SPECIFIC CAUSES OF ACUTE KIDNEY FAILURE

• What will happen when the human had acute kidney failure?

• Specific Causes of Acute Kidney Failure

• What are the symptoms?

• Diagnosis

• Treatment for Acute Kidney Failure

Specific causes of acute kidney failure

▪   Prerenal failure and acute tubular necrosis
▪   Vascular causes of acute kidney failure
▪   Nephrotoxic causes of acute kidney failure
▪   Glomerulonephritic and vasculitic causes of
    acute kidney failure
▪   Interstitial nephritis as a cause of acute
    kidney failure
▪   'Haematological' causes of acute kidney failure
▪   Hepatokidney Syndrome
▪   Tropical

Prerenal failure and acute tubular necrosis
 

Between 80 and 90 per cent of the cases of acute renal failure seen by physicians will fall into the categories of prerenal failure and acute tubular necrosis (those due to prostatic obstruction usually being managed by others). The term 'prerenal failure' is used when renal dysfunction is entirely attributable to hypoperfusion, and where restoration of renal perfusion leads to rapid recovery. The term 'acute tubular necrosis' does not find favour with all; although necrosis of tubular cells can usually be found by diligent examination, the lesion may be inconspicuous and the pathophysiological implications of such necrosis as might be seen remain uncertain. The glomeruli and vessels are usually normal. In common usage (retained here), the term 'acute tubular necrosis' describes a clinical entity comprising acute renal failure with three main characteristics: 

1. It is seen in specific clinical contexts, frequently involving circulatory compromise and/or nephrotoxins;
2. Urinary abnormalities usually suggest tubular dysfunction; and
3. Essentially complete recovery of renal function is expected within days or weeks in most cases if the patient survives the precipitating insult, with a period of polyuria commonly following oliguria (but see the later section on prognosis).

The syndrome can be seen after virtually any episode of severe circulatory compromise, but not all causes of circulatory derangement are equally devastating to renal function. Primary impairment of cardiac performance, for example following myocardial infarction, may cause plasma creatinine to rise somewhat, but rarely causes renal failure of sufficient severity to require renal replacement therapy.

By contrast, an apparently similar haemodynamic upset caused by sepsis frequently does. Multiple insults are the rule rather than the exception. Circumstances associated with a particularly high risk of acute renal failure include repair of a ruptured aortic aneurysm (20 %, as opposed to 3 % for elective repair), hepatobiliary surgery (10 %), pancreatitis (10 %), and burns (2 to 38 %, depending on the series).