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Oliguria and Acute Renal Failure

Key Concepts:

Terms in this set (15)

Prerenal Insult
A. Prerenal insult is the most common cause of acute renal failure, accounting for 70%.
B. It is usually caused by reduced renal perfusion pressure secondary to extracellular fluid volume loss (diarrhea, diuresis, GI hemorrhage), or secondary to extracellular fluid sequestration (pancreatitis, sepsis), in-adequate cardiac output, renal vasoconstriction (sepsis, liver disease), or inadequate fluid intake or replacement.

Intrarenal Insult
A. Insult to the renal parenchyma (tubular necrosis) causes 20% of acute renal failure.
B. Prolonged hypoperfusion is the most common cause of tubular necrosis.
C. Nephrotoxins (radiographic contrast, aminoglycosides) are the second most common cause of tubular necrosis.
D. Pigmenturia induced renal injury can be caused by intravascular hemolysis or rhabdomyolysis.
E. Acute glomerulonephritis or acute inflammation of renal interstitium (acute interstitial nephritis) (usually from allergic reactions to beta-lactam antibiotics, sulfonamides, rifampin, NSAIDs, cimetidine, phenytoin, allopurinol, thiazides, furosemide, analgesics) are occasional causes of intrarenal kidney failure.

Postrenal Insult
A. Postrenal damage results from obstruction of urine flow, and it is the least common cause of acute renal failure, accounting for 10%.
B. Postrenal insult may be caused by extrarenal obstructive uropathy (prostate cancer, benign prostatic hypertrophy, renal calculi obstruction) or by intrarenal obstruction (amyloidosis, uric acid crystals, multiple myeloma, or acyclovir).