II. Causes: Prerenal Failure (70% of causes)

  1. See Acute Prerenal Failure
  2. See Medication Causes of Prerenal Failure
  3. Mechanism: Decreased renal perfusion
    1. Intravascular volume depletion (e.g. Dehydration, third-spacing)
    2. Decreased arterial pressure (e.g. CHF, Sepsis)
  4. Extracellular fluid loss (Volume depletion)
    1. Burn Injury
    2. Diarrhea
    3. Vomiting
    4. Diuresis (e.g. Diuretics, DKA)
    5. Diaphoresis
    6. Hemorrhage (e.g. trauma, major upper gastrointestinal Hemorrhage)
  5. Extracellular fluid volume sequestration
    1. Pancreatitis
    2. Muscle crush injury
    3. Systemic vasodilation (e.g. Septic Shock, Neurogenic Shock)
  6. Inadequate Cardiac output
    1. Severe Congestive Heart Failure
    2. Cardiogenic Shock
  7. Intra-Renal Vasoconstriction
    1. See Medication Causes of Prerenal Failure (e.g. ACE Inhibitors, ARBs, NSAIDS)
    2. Cardiorenal syndrome
    3. Hepatorenal Syndrome
    4. Abdominal Compartment Syndrome

III. Causes: Intrinsic Renal Failure - Vascular Injury

  1. Afferent arteriolar Vasoconstriction
    1. Results in decreased driving force
    2. Decreased Glomerular filtration
  2. Causes (Microvascular and Macrovascular)
    1. Renal Artery Stenosis
    2. Thromboembolism
    3. Malignant Hypertension
    4. Thrombotic Thrombocytopenic Purpura (TTP)
    5. Hemolytic Uremic Syndrome (HUS)
    6. Vasculitis

IV. Causes: Intrinsic Renal Failure - Glomerulonephritis

  1. See Acute Glomerulonephritis
  2. Associated with Hematuria and Proteinuria
  3. Causes
    1. Systemic illness (e.g. Systemic Lupus Erythematosus)
    2. Pulmonary-Renal Syndroms (e.g. Wegener's Granulomatosis, Goodpasture Syndrome)

V. Causes: Intrinsic Renal Failure - Acute Interstitial Nephritis

  1. Associated with erythematous maculopapular rash, fever, arthralgias (30% of cases)
  2. Causes
    1. See Medication Causes of Interstitial Nephritis
  3. Infectious Causes
    1. Diphtheria (classic)
    2. Group A beta hemolytic Streptococcus (classic)
    3. Legionella
    4. Yersinia
    5. Staphylococcus or Streptococcus infection
    6. Mycobacterium
    7. Toxoplasmosis
    8. Mycoplasma
    9. Leptospira
    10. Rickettsia
    11. Syphilis
    12. Herpes viruses (e.g. CMV, EBV, HSV)
    13. Human Immunodeficiency Virus (HIV)
    14. Hantavirus
    15. Hepatitis C
    16. Mumps
    17. Candidiasis
    18. Histoplasmosis
  4. Medication Causes (AIN occurs >2 weeks after drug started)
    1. See Medication Causes of Interstitial Nephritis (most common cause of Acute Interstitial Nephritis)
    2. See Medication Causes of Acute Tubular Necrosis
    3. Typically secondary to a drug hypersensitivity or other allergic or autoimmune disorder
      1. Example: Penicillins or Cephalosporin Hypersensitivity Reaction
  5. Miscellaneous conditions
    1. Glomerulonephritis
    2. Necrotizing Vasculitis
    3. Systemic Lupus Erythematosus
    4. Acute Kidney transplant rejection
    5. Sarcoidosis

VI. Causes: Intrinsic Renal Failure - Tubular Injury

  1. See Acute Tubular Necrosis
  2. Most common cause of intrinsic Acute Renal Failure cases
  3. Mechanism
    1. Tubules injured in most but not all acute failure
      1. Renal ischemia from prolonged Hypotension
        1. Trauma
        2. Hemorrhage
        3. Cardiac Arrest
        4. Interrupted renal blood flow during surgery
      2. Nephrotoxic Drugs
        1. See Medication Causes of Acute Tubular Necrosis
      3. Pigmenturia and Crystals
        1. Rhabdomyolysis
        2. Intravascular Hemolysis
        3. Calcium Phosphate precipitation
        4. Uric Acid crystals
        5. Tumor Lysis Syndrome
        6. Multiple Myeloma
    2. Tubular obstruction
      1. Abnormal material inspissates and plugs flow
    3. Back-leak
      1. Tubular cells loose integrity
      2. Back-leaks ultrafiltrate
      3. Results in poor waste clearance
  4. Course (3 phases)
    1. Initiation phase (minutes to hours)
      1. Starts with well functioning Kidney
      2. Kidney bombarded by potential toxins
    2. Maintenance phase
      1. Established loss of Renal Function
      2. Kidney unresponsive to simple interventions
    3. Recovery phase (weeks to months)
      1. Complete recovery in Acute Tubular Necrosis

VII. Causes: Postrenal Failure (Renal outflow obstruction)

  1. See Acute Postrenal Failure
  2. Intrarenal (distal tubules)
    1. Nephrolithiasis
    2. Multiple Myeloma protein
    3. Medications predisposing to Uric Acid crystals (Hyperuricemia, Gout)
      1. See Medication Causes of Postrenal Failure
      2. Includes Methotrexate, Acyclovir, and Protease Inhibitors (e.g. Indinavir or Crixivan)
  3. Extra-Ureteral Obstruction
    1. Prostate Cancer
    2. Bladder Cancer
    3. Cervical Cancer
    4. Retroperitoneal fibrosis
    5. Accidental ureteral ligation during pelvic surgery
  4. Ureteral Obstruction (Bilateral in Renal Failure)
    1. Nephrolithiasis
    2. Thrombosis
    3. Pyogenic debris or sloughed papillae
    4. Edema from retrograde pyelography
  5. Bladder neck obstruction
    1. Benign Prostatic Hypertrophy (BPH)
    2. Neurogenic Bladder
    3. Prostate Cancer
    4. Bladder Cancer
    5. Autonomic Neuropathy
    6. Ganglionic blocking medication
  6. Urethral Obstruction
    1. Urethral valves
    2. Urethral stricture

VIII. Mechanism: Specific Examples

  1. See Intravenous Contrast Related Acute Renal Failure
  2. Renal Ischemia
    1. Tubular obstruction and back-leak
  3. Aminoglycoside Antibiotics
    1. Decreased Glomerular Filtration Rate
    2. Tubular cell injury
  4. Rhabdomyolysis
    1. Decreased afferent blood flow
    2. Renal tubular obstruction

Images: Related links to external sites (from Google)

Ontology: Kidney Failure, Acute (C0022660)

Definition (NCI) Sudden and sustained deterioration of the kidney function characterized by decreased glomerular filtration rate, increased serum creatinine or oliguria.
Definition (NCI) A disorder characterized by the acute loss of renal function and is traditionally classified as pre-renal (low blood flow into kidney), renal (kidney damage) and post-renal causes (ureteral or bladder outflow obstruction).
Definition (CSP) clinical syndrome characterized by a sudden decrease in glomerular filtration rate, usually associated with oliguria and always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations.
Concepts Disease or Syndrome (T047)
MSH D007675 , D058186
ICD9 584, 584.9
ICD10 N17 , N17.9
SnomedCT 155855008, 197653006, 14669001
English Kidney Failure, Acute, Acute renal failure, KIDNEY, FAILURE, ACUTE, ACUTE KIDNEY FAILURE, FAILURE KIDNEY ACUTE, KIDNEY FAILURE ACUTE, RENAL FAILURE ACUTE, ACUTE RENAL FAILURE, RENAL FAILURE, ACUTE, RENAL SHUTDOWN ACUTE, Acute renal failure syndrome, NOS, Acute renal failure NOS, Acute renal failure, unspecified, ARF, acute renal failure, acute renal failure (diagnosis), arf, Acute renal failure (disorder), ARF (acute renal failure), Acute kidney failure, Failure kidney acute, Kidney failure acute, Renal failure acute, Renal shutdown acute, Acute kidney failure NOS, Acute renal failure NOS (disorder), Acute and unspecified renal failure, Acute kidney injury, Acute kidney failure, unspecified, Kidney Failure, Acute [Disease/Finding], Acute Kidney Failure, Kidney Failures, Acute, Acute Renal Failure, Renal Failure, Acute, Acute Kidney Failures, Acute Renal Failures, Renal Failures, Acute, kidney failure acute, Failure;renal;acute, syndrome acute renal failure, acute renal failures, renal failure acute, acute renal shutdown, acute failure kidney, acute kidney failure, failure acute renal, acute failure renal, acute renal insufficiency, Acute renal failure syndrome, ARF - Acute renal failure, Acute renal failure syndrome (disorder)
French INSUFFISANCE RENALE AIGUE, Insuffisance rénale aiguë, Ligo-anurie aiguë, Insuffisance rénale aiguë, non précisée, SIDERATION RENALE, Défaillance rénale aigüe, Défaillance rénale aiguë
Portuguese INSUFICIENCIA RENAL AGUDA, Insuficiência renal aguda NE, Falência renal aguda, PARALIZACAO RENAL, Insuficiência renal aguda
Spanish INSUFICIENCIA RENAL AGUDA, Fallo renal agudo, Insuficiencia renal aguda no especificada, Acute renal failure, FALLO RENAL AGUDO, Insuficiencia renal aguda
Dutch niet-gespecificeerd acuut nierfalen, acuut falen nier, Acute nierinsufficiëntie, niet gespecificeerd, acuut nierfalen, Nierfalen, acuut, Acute nierinsufficiëntie, Insufficiëntie, acute nier-, Nierinsufficiëntie, acute, Renale insufficiëntie, acute
German akutes Nierenversagen, akutes Nierenversagen, unspezifisch, Versagen der Niere akut, Nierenausfall akut, Akutes Nierenversagen, nicht naeher bezeichnet, NIERENEMBOLIE, NIERENVERSAGEN AKUT, Renales Versagen, akutes, Akutes Nierenversagen, Nierenversagen, akutes, Nierenversagen akut
Italian Insufficienza renale acuta, non specificata, Insufficienza renale acuta
Japanese 急性腎不全、詳細不明, 急性腎不全, 急性腎機能停止, キュウセイジンフゼンショウサイフメイ, キュウセイジンキノウテイシ, キュウセイジンフゼン
Swedish Njursvikt, akut
Finnish Munuaisten äkillinen vajaatoiminta
Czech Akutní selhání ledvin, Renální selhání akutní, Akutní renální selhání, Akutní renální selhání blíže neurčené, akutní selhání ledvin, ledviny - selhání akutní
Korean 상세불명의 급성 콩팥(신장)기능상실, 급성 콩팥(신장)기능상실
Croatian BUBREŽNA INSUFICIJENCIJA, AKUTNA
Hungarian acut veseelégtelenség, Acut veseelégtelenség, Acut veseelégtelenség, k.m.n., Acut veseleállás

Ontology: Acute kidney injury (C2609414)

Definition (MSH) Abrupt reduction in kidney function defined as an absolute increase in serum CREATININE of more than or equal to 0.3. mg/dl, a percentage increase in serum creatinine of more than or equal to 50%, or a reduction in urine output. Acute kidney injury encompasses the entire spectrum of the syndrome including acute kidney failure; ACUTE KIDNEY TUBULAR NECROSIS; and other less severe conditions.
Concepts Injury or Poisoning (T037)
MSH D058186
Spanish Lesión renal aguda, Lesión Renal Aguda, Lesion Renal Aguda
English Acute kidney injury, Acute Kidney Injury, Acute Renal Injuries, Renal Injury, Acute, Acute Kidney Injuries, Acute Renal Injury, Renal Injuries, Acute, Kidney Injury, Acute, Kidney Injuries, Acute, Acute Kidney Injury [Disease/Finding]
Portuguese Lesão renal aguda, Lesão Renal Aguda
Dutch acuut nierletsel
German akute Nierenschaedigung, Akute Nierenschädigung, Akute Nierenschaedigung, Akute Nierenverletzung
Czech Akutní poranění ledvin, ledviny - akutní poškození, akutní poškození ledvin
Japanese 急性腎不全, キュウセイジンフゼン
French Lésion rénale aiguë, Atteinte rénale aigüe, Atteinte rénale aiguë, Lésion rénale aigüe
Italian Lesione renale acuta
Russian OSTROE POVREZHDENIE POCHEK, ОПП, POCHEK OSTROE POVREZHDENIE, OPP, ПОЧЕЧНАЯ НЕДОСТАТОЧНОСТЬ ОСТРАЯ, RENAL'NAIA NEDOSTATOCHNOST' OSTRAIA, ПОЧЕК ОСТРОЕ ПОВРЕЖДЕНИЕ, ОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК, ПОЧЕЧНАЯ НЕДОСТАТОЧНОСТЬ ФУНКЦИОНАЛЬНАЯ, ОСТРАЯ, POCHECHNAIA NEDOSTATOCHNOST' FUNKTSIONAL'NAIA, OSTRAIA, POCHECHNAIA NEDOSTATOCHNOST' OSTRAIA, РЕНАЛЬНАЯ НЕДОСТАТОЧНОСТЬ ОСТРАЯ
Polish Acute Kidney Injury
Hungarian Acut vesesérülés