acute renal failure


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Related to acute renal failure: chronic renal failure

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 ?
Acute renal failure in pregnancy: Tertiary centre experience from north Indian population.
The contribution of acute renal failure from medical causes has remained between 55-67% of all cases of ARF, whereas sepsis, nephrotoxic drugs, open heart surgery in poor risk patients, cardiogenic shock and severe trauma following industrial and traffic accidents have emerged as the leading cause of ARF in developed countries (Rasmussen 1985, (10) Lein 1985, (11) Beaman 198513 and Schusterman 198715).
Evaluating the relative frequency and predicting factors of acute renal failure following coronary artery bypass grafting.
Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients.
Acute renal failure is a sudden, sharp decline in renal function caused by toxins or conditions resulting in tissue hypoxia.
Ceftriaxone, an antiobiotic, has been reported to cause biliary pseudolithiasis and nephrolithiasis, but postrenal acute renal failure was rarely reported in the past.
Although acute renal failure sometimes stems from blockages that interfere with the flow of blood to the kidneys or the flow of urine from them, the most common cause is the ingestion of substances that are toxic to the kidneys, such as pesticides, antifreeze, cleaning fluids, and some medications developed for use by humans, such as ibuprofen.
Acute renal failure result either from direct toxic effect on proximal tubule of Mellittin or secondary to vasoconstrictive effect of it.
After adjusting their results for various differing characteristics such as age, disease, and other medications, the researchers found that pre-operative aspirin was associated with a significant decrease in the incidence of post-operative kidney failure: acute renal failure occurred in 86 out of 2247 patients taking aspirin, and in 65 out of 972 patients not taking it.
A diagnosis of cocaine-induced rhabdomyolysis with secondary acute renal failure was made.

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