Acute renal failure classification: Difference between revisions
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===Pre-renal (compromise in the renal blood flow)=== | |||
* [[Hypovolemia]] (decreased blood volume) - | |||
** [[Shock (medical)|Shock]], [[hemorrhage]], [[burns]], [[dehydration]] | |||
** Fluid loss from [[diuretic]]s use, [[diabetes mellitus]], [[hypoadrenalism]] | |||
** Gastrointestinal fluid loss: [[vomiting]], surgical drainage, [[diarrhea]] | |||
** Extra-vascular space sequestration: [[pancreatitis]], [[hypoalbuminemia]], [[peritonitis]], [[trauma]], [[burns]] | |||
*Low cardiac output - | |||
** [[Cardiac arrhthymia]]'s | |||
** [[Congestive heart failure]]: [[left ventricular failure]], [[right ventricular failure]] | |||
** Valvular disorders: severe [[aortic stenosis]] | |||
** Severe [[pulmonary hypertension]], massive [[pulmonary emobolism]] | |||
* Systemic vasodilatation - | |||
** [[Anaphylaxis]] | |||
** [[Sepsis]] | |||
** [[Antihypertensives]] | |||
* [[Hepatorenal syndrome]] in which renal [[perfusion]] is compromised in [[liver failure]] ([[cirrhosis]] with [[ascites]]) | |||
* Vascular problems - | |||
** [[Atheroembolic disease]] | |||
** [[Renal vein thrombosis]] (which can occur as a complication of the [[nephrotic syndrome]]) | |||
** Renal [[hypoperfusion]] from [[cyclooxygenase inhibitors]], [[ACE inhibitors]] | |||
** Renal [[vasoconstriction]] from [[hypercalcemia]], [[cyclosporine]], [[tacrolimus]] and [[amphotericin B]] | |||
* [[Hyperviscosity syndrome]] - | |||
** [[Multiple myeloma]] | |||
** [[Polycythemia]] | |||
** [[Waldenstrom's macroglobulinemia]] | |||
===Renal (damage to the kidney itself)=== | |||
* Diseases affecting the renal vasculature - | |||
** Renal arterial obstruction: [[atherosclerosis]], [[dissecting aneurysm]], [[thrombosis]], [[embolism]] | |||
** Renal venous obstruction: [[thrombosis]] of the [[veins]] | |||
* Diseases affecting the [[renal glomeruli]] - | |||
** [[Glomerulonephritis]], which may be due to a variety of causes, such as [[anti glomerular basement membrane disease]]/ [[Goodpasture's syndrome]], [[Wegener's granulomatosis]] or acute [[lupus nephritis]] with [[systemic lupus erythematosus]] | |||
*** [[Vasculitis]] | *** [[Vasculitis]] | ||
*** [[Accelerated hypertension]] | *** [[Accelerated hypertension]] | ||
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*** Infiltration: Malignancies ([[leukemia]]s and [[lymphoma]]'s) | *** Infiltration: Malignancies ([[leukemia]]s and [[lymphoma]]'s) | ||
** [[Graft rejection]] | ** [[Graft rejection]] | ||
===Post-renal (obstructive causes in the urinary tract)=== | |||
Due to: | |||
** [[medication]] interfering with normal bladder emptying. | ** [[medication]] interfering with normal bladder emptying. | ||
** [[benign prostatic hypertrophy]] or [[prostate cancer]]. | ** [[benign prostatic hypertrophy]] or [[prostate cancer]]. | ||
Revision as of 22:45, 24 December 2012
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Acute renal failure Microchapters |
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Acute renal failure classification On the Web |
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American Roentgen Ray Society Images of Acute renal failure classification |
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Risk calculators and risk factors for Acute renal failure classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Acute renal failure can complicate a wide spectrum of disorders, and for the purpose of diagnosis and management is divided according to the mechanism that lead to renal compromise. The three categories are pre-renal azotemia (diseases that cause renal hypoperfusion), renal azotemia (diseases directly affecting the renal parenchyma), and post-renal azotemia (diseases affecting the urinary tract causing obstruction).
Classification
Acute renal failure is usually categorised (as in the flowchart below) according to pre-renal, renal and post-renal causes.
| Acute Renal Failure | |||||||||||||||||||||||||||||||||
| Pre-renal | Renal | Post-renal | |||||||||||||||||||||||||||||||
Pre-renal (compromise in the renal blood flow)
- Hypovolemia (decreased blood volume) -
- Shock, hemorrhage, burns, dehydration
- Fluid loss from diuretics use, diabetes mellitus, hypoadrenalism
- Gastrointestinal fluid loss: vomiting, surgical drainage, diarrhea
- Extra-vascular space sequestration: pancreatitis, hypoalbuminemia, peritonitis, trauma, burns
- Low cardiac output -
- Cardiac arrhthymia's
- Congestive heart failure: left ventricular failure, right ventricular failure
- Valvular disorders: severe aortic stenosis
- Severe pulmonary hypertension, massive pulmonary emobolism
- Systemic vasodilatation -
- Hepatorenal syndrome in which renal perfusion is compromised in liver failure (cirrhosis with ascites)
- Vascular problems -
- Atheroembolic disease
- Renal vein thrombosis (which can occur as a complication of the nephrotic syndrome)
- Renal hypoperfusion from cyclooxygenase inhibitors, ACE inhibitors
- Renal vasoconstriction from hypercalcemia, cyclosporine, tacrolimus and amphotericin B
- Hyperviscosity syndrome -
Renal (damage to the kidney itself)
- Diseases affecting the renal vasculature -
- Renal arterial obstruction: atherosclerosis, dissecting aneurysm, thrombosis, embolism
- Renal venous obstruction: thrombosis of the veins
- Diseases affecting the renal glomeruli -
- Glomerulonephritis, which may be due to a variety of causes, such as anti glomerular basement membrane disease/ Goodpasture's syndrome, Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythematosus
- Acute tubular necrosis from
- Ischemia - Same causes as for pre-renal failure
- Toxins - Radiocontrast agents, aminoglycosides, cisplatin, acetaminophen, myoglobin from rhabdomyolysis, hemosiderin from hemolysis, light chain immunolobulins in multiple myeloma, uric acid crystals, etc.
- Interstitial nephritis
- Infections: Acute pyelonephritis, cytomegalovirus infection, etc.
- Allergic: Penicillin's, sulphonamides, rifampin, diuretic agents, ACE inhibitors
- Infiltration: Malignancies (leukemias and lymphoma's)
- Graft rejection
Post-renal (obstructive causes in the urinary tract)
Due to:
- medication interfering with normal bladder emptying.
- benign prostatic hypertrophy or prostate cancer.
- kidney stones.
- due to abdominal malignancy (e.g. ovarian cancer, colorectal cancer).
- obstructed urinary catheter.