Acute Prerenal Failure

Aka: Acute Prerenal Failure, Prerenal Failure, Prerenal Uremia Syndrome, Prerenal Failure Causes

advertisement

II. Epidemiology

  1. Accounts for 50-70% of all Acute Renal Failure

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

  1. See Medication Causes of Prerenal Failure
  2. Mechanism: Decreased renal perfusion
    1. Intravascular volume depletion (e.g. Dehydration, third-spacing)
    2. Decreased arterial pressure (e.g. CHF, Sepsis)
  3. 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)
  4. Extracellular fluid volume sequestration
    1. Pancreatitis
    2. Muscle crush injury
    3. Systemic vasodilation (e.g. Septic Shock, Neurogenic Shock)
  5. Inadequate Cardiac Output
    1. Severe Congestive Heart Failure
    2. Cardiogenic Shock
  6. 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

IV. Pathophysiology

  1. Reduced Cardiac Output and renal perfusion pressure (shock states)
  2. Results in afferent arteriole constriction
  3. Avid Sodium and Water reabsorption
  4. Oliguria
  5. Acute Tubular Necrosis if prolonged hypoperfusion

V. Signs

  1. Impaired Cardiac Output
    1. Neck vein distention
    2. Rales
    3. Gallup Rhythm
    4. Pedal edema
  2. Orthostatic Blood Pressure and pulse changes
  3. Weight loss
  4. Decreased fluid intake
  5. Decreased Urine Output

VI. Differential Diagnosis

  1. See Acute Kidney Injury
  2. See Postrenal Failure

VII. Diagnostics

  1. Empiric volume replacement
  2. Invasive cardiac monitoring

VIII. Labs

  1. See Renal Function
  2. Urine Sediment
    1. Normal sediment
    2. Hyaline Casts
    3. Granular Casts

IX. Management

  1. See Acute Kidney Injury Management

X. Prognosis

  1. See Acute Kidney Injury Prognosis

XI. Prevention

  1. See Prevention of Kidney Disease Progression

XII. Resources

  1. Acute Kidney Injury Guidelines
    1. http://www.renal.org/clinical/guidelinessection/AcuteKidneyInjury.aspx

XIII. Reference:

  1. Anderson (8/15/1993) Hospital Practice, p. 61-75
  2. Meyer (2007) N Engl J Med 357(13): 1316-25 [PubMed]
  3. Rahman (2012) Am Fam Physician 86(7): 631-9 [PubMed]
  4. Singri (2003) JAMA 289(6):747-51 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Acute Prerenal Failure." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Organ Failure

advertisement