Acute renal failure

Acute renal failure is a topic covered in the Diagnosaurus.

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Etiology

Prerenal azotemia

  • Dehydration
  • Hemorrhage, e.g., GI bleeding
  • Congestive heart failure
  • Renal artery stenosis including fibromuscular dysplasia
  • NSAIDs, ACE inhibitors
Postrenal azotemia
  • Obstruction, e.g., BPH, bladder tumor, pelvic mass
Intrinsic renal disease Acute tubular necrosis
  • Toxins: NSAIDs, antibiotics, contrast, multiple myeloma, rhabdomyolysis, hemolysis, chemotherapy, hyperuricemia, cyclosporine
  • Ischemia, e.g., prolonged prerenal azotemia
Acute glomerulonephritis
  • Immune complex: IgA nephropathy, endocarditis, SLE, cryoglobulinemia, postinfectious, membranoproliferative, Henoch-Schönlein purpura
  • Pauci-immune (ANCA+): Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyarteritis
  • Anti-GBM: Goodpasture's syndrome, anti-GBM glomerulonephritis
  • Other: malignant hypertension, TTP, scleroderma renal crisis, preeclampsia-eclampsia
Acute interstitial nephritis
  • Drugs: beta-lactams, sulfa, diuretics, NSAIDs, rifampin, phenytoin, allopurinol
  • Infections: Streptococcus, leptospirosis, CMV, histoplasmosis, Rocky Mountain spotted fever
  • Immune: SLE, Sjögren's syndrome, sarcoidosis, cryoglobulinemia

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Etiology

Prerenal azotemia

  • Dehydration
  • Hemorrhage, e.g., GI bleeding
  • Congestive heart failure
  • Renal artery stenosis including fibromuscular dysplasia
  • NSAIDs, ACE inhibitors
Postrenal azotemia
  • Obstruction, e.g., BPH, bladder tumor, pelvic mass
Intrinsic renal disease Acute tubular necrosis
  • Toxins: NSAIDs, antibiotics, contrast, multiple myeloma, rhabdomyolysis, hemolysis, chemotherapy, hyperuricemia, cyclosporine
  • Ischemia, e.g., prolonged prerenal azotemia
Acute glomerulonephritis
  • Immune complex: IgA nephropathy, endocarditis, SLE, cryoglobulinemia, postinfectious, membranoproliferative, Henoch-Schönlein purpura
  • Pauci-immune (ANCA+): Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyarteritis
  • Anti-GBM: Goodpasture's syndrome, anti-GBM glomerulonephritis
  • Other: malignant hypertension, TTP, scleroderma renal crisis, preeclampsia-eclampsia
Acute interstitial nephritis
  • Drugs: beta-lactams, sulfa, diuretics, NSAIDs, rifampin, phenytoin, allopurinol
  • Infections: Streptococcus, leptospirosis, CMV, histoplasmosis, Rocky Mountain spotted fever
  • Immune: SLE, Sjögren's syndrome, sarcoidosis, cryoglobulinemia

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