acute renal failure

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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 ?
Successful treatment of acute kidney injury in patients with idiopathic nephrotic syndrome using human atrial natriuretic peptide.
Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery.
One other interesting finding in our study was the development of acute kidney injury in patients who received synthetic colloids during their stay in intensive care unit as shown in table.
The present study was undertaken to identify the causes and to study the outcome of acute kidney injury in Type 2 diabetic patients.
Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study.
They concluded that dabigatran was associated with a reduced risk of acute kidney injury (increase in serum creatinine >0.3 mg/dL) in comparison to warfarin.
Urinary neutrophil gelatinase-associated lipocalin predicts the severity of contrast-induced acute kidney injury in chronic kidney disease patients undergoing elective coronary procedures.
The total number of hospitalizations with acute kidney injury increased from 953,926 in 2000 to 1,823,054 in 2006 and 3,959,560 in 2014 (Table).
The patient's acute kidney injury was attributed to dehydration with a fractional excretion of sodium (FENa) less than 1% suggestive of prerenal.
Myrvang, "Acute kidney injury: Obesity is associated with AKI after surgery via oxidative stress," Nature Reviews Nephrology, vol.
Despite considerable improvement in acute kidney injury (AKI) recognition achieved over the last decades, early diagnosis is still a challenge.

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