acute renal failure

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acute renal failure (ARF)

renal failure of sudden onset, such as from physical trauma, infection, inflammation, or toxicity. Symptoms include uremia and usually oliguria or anuria, with hyperkalemia and pulmonary edema. Three types are distinguished: prerenal, associated with poor systemic perfusion and decreased renal blood flow, such as with hypovolemic shock or congestive heart failure; intrarenal, associated with disease of the renal parenchyma, such as tubulointerstitial nephritis, acute interstitial nephritis, or nephrotoxicity; and postrenal, resulting from obstruction of urine flow out of the kidneys. See also renal failure.
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Causes of acute renal failure

acute renal failure

An abrupt decline in renal function, marked by a rise in serum creatinine or azotemia, triggered by various processes—e.g., sepsis, shock, trauma, kidney stones, drug toxicity (aspirin, lithium, substances of abuse), toxins, iodinated radiocontrast.

Clinical findings
• Cardiovascular
Congestive heart failure, myocardial infarction, arrhythmias, cardiac arrest occur in up to 35% of patients with ARF. The elderly with low cardiac reserve are at risk of fluid overload secondary to oliguric ARF.

• Pulmonary
Lung disease occurs in over half of patients with ARF and may be linked to shared pulmonary and renal syndromes—e.g., Goodpasture syndrome, Wegener granulomatosis, polyarteritis nodosa, cryoglobulinemia, sarcoidosis. Hypoxia is common during hemodialysis and attributed to white cell sequestration by the lungs and alveolar hypoventilation.

• GI tract
Nausea, vomiting, anorexia; GI bleeding occurs in ± one third of patients with ARF and causes nearly 10% of deaths in patients with ARF. Other GI complaints include pancreatitis, jaundice linked to hepatic congestion, blood transfusions, and sepsis.

• Infections
Occur in up to 33% of patients with ARF; most occur in the lungs and urinary tract, and have mortality rates of up to 72%.
 
• Neurologic signs of uraemia occur in one-third of ARF patients, and have the expected findings of lethargy, somnolence, reversal of the sleep-wake cycle, and cognitive or memory deficits.

Types
• Prerenal—adaptive response to volume depletion and hypotension.
• Renal/intrinsic—response to cytotoxicity, ischaemia, or inflammation with structural and functional damage to the renal parenchyma.
• Postrenal—obstruction to the passage of urine.

Acute renal failure by type
Crescentic GN—renal vasculitis, anti-GBM disease, immune complex diseases.
Acute tubular injury—ischaemic, toxic, crystals, myoglobinuria
Acute tubulointerstitial nephritis.
Thrombotic microangiopathy—haemolytic-uraemic syndrome, accelerated hypertension, scleroderma.

acute renal failure

Acute kidney failure Nephrology An abrupt decline in renal function, triggered by various processes–eg, sepsis, shock, trauma, kidney stones, drug toxicity-aspirin, lithium, substances of abuse, toxins, iodinated radiocontrast. Cf Chronic kidney failure.

a·cute re·nal fail·ure

(ARF) (ă-kyūt' rē'năl fāl'yŭr)
A rapid decline of kidney function due to tubular injury. Signs are azotemia, fluid and electrolyte imbalance, and metabolic acidosis. Commonly caused by ischemia or nephrotoxins.
References in periodicals archive ?
Circulating miR-210 predicts survival in critically ill patients with acute kidney injury.
Acute kidney injury, or acute renal failure, is the term used when the kidneys cannot remove salt, water and waste products from the blood.
Tell them what symptoms to be aware of so they can recognize and possibly mitigate the risk of acute kidney injury.
The goal of the study is to determine the ability of protective RIC to reduce acute kidney injury induced by intraoperative renal ischemia during partial nephrectomy (PN), potentially resulting in better postoperative renal function.
A systematic review and meta-analysis was conducted to estimate the risk of acute kidney injury after use of iso- and low-osmolar contrast media.
The study found that three of the patients had acute kidney injury marked by the excretion of an abnormally small volume of urine, known as oliguric acute kidney injury, and the fourth had a decrease in effective blood flow to the kidney, known as prerenal acute kidney injury.
35 times the chance of developing acute kidney injury as did those given polyethylene glycol purgatives.
Thrasos' lead therapeutic program for acute kidney injury has demonstrated strong potential in preliminary studies and we are pleased to support this program and other potential opportunities in renal disease, a field of huge unmet medical need.
Symptoms of acute kidney injury may include nausea, vomiting, feeling drowsy, difficulty to paying attention, high blood pressure, nosebleeds, seizures, bruising easily, persistent hiccups, little or no urine and numbness.
A basic measurement of urine volume during an operation or over the course of treatment in an intensive care unit (ICU) can tell a doctor if a patient is suffering from an acute kidney injury.
and colleagues from Indiana University School of Medicine and Butler University said that nearly 3 percent of cases of pediatric acute kidney injury over a decade could be traced directly to having taken the common nonsteroidal anti-inflammatory drugs, or NSAIDs.
They first relate the top 100 secrets in the field, then describe patient assessment, acute kidney injury, chronic kidney disease, primary and secondary glomerular disorders, infection-associated glomerulonephritides, other renal parenchymal diseases, diseases in special populations like pregnant women and the elderly, treatment options, transplantation, hypertension, and acid-base and electrolyte disorders.

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