Acute Renal Failure
First Things First (assess & treat for the following)
- Is there an acute increase in BUN or serum creatinine?
- Is pt oliguric (100-500 mL/d), anuric (< 100 mL/d) or polyuric (>500 mL/d)?
- If anuric, think complete urinary tract obstruction, bilateral renal arterial or venous occlusion, bilateral cortical necrosis, overwhelming acute tubular necrosis (ATN) or glomerular nephritis (GN).
- If polyuric, think recovery phase ATN, interstitial nephritis, partial intermittent obstruction, postobstructive renal failure (RF).
- Place bladder catheter to rule out or relieve lower urinary tract obstruction.
- Collect urine sample for analysis, lytes & creatinine prior to interventions (eg, diuretics).
- Assess & correct volume status & electrolyte abnormalities.
- Avoid further renal insult such as hypovolemia, hypotension, nephrotoxins.
- Adjust dosages of all renally excreted drugs.
- Identify & aggressively treat potentially reversible causes of RF.
- Is it prerenal, renal or postrenal?
- Prerenal
- Hypovolemia (GI, renal, skin losses, hemorrhage, third-spacing)
- Decreased effective intravascular volume (hypoalbuminemia, cirrhosis, nephrotic syndrome, left ventricular cardiac failure, vasodilator therapy, anesthetics, anaphylaxis, sepsis)
- Renal artery occlusion
- Autoregulatory failure in states of renal hypoperfusion, due to NSAIDs, ACE inhibitors
- Renal
- Glomerular/vascular
- Acute GN (Goodpasture’s, SLE, Henoch-Schonlein, poststreptococcal)
- Vasculitis/immune complex disorders: hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), polyarteritis nodosa (PAN), Wegener’s granulomatosis
- Malignant HTN
- Bilateral renal vein thrombosis
- Acute interstitial nephritis (AIN)
- Ischemia
- Toxins (eg, aminoglycosides, cyclosporine, myoglobin)
- AIN
- Drug hypersensitivity
- Infections
- Immunologic disorders
- Glomerular/vascular
- Postrenal
- Extrarenal
- Ureteral obstruction (bilateral or solitary kidney)
- Lower tract obstruction (bladder neck or urethra)
- Intrarenal: tubular occlusion (eg, crystals, protein, pyogenic debris, stones, blood clots, papillary necrosis)
- Extrarenal
- Prerenal
There's more to see -- the rest of this topic is available only to subscribers.
Last updated: April 16, 2010
Citation
"Acute Renal Failure." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534012/all/Acute_Renal_Failure.
Acute Renal Failure. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534012/all/Acute_Renal_Failure. Accessed October 10, 2024.
Acute Renal Failure. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534012/all/Acute_Renal_Failure
Acute Renal Failure [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2024 October 10]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534012/all/Acute_Renal_Failure.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Acute Renal Failure
ID - 534012
Y1 - 2010/04/16/
BT - Pocket ICU Management
UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534012/all/Acute_Renal_Failure
PB - PocketMedicine.com, Inc
DB - Anesthesia Central
DP - Unbound Medicine
ER -