Acute kidney failure resident survival guide: Difference between revisions
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==Overview== | ==Overview== | ||
Acute Renal Failure is an abrupt reduction in [[kidney]] function defined as at-least one of the following: | Acute Renal Failure is an abrupt reduction in [[kidney]] function defined as at-least one of the following: 1. an absolute increase in the serum levels of [[creatinine]] of 26.4 μmol/L(0.3mg/dl) or more; 2. a percentage increase in the serum levels of creatinine of more than 50%(1.5 fold increase from baseline); or 3. a reduction in volume of [[urine]] output(oliguria <0.5 ml/kg hourly for >6 hours. Acute renal failure is increasingly common, particularly in elderly population, hospital inpatients, and critically ill patients and it carries a high mortality. The most common cause of in-hospital acute renal failure in [[acute tubular necrosis]] resulting from multiple nephrotoxic insults such as [[sepsis]], [[hypotension]], and use of [[nephrotoxic drugs]] or [[radio-contrast media]]. Patients at risk include elderly people, [[diabetics]], patients with [[hypertension]] or [[vascular disease]], and those pre-existing renal impairment. | ||
1. an absolute increase in the serum levels of [[creatinine]] of 26.4 μmol/L(0.3mg/dl) or more; | |||
2. a percentage increase in the serum levels of creatinine of more than 50%(1.5 fold increase from baseline); or | |||
3. a reduction in volume of [[urine]] output(oliguria <0.5 ml/kg hourly for >6 hours. | |||
Acute renal failure is increasingly common, particularly in elderly population, hospital inpatients, and critically ill patients and it carries a high mortality. The most common cause of in-hospital acute renal failure in [[acute tubular necrosis]] resulting from multiple nephrotoxic insults such as [[sepsis]], [[hypotension]], and use of [[nephrotoxic drugs]] or [[radio-contrast media]]. Patients at risk include elderly people, [[diabetics]], patients with [[hypertension]] or [[vascular disease]], and those pre-existing renal impairment. | |||
==Causes== | ==Causes== | ||
Revision as of 22:39, 27 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Acute Renal Failure is an abrupt reduction in kidney function defined as at-least one of the following: 1. an absolute increase in the serum levels of creatinine of 26.4 μmol/L(0.3mg/dl) or more; 2. a percentage increase in the serum levels of creatinine of more than 50%(1.5 fold increase from baseline); or 3. a reduction in volume of urine output(oliguria <0.5 ml/kg hourly for >6 hours. Acute renal failure is increasingly common, particularly in elderly population, hospital inpatients, and critically ill patients and it carries a high mortality. The most common cause of in-hospital acute renal failure in acute tubular necrosis resulting from multiple nephrotoxic insults such as sepsis, hypotension, and use of nephrotoxic drugs or radio-contrast media. Patients at risk include elderly people, diabetics, patients with hypertension or vascular disease, and those pre-existing renal impairment.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Pre Renal Causes
- Hypovolaemia
- * Haemorrhage
- * Volume depletion(for example vomiting, diarrhea, burns, inappropriate diuresis)
- Renal Hypoperfusion
- * Non-steroidal anti-inflammatory drugs/selective cyclo-oxygenase 2 inhibitors
- * Angiotension converting enzyme inhibitors/angiotension receptor antagonist
- * Abdominal aortic aneurysm
- * Renal artery stenosis/occlusion
- * Hepatorenal syndrome
- Hypotension
- * Cardiogenic shock
- * Distributive shock(for example sepsis, anaphylaxis)
- Oedematous States
Intrinsic Renal Causes
- Glomerular disease
- * Inflammatory- post-infectious glomerulonephritis, cryoglobulinaemia, Henoch-Schonlein purpura, systemic lupus erythematosus, antineutrophil cytoplasmic antibody associated glomerulonephritis, anti-glomerular basement membrane disease
- * Thrombotic- disseminated intravascular coagulation, thrombotic microangiopathy
- Interstitial Nephritis
- * Drug Induced- Non-steriodal anti-inflammatory drugs, antibiotics
- * Infiltrative- Lymphoma
- * Granulomatous- Sarcoidosis, Tuberculosis
- * Infection related- post-infective, Pyelonephritis
- Tubular Injury
- * Ischemia- prolonged renal hypoperfusion
- * Toxins- drugs(such as aminoglycosides), radiocontrast media, pigments(such as myoglobin), heavy metals(such as cisplatinum)
- * Metabolic- hypercalcemia, immunoglobin light chains
- * Crystals- urate, oxalate
- Vascular
- * Vasculitis(usually associated with antineutrophil cytoplasmic antibody)
- * Cryoglobulinaemia
- * Polyarteritis nodosa
- * Thrombotic microangiopathy
- * Cholesterol emboli
- * Renal artery thrombosis/renal vein thrombosis
Post Renal Causes
- Intrinsic
- * Intra-luminal- stone, blood clot, papillary necrosis
- * Intra-mural- urethral stricture, prostatic hypertrophy or malignancy, bladder tumor, radiation fibrosis
- Extrinsic
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Hilton R (2011). "Defining acute renal failure". CMAJ. 183 (10): 1167–9. doi:10.1503/cmaj.081170. PMC 3134724. PMID 21624906.