Nephrology Book


Acute Kidney Injury Causes

Aka: Acute Kidney Injury Causes, Acute Renal Failure Causes, Prerenal Failure Causes, Postrenal Failure Causes, Intrinsic Renal Failure Causes, Infectious Causes of Acute Interstitial Nephritis
  1. See Also
    1. Acute Kidney Injury
    2. Acute Interstitial Nephritis
    3. Acute Prerenal Failure
    4. Acute Postrenal Failure
    5. Medication Causes of Acute Kidney Injury
    6. Nephrotoxicity Risk
    7. Intravenous Contrast Related Acute Renal Failure
    8. Chronic Renal Failure
    9. Prevention of Kidney Disease Progression
  2. Causes: Prerenal Failure (70% of causes)
    1. See Acute Prerenal Failure
    2. See Medication Causes of Prerenal Failure
    3. Mechanism: Decreased renal perfusion
      1. Intravascular volume depletion (e.g. Dehydration, third-spacing)
      2. Decreased arterial pressure (e.g. CHF, Sepsis)
    4. Extracellular fluid loss (Volume depletion)
      1. Burn Injury
      2. Diarrhea
      3. Vomiting
      4. Diuresis (e.g. Diuretics, DKA)
      5. Diaphoresis
      6. Hemorrhage (e.g. Trauma, major upper gastrointestinal Hemorrhage)
    5. Extracellular fluid volume sequestration
      1. Pancreatitis
      2. Muscle crush injury
      3. Systemic vasodilation (e.g. Septic Shock, Neurogenic Shock)
    6. Inadequate Cardiac Output
      1. Severe Congestive Heart Failure
      2. Cardiogenic Shock
    7. Intra-Renal Vasoconstriction
      1. See Medication Causes of Prerenal Failure (e.g. ACE Inhibitors, ARBs, NSAIDS)
      2. Cardiorenal syndrome
      3. Hepatorenal Syndrome
      4. Abdominal Compartment Syndrome
  3. Causes: Intrinsic Renal Failure - Vascular Injury
    1. Afferent arteriolar Vasoconstriction
      1. Results in decreased driving force
      2. Decreased Glomerular filtration
    2. Causes (Microvascular and Macrovascular)
      1. Renal Artery Stenosis
      2. Thromboembolism
      3. Malignant Hypertension
      4. Thrombotic Thrombocytopenic Purpura (TTP)
      5. Hemolytic Uremic Syndrome (HUS)
      6. Vasculitis
  4. Causes: Intrinsic Renal Failure - Glomerulonephritis
    1. See Acute Glomerulonephritis
    2. Associated with Hematuria and Proteinuria
    3. Causes
      1. Hematologic Disorders (e.g. Hemolytic Uremic Syndrome, Thrombotic Thrombocytopenic Purpura)
      2. Systemic Inflammation (e.g. Systemic Lupus Erythematosus, IgA Nephropathy, Henoch-Schonlein Purpura)
      3. Pulmonary-Renal Syndromes (e.g. Granulomatosis with Polyangiitis, Goodpasture Syndrome)
  5. Causes: Intrinsic Renal Failure - Acute Interstitial Nephritis
    1. Associated with erythematous maculopapular rash, fever, Arthralgias (30% of cases)
    2. Analogous to an Allergic Reaction within the Kidney
    3. Medication Causes
      1. See Medication Causes of Interstitial Nephritis
      2. See Medication Causes of Acute Tubular Necrosis
      3. Most common cause of Acute Interstitial Nephritis
        1. Acute Interstitial Nephritis typically occurs >2 weeks after drug started
      4. Typically secondary to a Drug Hypersensitivity or other allergic or autoimmune disorder
        1. Example: Penicillins or Cephalosporin Hypersensitivity Reaction
    4. Infectious Causes (5-10% of Acute Interstitial Nephritis causes)
      1. Diphtheria (classic)
      2. Group A beta hemolytic Streptococcus (classic)
      3. Legionella
      4. Yersinia
      5. Staphylococcus or Streptococcus infection
      6. Mycobacterium
      7. Toxoplasmosis
      8. Mycoplasma
      9. Leptospira
      10. Rickettsia
      11. Syphilis
      12. Herpes viruses (e.g. CMV, EBV, HSV)
      13. Human Immunodeficiency Virus (HIV)
      14. Hantavirus
      15. Hepatitis C
      16. Mumps
      17. Candidiasis
      18. Histoplasmosis
    5. Miscellaneous conditions
      1. Glomerulonephritis
      2. Necrotizing Vasculitis
      3. Systemic Lupus Erythematosus
      4. Acute kidney Transplant Rejection
      5. Sarcoidosis
  6. Causes: Intrinsic Renal Failure - Tubular Injury
    1. See Acute Tubular Necrosis
    2. Most common cause of intrinsic Acute Renal Failure cases
    3. Final common pathway of Kidney injury resulting in cell death and necrosis (analogous to ARDS)
    4. Mechanism
      1. Tubules injured in most but not all acute failure
        1. Renal ischemia (hypoperfusion with <500 ml urine/day)
          1. Trauma with Hemorrhage (common)
          2. Sepsis (common)
          3. Cardiac Arrest
          4. Interrupted renal Blood Flow during surgery
        2. Toxins: Nephrotoxic Drugs, pigmenturia and crystals (typically not oliguric)
          1. See Medication Causes of Acute Tubular Necrosis
          2. Rhabdomyolysis
          3. Intravascular Hemolysis
          4. Calcium Phosphate precipitation
          5. Uric Acid crystals
          6. Tumor Lysis Syndrome
          7. Multiple Myeloma
      2. Tubular obstruction
        1. Abnormal material inspissates and plugs flow
      3. Back-leak
        1. Tubular cells loose integrity
        2. Back-leaks ultrafiltrate
        3. Results in poor waste clearance
    5. Course (3 phases)
      1. Initiation phase (minutes to hours)
        1. Starts with well functioning Kidney
        2. Kidney bombarded by potential toxins
      2. Maintenance phase
        1. Established loss of Renal Function
        2. Kidney unresponsive to simple interventions
      3. Recovery phase (weeks to months)
        1. Complete recovery in Acute Tubular Necrosis
  7. Causes: Postrenal Failure (Renal outflow obstruction)
    1. See Acute Postrenal Failure
    2. Intrarenal (distal tubules)
      1. Nephrolithiasis
      2. Multiple MyelomaProtein
      3. Medications predisposing to Uric Acid crystals (Hyperuricemia, Gout)
        1. See Medication Causes of Postrenal Failure
        2. Includes Methotrexate, Acyclovir, and Protease Inhibitors (e.g. Indinavir or Crixivan)
    3. Extra-Ureteral Obstruction
      1. Prostate Cancer
      2. Bladder Cancer
      3. Cervical Cancer
      4. Retroperitoneal fibrosis
      5. Accidental ureteral ligation during pelvic surgery
    4. Ureteral Obstruction (Bilateral in Renal Failure)
      1. Nephrolithiasis
      2. Thrombosis
      3. Pyogenic debris or sloughed papillae
      4. Edema from retrograde pyelography
    5. Bladder neck obstruction
      1. Benign Prostatic Hypertrophy (BPH)
      2. Neurogenic Bladder
      3. Prostate Cancer
      4. Bladder Cancer
      5. Autonomic Neuropathy
      6. Ganglionic blocking medication
    6. Urethral Obstruction
      1. Urethral valves
      2. Urethral Stricture
  8. Mechanism: Specific Examples
    1. See Intravenous Contrast Related Acute Renal Failure
    2. Renal Ischemia
      1. Tubular obstruction and back-leak
    3. Aminoglycoside Antibiotics
      1. Decreased Glomerular Filtration Rate
      2. Tubular cell injury
    4. Rhabdomyolysis
      1. Decreased afferent Blood Flow
      2. Renal tubular obstruction
  9. Resources
    1. Acute Kidney Injury Guidelines
  10. References
    1. Mercado (2019) Am Fam Physician 100(11): 687-94 [PubMed]
    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]

Kidney Failure, Acute (C0022660)

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
Hungarian acut veseelégtelenség, Acut veseelégtelenség, Acut veseelégtelenség, k.m.n., Acut veseleállás
Norwegian Akutt nyresvikt
Derived from the NIH UMLS (Unified Medical Language System)

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
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
Derived from the NIH UMLS (Unified Medical Language System)

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