Acute Renal Failure

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Acute Renal Failure

• failure of renal excretory function due to depression of glomerular filtration rate

Associated features

• reduced erythropoeitin
• reduced Vitamin D hydroxylation
• impaired regulation of Acid-Base Balance
• impaired regulation of Sodium and Water balance

Causes

• Pre-renal (reduced perfusion)
  • Drugs
    • ACE inhibitors
    • Non Steroidal Anti Inflammatory Drugs
• Renal - e.g.
  • acute tubular necrosis
  • cortical necrosis
  • glomerulonephritis
  • infection
  • Diabetes Insipidus
  • Polyarteritis
  • Wegener's granulomatosis
  • accelerated hypertension
  • cholesterol embolism
  • Haemolytic Uraemic Syndrome
  • pre-eclampsia
  • acute tubulointerstitial nephritis
    • Non Steroidal Anti Inflammatory Drugs
    • Penicillins
  • acute hyperuricaemic nephropathy
    • rapid lysis of malignant tumour
• Post-renal (obstruction)

Investigations

 to determine underlying cause - e.g.

• rhabdomyolysis
  • creatinine kinase
  • urinary myoglobin
• intravascular haemolysis
  • lactate dehydrogenase (LDH)
  • urinary haemoglobin
• disseminated intravascular coagulopathy (DIC)
  • clotting screen
  • fibrin degradation products
• myeloma
  • paraprotein
  • Bence-Jones protein
• Systemic lupus erythematosus (SLE)
  • Anti-nuclear antibody (ANA)
  • DNA-binding
• hepatorenal syndrome

Treatment

• Pre-renal
  • volume replacement
  • opening of renal vasculature
• Post-renal
  • relieve obstruction

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