer
- Bladder Cancer
- Autonomic Neuropathy
- Ganglionic blocking medication
-
Urethral Obstruction
- Urethral valves
- Urethral Stricture
- Most common causes in children
- Neurologic conditions (17%)
- Urinary Tract Infection (13%)
- Medications (13%)
- Local inflammation (7%)
- Local invasive cancer (6%)
- Benign obstructive causes (6%)
- Constipation (13%)
- Incarcerated Hernias (2%)
- Gatti (2001) J Urol 165(3):918-21 [PubMed]
VIII. Mechanism: Specific Examples
- See Intravenous Contrast Related Acute Renal Failure
- Renal Ischemia
- Tubular obstruction and back-leak
-
Aminoglycoside
Antibiotics
- Decreased Glomerular Filtration Rate
- Tubular cell injury
-
Rhabdomyolysis
- Decreased afferent Blood Flow
- Renal tubular obstruction
IX. Resources
X. References
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Related Studies
Definition (NCI_CTCAE) | A disorder characterized by the acute loss of renal function and is traditionally classified as pre-renal (low blood flow into kidney), renal (kidney damage) and post-renal causes (ureteral or bladder outflow obstruction). |
Definition (NCI) | Sudden and sustained deterioration of the kidney function characterized by decreased glomerular filtration rate, increased serum creatinine or oliguria. |
Definition (CSP) | clinical syndrome characterized by a sudden decrease in glomerular filtration rate, usually associated with oliguria and always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. |
Concepts | Disease or Syndrome (T047) |
MSH | D007675 , D058186 |
ICD9 | 584, 584.9 |
ICD10 | N17 , N17.9 |
SnomedCT | 14669001, 197653006, 155855008 |
English | Kidney Failure, Acute, RENAL FAILURE ACUTE, RENAL SHUTDOWN ACUTE, Acute renal failure NOS, Acute renal failure, unspecified, ARF, acute renal failure, acute renal failure (diagnosis), ARF (acute renal failure), Failure kidney acute, Kidney failure acute, Renal failure acute, Renal shutdown acute, Acute kidney failure NOS, Acute and unspecified renal failure, Acute kidney failure, unspecified, Kidney Failure, Acute [Disease/Finding], Acute Kidney Failure, Kidney Failures, Acute, Acute Renal Failure, Renal Failure, Acute, Acute Kidney Failures, Acute Renal Failures, Renal Failures, Acute, kidney failure acute, Failure;renal;acute, syndrome acute renal failure, acute renal failures, renal failure acute, acute renal shutdown, acute failure kidney, acute kidney failure, arf, failure acute renal, acute failure renal, acute renal insufficiency, Acute renal failure, Acute renal failure NOS (disorder), Acute renal failure (disorder), Acute kidney failure, AKI, Acute kidney injury, Acute renal failure syndrome, ARF - Acute renal failure, Acute renal failure syndrome (disorder), Acute renal failure syndrome, NOS |
French | INSUFFISANCE RENALE AIGUE, Insuffisance rénale aiguë, Ligo-anurie aiguë, Insuffisance rénale aiguë, non précisée, SIDERATION RENALE, Défaillance rénale aigüe, Défaillance rénale aiguë |
Portuguese | INSUFICIENCIA RENAL AGUDA, Insuficiência renal aguda NE, Falência renal aguda, PARALIZACAO RENAL, Insuficiência renal aguda |
Spanish | INSUFICIENCIA RENAL AGUDA, Fallo renal agudo, Insuficiencia renal aguda no especificada, FALLO RENAL AGUDO, Insuficiencia renal aguda |
Dutch | niet-gespecificeerd acuut nierfalen, acuut falen nier, Acute nierinsufficiëntie, niet gespecificeerd, acuut nierfalen, Nierfalen, acuut, Acute nierinsufficiëntie, Insufficiëntie, acute nier-, Nierinsufficiëntie, acute, Renale insufficiëntie, acute |
German | akutes Nierenversagen, akutes Nierenversagen, unspezifisch, Versagen der Niere akut, Nierenausfall akut, Akutes Nierenversagen, nicht naeher bezeichnet, NIERENEMBOLIE, NIERENVERSAGEN AKUT, Renales Versagen, akutes, Akutes Nierenversagen, Nierenversagen, akutes, Nierenversagen akut |
Italian | Insufficienza renale acuta, non specificata, Insufficienza renale acuta |
Japanese | 急性腎不全、詳細不明, 急性腎不全, 急性腎機能停止, キュウセイジンフゼンショウサイフメイ, キュウセイジンキノウテイシ, キュウセイジンフゼン |
Swedish | Njursvikt, akut |
Finnish | Munuaisten äkillinen vajaatoiminta |
Czech | Akutní selhání ledvin, Renální selhání akutní, Akutní renální selhání, Akutní renální selhání blíže neurčené, akutní selhání ledvin, ledviny - selhání akutní |
Korean | 상세불명의 급성 콩팥(신장)기능상실, 급성 콩팥(신장)기능상실 |
Croatian | BUBREŽNA INSUFICIJENCIJA, AKUTNA |
Hungarian | acut veseelégtelenség, Acut veseelégtelenség, Acut veseelégtelenség, k.m.n., Acut veseleállás |
Norwegian | Akutt nyresvikt |
Ontology: Acute kidney injury (C2609414)
Definition (MSH) | Abrupt reduction in kidney function. Acute kidney injury encompasses the entire spectrum of the syndrome including acute kidney failure; ACUTE KIDNEY TUBULAR NECROSIS; and other less severe conditions. |
Concepts | Injury or Poisoning (T037) |
MSH | D058186 |
Spanish | Lesión renal aguda, Lesión Renal Aguda |
English | Acute kidney injury, Acute Kidney Injury, Acute Renal Injuries, Renal Injury, Acute, Acute Kidney Injuries, Acute Renal Injury, Renal Injuries, Acute, Kidney Injury, Acute, Kidney Injuries, Acute, Acute Kidney Injury [Disease/Finding] |
Portuguese | Lesão renal aguda, Lesão Renal Aguda |
Dutch | acuut nierletsel |
German | akute Nierenschaedigung, Akute Nierenschädigung, Akute Nierenschaedigung, Akute Nierenverletzung |
Czech | Akutní poranění ledvin, ledviny - akutní poškození, akutní poškození ledvin, AKI |
Japanese | 急性腎不全, キュウセイジンフゼン |
French | Lésion rénale aiguë, Atteinte rénale aigüe, Atteinte rénale aiguë, Lésion rénale aigüe |
Italian | Lesione renale acuta |
Russian | OSTROE POVREZHDENIE POCHEK, ОПП, POCHEK OSTROE POVREZHDENIE, OPP, ПОЧЕЧНАЯ НЕДОСТАТОЧНОСТЬ ОСТРАЯ, RENAL'NAIA NEDOSTATOCHNOST' OSTRAIA, ПОЧЕК ОСТРОЕ ПОВРЕЖДЕНИЕ, ОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК, ПОЧЕЧНАЯ НЕДОСТАТОЧНОСТЬ ФУНКЦИОНАЛЬНАЯ, ОСТРАЯ, POCHECHNAIA NEDOSTATOCHNOST' FUNKTSIONAL'NAIA, OSTRAIA, POCHECHNAIA NEDOSTATOCHNOST' OSTRAIA, РЕНАЛЬНАЯ НЕДОСТАТОЧНОСТЬ ОСТРАЯ |
Hungarian | Acut vesesérülés |
Polish | Niewydolność nerek ostra, Ostra niewydolność nerek, Ostre uszkodzenie nerek, Zaburzenia funkcji nerek ostre, Ostre zaburzenia funkcji nerek, Uszkodzenie nerek ostre, Ostra dysfunkcja nerek, Ostra niedomoga nerek |
Norwegian | Akutt nyreskade, Nyreskade, akutt |