Acute Prerenal Failure

Aka: Acute Prerenal Failure, Prerenal Failure, Prerenal Uremia Syndrome

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II. Epidemiology

  1. Accounts for 50-70% of all Acute Renal Failure

III. Causes

  1. See Prerenal Failure Causes
  2. See Medication Causes of Prerenal Failure

IV. Pathophysiology

  1. Reduced Cardiac Output and renal perfusion pressure (shock states)
  2. Results in afferent arteriole constriction
  3. Avid Sodium and Water reabsorption
  4. Oliguria
  5. Acute Tubular Necrosis if prolonged hypoperfusion

V. Signs

  1. Impaired Cardiac Output
    1. Neck vein distention
    2. Rales
    3. Gallup Rhythm
    4. Pedal edema
  2. Orthostatic Blood Pressure and pulse changes
  3. Weight loss
  4. Decreased fluid intake
  5. Decreased Urine Output

VI. Diagnostics

  1. Empiric volume replacement
  2. Invasive cardiac monitoring

VII. Labs

  1. See Renal Function
  2. Urine Sediment
    1. Normal sediment
    2. Hyaline Casts
    3. Granular Casts

VIII. Management

  1. See Acute Kidney Injury Management

IX. Prognosis

  1. See Acute Kidney Injury Prognosis

X. Prevention

  1. See Prevention of Kidney Disease Progression

XI. Resources

  1. Acute Kidney Injury Guidelines
    1. http://www.renal.org/clinical/guidelinessection/AcuteKidneyInjury.aspx

XII. Reference:

  1. Anderson (8/15/1993) Hospital Practice, p. 61-75
  2. Meyer (2007) N Engl J Med 357(13): 1316-25 [PubMed]
  3. Rahman (2012) Am Fam Physician 86(7): 631-9 [PubMed]
  4. Singri (2003) JAMA 289(6):747-51 [PubMed]

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