Acute renal failure causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Acute renal failure}}
{{Acute renal failure}}
{{CMG}}
{{CMG}}; {{AE}} {{AN}}


==Overview==
==Overview==
 
[[Glomerular filtration rate]] depends on multiple factors, particularly the [[renal blood flow]]. The pressure difference across the renal vasculature i.e the difference in pressure between the renal arterioles and venules is directly proportional to the [[GFR]]. Any decrease in [[renal blood flow]], injury to the renal tubules or obstruction to the urinary tract outflow can cause decreased urinary output.
==Causes==
===Common Causes===
===Common Causes===
Acute renal failure is usually categorised (as in the flowchart below) according to ''pre-renal, renal'' and ''post-renal'' causes.
Acute renal failure is usually categorised (as in the flowchart below) according to ''pre-renal, renal'' and ''post-renal'' causes.
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{{familytree/end}}
{{familytree/end}}


* ''Pre-renal'' (causes in the blood supply):
====Pre-renal====
** [[hypovolemia]] (decreased blood volume), usually from [[Shock (medical)|shock]] or [[dehydration]] and fluid loss or excessive [[diuretic]]s use.
* [[Hypovolemia]] (decreased blood volume) -
** [[hepatorenal syndrome]] in which renal [[perfusion]] is compromised in [[liver failure]]
** [[Shock (medical)|Shock]], [[hemorrhage]], [[burns]], [[dehydration]]
** vascular problems, such as [[atheroembolic disease]] and [[renal vein thrombosis]] (which can occur as a complication of the [[nephrotic syndrome]])
** 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 arrhythmia]]'s
** [[Congestive heart failure]]: [[left ventricular failure]], [[right ventricular failure]]
** Valvular disorders: severe [[aortic stenosis]]
** Severe [[pulmonary hypertension]], massive [[pulmonary embolism]]
* 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 [[Non-steroidal anti-inflammatory drugs|cyclooxygenase inhibitors]], [[ACE inhibitors]]
** Renal [[vasoconstriction]] from [[hypercalcemia]], [[cyclosporine]], [[tacrolimus]] and [[amphotericin B]]
* [[Hyperviscosity syndrome]] -
** [[Multiple myeloma]]
** [[Polycythemia]]
** [[Waldenstrom's macroglobulinemia]]
 
====Renal====
* 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]]
** [[Accelerated hypertension]]
** [[Hemolytic uremic syndrome]]
* [[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 disease|light chain immunoglobulins]] in [[multiple myeloma]], [[uric acid]] crystals, etc.
* [[Interstitial nephritis]]
** Infections: [[Acute pyelonephritis]], [[cytomegalovirus]] infection, etc.
** Allergic: [[Penicillin]]'s, [[sulphonamides]], [[rifampin]], [[diuretics]], [[ACE inhibitors]]
** Infiltration: Malignancies ([[leukemia]]s and [[lymphoma]]'s)
* [[Graft rejection]]
 
====Post-renal====
* Ureteric:
** Ureteric [[calculi]]
** [[Blood clot]]
** Sloughed renal pappilae
** External compression ([[retroperitoneal fibrosis]])
* Bladder:
** [[Medication]] interfering with normal bladder emptying
** [[Neurogenic bladder]]
*** [[Syringomyelia]]
*** [[Tabes dorsalis]]
*** [[Neurosyphilis]]
*** [[Multiple sclerosis]]
** [[Benign prostatic hypertrophy]] or [[prostate cancer]].
* Urethal:
** Obstructed urinary catheter
** [[Urethral stricture]]s
** [[Phimosis]]
** Posterior urethral valve
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Malignant hypertension]], [[Systemic hypertension]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Amyl Alcohol]], [[Aristolochic acid]], [[Arsenic]], [[Bismuth]], [[Cadmium]], [[Carbon Tetrachloride]], [[Carmustine]], [[Cephaloridine]], [[Chloroform]], [[Chromium]], [[Copper]], [[Diethylene glycol]], [[Dioxane]], [[Gallium]], [[Gasoline]], [[Germanium]], [[Glue sniffing]], [[Gold]],  [[Herbicide]], [[Lead]], [[Lithium]], [[Lomustine]], [[Mercury]], [[Methanol]], [[Nitrosourea compounds]], [[Paint thinner]], [[Para-amino salicylic acid]], [[Paraquat ochratoxin A]], [[Perchloroethylene]], [[Pesticide]], [[Platinum]], [[Radiocontrast agents]], [[Silica]], [[Silver]], [[Solvents]], [[Styrene]], [[Sulphonamides]], [[Thallium]], [[Toluene]], [[Trichloroethane]], [[Trichloroethylene]], [[Uranium]], [[Zinc]] overdose
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Dermatomyositis]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetaminophen]], [[Aminoglycosides]], [[Amlodipine besylate and Valsartan]], [[Amphotericin B]], [[Anticancer agents]], [[Aspirin]], [[Bacitracin]], [[Capreomycin]], [[Chlortetracycline]], [[Cidofovir]], [[Cisplatin]], [[Cyclophosphamide]], [[Cyclosporin]], [[Ibuprofen]], [[Ifosfamide]], [[Methicillin]], [[Methotrexate]], [[Mithramycin]], [[Neomycin]], [[Nonsteroidal anti-inflammatory drugs]], [[Oxytetracycline]], [[Polymyxin B]], [[Rifampin]], [[Trimethoprim]], [[Vancomycin]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| Agents causing [[methemoglobinemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Hepatorenal syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Adenine phosphoribosyltransferase deficiency]], [[McArdle disease]], [[Glycogen storage disease type V]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Capillary leak syndrome]] with [[monoclonal gammopathy]], [[Disseminated intravascular coagulation]], [[Hemolytic uremic syndrome]], [[Thrombotic thrombocytopenic purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Boutonneuse fever]], [[Clostridium tetani]], [[Diphtheria]], [[Ehrlichiosis]], [[Escherichia coli O157:H7]], [[Hantavirus]], [[Hemorragic fever with renal syndrome]], [[India tick typhus]], [[Israeli spotted fever]], [[Kenya tick typhus]], [[Leptospirosis]], [[Marseilles fever]], [[Mediterranean Spotted Fever]], [[Toxic shock syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Dermatomyositis]], [[Rhabdomyolysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Hyperuricemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Eclampsia]], [[Pre-eclampsia]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Mesangial proliferative glomerulonephritis]], [[Post-streptococcal glomerulonephritis]], [[Renal artery stenosis]], [[Membranoproliferative glomerulonephritis]], [[Hemolytic uremic syndrome]], [[Hepatorenal syndrome]], [[Thrombotic thrombocytopenic purpura]], [[Rhabdomyolysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Obstructive uropathy]], [[Reflux nephropathy]], [[Hydronephrosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Blood transfusion]] and its complications, [[Cholesterol embolism]], [[Crush syndrome]], [[Dehydration]], [[Epidemic dropsy]],  [[Formaldehyde]], [[Heat stroke]], [[Hyperosmolar non-ketotic diabetic coma]], [[Perioperative mortality|Post-surgical complication]], [[Shock]], [[Tumor lysis syndrome]]
|-
|}


* ''Renal'' (damage to the kidney itself):
===Causes in Alphabetical Order===
** [[infection]] usually [[sepsis]] (systemic inflammation due to infection),rarely of the kidney itself, termed [[pyelonephritis]]
{{MultiCol}}
** [[toxin]]s or [[medication]] (e.g. some [[NSAID]]s, [[aminoglycoside]] [[antibiotics]], [[iodinated contrast]], [[Lithium salt|lithium]])
* [[Bacitracin]]
** [[rhabdomyolysis]] (breakdown of [[muscle]] tissue) - the resultant release of [[myoglobin]] in the [[blood]] affects the kidney; it can be caused by [[injury]] (especially crush injury and extensive [[blunt trauma]]), [[statin]]s, [[stimulant]]s and some other drugs
* [[Bismuth]]
** [[hemolysis]] (breakdown of [[red blood cell]]s) - the [[hemoglobin]] damages the [[tubules]]; it may be caused by various conditions such as [[sickle-cell disease]], and [[lupus erythematosus]]
* [[Blood transfusion]] and complications
** [[multiple myeloma]], either due to [[hypercalcemia]] or "cast nephropathy" (multiple myeloma can also cause [[chronic renal failure]] by a different mechanism)
* [[Boutonneuse fever]]
** acute [[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]]
* [[Cadmium]]
* [[Capillary leak syndrome]] with [[monoclonal gammopathy]]
* [[Capreomycin]]
* [[Carbon tetrachloride]]
* [[Carmustine]]
* [[Cephaloridine]]
* [[Chloroform]]
* [[Chlortetracycline]]
* [[Cholesterol embolism]]
* [[Chromium]]
* [[Cidofovir]]
* [[Cisplatin]]
* [[Clostridium tetani]]
* [[Copper]]
* [[Crush syndrome]]
* [[Cyclophosphamide]]
* [[Cyclosporin]]
* [[Dehydration]]
* [[Dermatomyositis]]
* [[Diethylene glycol]]
* [[Dioxane]]
* [[Diphtheria]]
* [[Disseminated intravascular coagulation]]
* [[Eclampsia]]
* [[Ehrlichiosis]]
* [[Epidemic dropsy]]
* [[Erythroderma]]
* [[Escherichia coli O157:H7]]
* [[Gallium]]
* [[Gasoline]]
* [[Germanium]]
* [[Glue sniffing]]
* [[Gold]]
* [[Glycogen storage disease type V]]
* [[Hantavirus]]
* [[Heat stroke]]
* [[Hemolytic uremic syndrome]]
* [[Hemorragic fever with renal syndrome]]
* [[Hepatorenal syndrome]]
* [[Herbicide]]
* [[Hyperosmolar non-ketotic diabetic coma]]
* [[Hyperuricemia]]
* [[Ibuprofen]]
* [[Ifosfamide]]
* [[India tick typhus]]
* [[Israeli spotted fever]]
* [[Kenya tick typhus]]
{{ColBreak}}
* [[Lead]]
* [[Leptospirosis]]
* [[Lithium]]
* [[Lomustine]]
* [[Malignant hypertension]]
* [[Marseilles fever]]
* [[McArdle disease]]
* [[Mediterranean spotted fever]]
* [[Membranoproliferative glomerulonephritis]]
* [[Mercury]]
* [[Mesangial proliferative glomerulonephritis]]
* [[Methanol]]
* [[Methemoglobinemia]] producing agents
* [[Methicillin]]
* [[Methotrexate]]
* [[Mithramycin]]
* [[Neomycin]]
* [[Nitrosourea compounds]]
* [[Nonsteroidal anti-inflammatory drugs]]
* [[Oxytetracycline]]
* [[Paint thinner]]
* [[Para-amino salicylic acid]]
* [[Paraquat ochratoxin A]]
* [[Perchloroethylene]]
* [[Pesticide]]
* [[Platinum]]
* [[Polymyxin]]
* [[Polymyxin B]]
* [[Post-streptococcal glomerulonephritis]]
* [[Pre-eclampsia]]
* [[Radiocontrast agents]]
* [[Renal artery stenosis]]
* [[Rhabdomyolysis]]
* [[Rifampin]]
* [[Shock]]
* [[Silica]]
* [[Silver]]
* [[Styrene]]
* [[Solvents]]
* [[Sulphonamides]]
* [[Perioperative mortality|Post-surgical complication]]
* [[Thallium]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Toluene]]
* [[Toxic shock syndrome]]
* [[Trichloroethane]]
* [[Trichloroethylene]]
* [[Trimethoprim]]
* [[Tumor lysis syndrome]]
* [[Uranium]]
* [[Vancomycin]]
* [[Zinc]] overdose
{{EndMultiCol}}


* ''Post-renal'' (obstructive causes in the urinary tract) due to:
==References==
** [[medication]] interfering with normal bladder emptying.
{{Reflist|2}}
** [[benign prostatic hypertrophy]] or [[prostate cancer]].
{{WH}}
** [[kidney stones]].
{{WS}}
** due to abdominal malignancy (e.g. [[ovarian cancer]], [[colorectal cancer]]).
[[Category:Nephrology]]
** obstructed urinary catheter.
[[Category:Medical emergencies]]
[[Category:Kidney diseases]]
[[Category:Organ failure]]
[[Category:Causes of death]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Grammar]]

Latest revision as of 20:14, 15 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Overview

Glomerular filtration rate depends on multiple factors, particularly the renal blood flow. The pressure difference across the renal vasculature i.e the difference in pressure between the renal arterioles and venules is directly proportional to the GFR. Any decrease in renal blood flow, injury to the renal tubules or obstruction to the urinary tract outflow can cause decreased urinary output.

Causes

Common Causes

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

Renal

Post-renal

Causes by Organ System

Cardiovascular Malignant hypertension, Systemic hypertension
Chemical / poisoning Amyl Alcohol, Aristolochic acid, Arsenic, Bismuth, Cadmium, Carbon Tetrachloride, Carmustine, Cephaloridine, Chloroform, Chromium, Copper, Diethylene glycol, Dioxane, Gallium, Gasoline, Germanium, Glue sniffing, Gold, Herbicide, Lead, Lithium, Lomustine, Mercury, Methanol, Nitrosourea compounds, Paint thinner, Para-amino salicylic acid, Paraquat ochratoxin A, Perchloroethylene, Pesticide, Platinum, Radiocontrast agents, Silica, Silver, Solvents, Styrene, Sulphonamides, Thallium, Toluene, Trichloroethane, Trichloroethylene, Uranium, Zinc overdose
Dermatologic Dermatomyositis
Drug Side Effect Acetaminophen, Aminoglycosides, Amlodipine besylate and Valsartan, Amphotericin B, Anticancer agents, Aspirin, Bacitracin, Capreomycin, Chlortetracycline, Cidofovir, Cisplatin, Cyclophosphamide, Cyclosporin, Ibuprofen, Ifosfamide, Methicillin, Methotrexate, Mithramycin, Neomycin, Nonsteroidal anti-inflammatory drugs, Oxytetracycline, Polymyxin B, Rifampin, Trimethoprim, Vancomycin
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Agents causing methemoglobinemia
Gastroenterologic Hepatorenal syndrome
Genetic Adenine phosphoribosyltransferase deficiency, McArdle disease, Glycogen storage disease type V
Hematologic Capillary leak syndrome with monoclonal gammopathy, Disseminated intravascular coagulation, Hemolytic uremic syndrome, Thrombotic thrombocytopenic purpura
Iatrogenic No underlying causes
Infectious Disease Boutonneuse fever, Clostridium tetani, Diphtheria, Ehrlichiosis, Escherichia coli O157:H7, Hantavirus, Hemorragic fever with renal syndrome, India tick typhus, Israeli spotted fever, Kenya tick typhus, Leptospirosis, Marseilles fever, Mediterranean Spotted Fever, Toxic shock syndrome
Musculoskeletal / Ortho Dermatomyositis, Rhabdomyolysis
Neurologic No underlying causes
Nutritional / Metabolic Hyperuricemia
Obstetric/Gynecologic Eclampsia, Pre-eclampsia
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Mesangial proliferative glomerulonephritis, Post-streptococcal glomerulonephritis, Renal artery stenosis, Membranoproliferative glomerulonephritis, Hemolytic uremic syndrome, Hepatorenal syndrome, Thrombotic thrombocytopenic purpura, Rhabdomyolysis
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic Obstructive uropathy, Reflux nephropathy, Hydronephrosis
Dental No underlying causes
Miscellaneous Blood transfusion and its complications, Cholesterol embolism, Crush syndrome, Dehydration, Epidemic dropsy, Formaldehyde, Heat stroke, Hyperosmolar non-ketotic diabetic coma, Post-surgical complication, Shock, Tumor lysis syndrome

Causes in Alphabetical Order


References

Template:WH Template:WS

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