Acute renal failure causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 (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
- 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 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 (leukemias and lymphoma's)
- Graft rejection
Post-renal (obstructive causes in the urinary tract)
Due to:
- Ureteric:
- Ureteric calculi
- Blood clot
- Sloughed renal pappilae
- External compression (retroperitoneal fibrosis)
- Bladder:
- Medication interfering with normal bladder emptying
- Neurogenic bladder
- Benign prostatic hypertrophy or prostate cancer.
- Urethal:
- Obstructed urinary catheter
- Urethral strictures
- Phimosis
- Posterior urethral valve
Complete list of Causes by Organ System
| Cardiovascular | Malignant hypertension, Systemic hypertension |
| Chemical / poisoning | |
| Dermatologic | No underlying causes |
| Drug Side Effect | |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | |
| Hematologic | |
| Iatrogenic | No underlying causes |
| Infectious Disease | |
| Musculoskeletal / Ortho | |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | |
| Renal / Electrolyte | |
| Rheum / Immune / Allergy | |
| Sexual | |
| Trauma | No underlying causes |
| Urologic | Obstructive uropathy, Reflux nephropathy, Hydronephrosis |
| Dental | No underlying causes |
| Miscellaneous |
Causes in Alphabetical Order