acute renal failure

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Related to Renal shutdown: prerenal, acute renal failure, Acute kidney injury

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 classic literature ?
Since Seth had been a boy in knee trousers there had been a half expressed intimacy between him and the maiden who now for the first time walked beside him.
Seth had not answered them, although he had been moved and flattered by some of the sen- tences scrawled in pencil upon the stationery of the banker's wife.
Helen and Seth stopped by a fence near where a low dark building faced the street.
On the street as he walked beside the girl new and daring thoughts had come into Seth Richmond's mind.
And then, looking down, Seth had seen the bees everywhere all about him in the long grass.
The garden that had been so mysterious and vast, a place that with Seth beside her might have become the background for strange and wonderful adven- tures, now seemed no more than an ordinary Wines- burg back yard, quite definite and limited in its outlines.
Nay, nay, Addy, thee mean'st me no unkindness," said Seth, "I know that well enough.
Before the first stroke had died away, Sandy Jim had loosed his plane and was reaching his jacket; Wiry Ben had left a screw half driven in, and thrown his screwdriver into his tool-basket; Mum Taft, who, true to his name, had kept silence throughout the previous conversation, had flung down his hammer as he was in the act of lifting it; and Seth, too, had straightened his back, and was putting out his hand towards his paper cap.
Seth lingered, and looked wistfully at Adam, as if he expected him to say something.
said Seth rather timidly, as he turned to leave the workshop.
said Adam, with the same gentle modulation of voice as when he spoke to Seth.
Four patients went for acute renal shutdown and they were referred for dialysis; 60 patients of moderate and severe haemorrhage were put on mechanical ventilation and extubated after 24 hours; 18 patients died.